By Laura Ungar and Trudy Lieberman September
3, 2019
MEMPHIS,
Tenn. — Army veteran Eugene Milligan is 75 years old and blind. He uses a
wheelchair since losing half his right leg to diabetes and gets dialysis for
kidney failure.
And he
has struggled to get enough to eat.
Earlier
this year, he ended up in the hospital after burning himself while boiling
water for oatmeal. The long stay caused the Memphis vet to fall off a charity’s
rolls for home-delivered Meals on Wheels, so he
had to rely on others, such as his son, a generous off-duty nurse and a local
church to bring him food.
“Many
times, I’ve felt like I was starving,” he said. “There’s neighbors that need
food too. There’s people at dialysis that need food. There’s hunger
everywhere.”
Indeed,
millions of seniors across the country quietly go hungry as the safety net
designed to catch them frays. Nearly 8% of Americans 60 and older were “food
insecure” in 2017, according to a recent study released by the
anti-hunger group Feeding America. That’s 5.5 million seniors who
don’t have consistent access to enough food for a healthy life, a number that
has more than doubled since 2001 and is only expected to grow as America grays.
While
the plight of hungry children elicits support and can be tackled in schools,
the plight of hungry older Americans is shrouded by isolation and a
generation’s pride. The problem is most acute in parts of the South and
Southwest. Louisiana has the highest rate among states, with 12% of seniors
facing food insecurity. Memphis fares worst among major metropolitan areas,
with 17% of seniors like Milligan unsure of their next meal.
And
government relief falls short. One of the main federal programs helping seniors
is starved for money. The Older Americans Act — passed more than half a century
ago as part of President Lyndon Johnson’s Great Society reforms — was amended
in 1972 to provide for home-delivered and group meals, along with other
services, for anyone 60 and older. But its funding has lagged far behind senior
population growth, as well as economic inflation.
The
biggest chunk of the act’s budget, nutrition services, dropped by 8% over the
past 18 years when adjusted for inflation, an AARP report found in
February. Home-delivered and group meals have decreased by nearly 21 million
since 2005. Only a fraction of those facing food insecurity get any meal
services under the act; a U.S. Government Accountability
Office report examining 2013 data found 83% got none.
With
the act set to expire Sept. 30, Congress is now considering its reauthorization
and how much to spend going forward.
Meanwhile,
according to the U.S. Department of Agriculture, only 45% of eligible adults 60
and older have signed up for another source of federal aid: SNAP, the food
stamp program for America’s poorest. Those who don’t are typically either
unaware they could qualify, believe their benefits would be tiny or can no
longer get to a grocery store to use them.
Even
fewer seniors may have SNAP in the future. More than 13% of SNAP households
with elderly members would lose benefits under a recent Trump administration
proposal.
For
now, millions of seniors — especially low-income ones — go without. Across the
nation, waits are common to receive home-delivered meals from a crucial
provider, Meals on Wheels, a network of 5,000 community-based programs. In
Memphis, for example, the wait to get on the Meals on Wheels schedule is more
than a year long.
“It’s
really sad because a meal is not an expensive thing,” said Sally Jones Heinz,
president and CEO of the Metropolitan Inter-Faith Association, which
provides home-delivered meals in Memphis. ”This shouldn’t be the way things are
in 2019.”
Since
malnutrition exacerbates diseases and prevents healing, seniors without steady,
nutritious food can wind up in hospitals, which drives up Medicare and Medicaid costs, hitting taxpayers with an even bigger bill.
Sometimes seniors relapse quickly after discharge — or worse.
Widower
Robert Mukes, 71, starved to death on a cold December day in 2016, alone in his
Cincinnati apartment.
The
Hamilton County Coroner listed the primary cause of death as “starvation of
unknown etiology” and noted “possible hypothermia,” pointing out that his
apartment had no electricity or running water. Death records show the
5-foot-7-inch man weighed just 100.5 pounds.
A Clear
Need
On a
hot May morning in Memphis, seniors trickled into a food bank at the Riverside
Missionary Baptist Church, 3 miles from the opulent tourist mecca of Graceland.
They picked up boxes packed with canned goods, rice, vegetables and meat.
