Preserving autonomy for seniors with home-delivered meals: 40+ years for the Older Americans Act

An overwhelming majority of seniors want to remain in their own homes as long as possible. Residing with a family member or friends may not be an option, and assisted living facilities may take too big a chunk out of a senior's fixed income. Older Americans, and I'd argue most of us, feel more independent when surrounded by their own belongings and in their own community. But, living alone or with another frail senior, like a spouse, can create its own problems. Millions of U.S. seniors suffer from hunger and food insecurity, some because of resource constraints, but others because of physical and mental challenges that put sound nutrition out of reach.

As part of the 1960's Great Society movement, Senator Patrick McNamara (D-MI) and Cong. John Fogarty (D-RI) were lead sponsors of the Older Americans Act (P.L. 89-73) (OAA), authorizing a variety of programs to help seniors remain at home and in their communities. When President Johnson signed the bill into law, there were about 26 million U.S. residents over age 65, or 9.8% of the population, and was growing. (In 2010, 18% of the US population was over age 60.) Proponents of the bill recognized the social and economic benefits of service programs for seniors, including nutrition support.

The Older Americans Act expires this year, and one of the law's champions in the U.S. Senate is making the case for its reauthorization. Senator Bernie Sanders (I-VT) issued earlier this year the report "Senior Hunger: The Human Toll and Budget Consequences." It makes a compelling case for OAA's food assistance programs for seniors.

*"Over 90 percent of seniors receiving home-delivered meals state that the program allows them to remain in their homes."

As assistant secretary for the Administration on Aging noted, elderly recipients of these meals may not necessarily be in desparate poverty, but may be

"functionally impaired, meaning that they may not be able to drive to a grocery store, carry their groceries, stand for even short periods of time, or they may have hands that are too affected by arthritis to prepare a meal."

The Home-Delivered Nutrition Service program provides meals daily to about 880,000 individuals.

In fiscal year 2010, appropriations for programs under the OAA totalled $2.3 billion, with nearly 60% going to grants to state and local organizations. Grants are provided to 56 State agencies, 629 local agencies on aging, and 244 Tribal organizations. I was surprised to learn that a large share of OAA's appropriation----$819 million----support nutrition programs for seniors, such as local Meals on Wheels providers.

For those who want to know the economic benefits of congregate or home-delivered meals for seniors, read the excerpts in the "Senior Hunger" report from Dr. Mark Lachs. He's the director of Geriatrics at New York Presbyterian Health System and a physician who makes house calls to older adults in New York.

"You don't have to be a doctor to understand that proper nutrition is the bedrock of all health, and nowhere are the medical consequences of malnutrition more devastating than in our older population."

The report notes that the cost of home-delivered meals for one person over an entire year is comparable to the cost of a single day in the hospital.

There are some, however, who question the need for the federal government's involvement in nutrition assistance programs for seniors. Kentucky Senator Rand Paul is one of them. During a Senate hearing earlier this year on reauthorization of the OAA, Senator Paul (R-KY) asked whether government programs are "squeezing" out private charity. He provided no evidence to support his assertion, and when I looked I found quite the opposite. Providers of home-delivered meals to seniors in my region depend on a wide mix of private and public support. Meals on Wheels, Inc. of Tarrant County, TX, for example, receives financial and in-kind contributions from ExxonMobil and Microsoft, to Max Adams Roofing and City Locksmith. For this local provider alone, I count more than 100 supporters, above and beyond federal and state government support.

Senator Paul also suggested the federal programs were inefficient. He read from a June 2011 Government Accountability Office report, but focused his remarks exclusively on the authors' description of duplication among federal nutrition support programs. The Senator displayed a chart showing (in his words) "this dizzying array" of food assistance programs, and suggested that his colleagues on the Committee were asking the wrong questions. The Senator indicated that more appropriate probes would examine topics such as "what if this program didn't exist tomorrow, would people still get food from the government?"

GAO indeed identified 18 different federal programs that provide nutrition assistance, including programs for seniors. Local providers, however, told GAO that

"...the multiple food assistance programs work together and provide various points of entry to the system to help increase access to food for vulnerable or target populations at high risk of malnutrition or hunger. ...since no one program alone is intended to meet a household's full nutritional needs, the variety of food assistance programs can help households fill gaps and address the specific needs of individual members."

The U.S. population and politics has changed substantially in the 40-plus years since the Older Americans Act became law. What hasn't changed is seniors' desire to remain in their homes as long as possible, and home-delivered supper helps make that wish come true for millions of them. Community-based nutrition support programs help seniors maintain their autonomy. Providers and supporters of such programs have known all along: it's more than a meal.


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Why is Senator Paul so concerned about the "squeezing out" of private charity? I think charities would be delighted to find fewer hungry people needing their services. And I'd be happy to stop writing checks to my local food bank.

I'm tempted to call the Meals on Wheels program I mentioned in my post and ask if they believe the modest contribution they receive from HHS via the Texas State agency "squeezes" out private donations. I'm likely to hear them say "excuse me?" "repeat the question," or the like.

By Celeste Monforton (not verified) on 08 Nov 2011 #permalink

Liz@1 "Why is Senator Paul so concerned about the 'squeezing out' of private charity?."

You're looking at it from the wrong direction. The basic idea (of Paul) is to reduce the size of the function to provide those services that only the government can provide.

The idea is that, if there's some other provider other than government, the government should not compete with them (it's not a service the government needs to provide).

Liz@1 "And I'd be happy to stop writing checks to my local food bank."

Basically, you'd be paying for it one way or another. If the service provided by the food back was instead provided by the government, your taxes would increase.

It should be noted that Medicare only pays for 20 days after a hospital stay and pays a piece for 80 more, no long term care. That is paid for by medicaid and is basically a privatization of the hold poor house which in a lot of cases were essentially homes for the destitute poor. We need to define things exactly to see where the costs are pushed off to. Medicaid spends a ton of money on the poor elderly in nursing homes.

Davep, I'd much rather pay for food for vulnerable populations out of my taxes rather than through charitable contributions. Ideally, I'd pay the same amount in taxes and more of it would go to essential services and less to invading other countries and other things I consider to be poor uses of revenue. But I'd also be happy to see my taxes increase if it meant my neighbors were better nourished. (Of course, if we don't get healthcare spending to stop increasing so quickly, everyone's taxes will rise quickly anyway.)

I guess there's a fundamental difference of opinion about what the role of government ought to be. I think it only makes sense for the country as a whole to make sure the most vulnerable citizens are cared for. Senator Paul doesn't seem to agree.