Marion
Thomas, 63, placed her box in the trunk of a friend’s car. She lives with
chronic back pain and high blood pressure and started coming to the pantry
three years ago. She’s disabled, relies on Social Security and gets $42 a month
from SNAP based on her income, household size and other factors. That’s much
less than the average $125-a-month benefit for households with seniors, but
more than the $16 minimum that one in five such households get. Still, Thomas
said, “I can’t buy very much.”
A day
later, the Mid-South Food Bank brought a “mobile pantry” to Latham Terrace, a
senior housing complex, where a long line of people waited. Some inched forward
in wheelchairs; others leaned on canes. One by one, they collected their
allotments.
The
need is just as real elsewhere. In Dallas, Texas, 69-year-old China Anderson
squirrels away milk, cookies and other parts of her home-delivered lunches for
dinner because she can no longer stand and cook due to scoliosis and eight
deteriorating vertebral discs.
As
seniors ration food, programs ration services.
Although
more than a third of the Meals on Wheels money comes from the Older Americans
Act, even with additional public and private dollars, funds are still so
limited that some programs have no choice but to triage people using score
sheets that assign points based on who needs food the most. Seniors coming from
the hospital and those without family usually top waiting lists.
More
than 1,000 were waiting on the Memphis area’s list recently. And in Dallas,
$4.1 million in donations wiped out a 1,000-person waiting list in December,
but within months it had crept back up to 100.
Nationally,
“there are tens of thousands of seniors who are waiting,” said Erika Kelly, chief
membership and advocacy officer for Meals on Wheels America. “While they’re
waiting, their health deteriorates and, in some cases, we know seniors have
died.”
Edwin
Walker, a deputy assistant secretary for the federal Administration on Aging,
acknowledged waits are a long-standing problem, but said 2.4 million people a
year benefit from the Older Americans Act’s group or home-delivered meals,
allowing them to stay independent and healthy.
Seniors
get human connection, as well as food, from these services. Aner Lee Murphy, a
102-year-old Meals on Wheels client in Memphis, counts on the visits with
volunteers Libby and Bob Anderson almost as much as the food. She calls them
“my children,” hugging them close and offering a prayer each time they leave.
But
others miss out on such physical and psychological nourishment. A devastating
phone call brought that home for Kim Daugherty, executive director of the Aging Commission of the Mid-South,
which connects seniors to service providers in the region. The woman on the
line told Daugherty she’d been on the waiting list for more than a year.
“Ma’am,
there are several hundred people ahead of you,” Daugherty reluctantly
explained.
“I just
need you all to remember,” came the caller’s haunting reply, “I’m hungry and I
need food.”
A Slow
Killer
James Ziliak, a poverty
researcher at the University of Kentucky who worked on the Feeding America
study, said food insecurity shot up with the Great Recession, starting in the
late 2000s, and peaked in 2014. He said it shows no signs of dropping to
pre-recession levels.
While
older adults of all income levels can face difficulty accessing and preparing
healthy food, rates are highest among seniors in poverty. They are also high
among minorities. More than 17% of black seniors and 16% of Hispanic seniors
are food insecure, compared with fewer than 7% of white seniors.
A host
of issues combine to set those seniors on a downward spiral, said registered
dietitian Lauri Wright, who chairs the Department of
Nutrition and Dietetics at the University of North Florida. Going to the
grocery store gets a lot harder if they can’t drive. Expensive medications
leave less money for food. Chronic physical and mental health problems sap
stamina and make it tough to cook. Inch by inch, hungry seniors decline.
And,
even if it rarely kills directly, hunger can complicate illness and kill
slowly.
Malnutrition
blunts immunity, which already tends to weaken as people age. Once they start
losing weight, they’re more likely to grow frail and are more likely to die
within a year, said Dr. John Morley, director of the division of geriatric
medicine at Saint Louis University.
Seniors
just out of the hospital are particularly vulnerable. Many wind up getting
readmitted, pushing up taxpayers’ costs for Medicare and Medicaid. A recent analysis by the Bipartisan
Policy Center found that Medicare could save $1.57 for every dollar
spent on home-delivered meals for chronically ill seniors after a
hospitalization.
Most
hospitals don’t refer senior outpatients to Meals on Wheels, and advocates say
too few insurance companies get involved in making sure seniors have enough to
eat to keep them healthy.
When
Milligan, the Memphis veteran, burned himself with boiling water last winter
and had to be hospitalized for 65 days, he fell off the Metropolitan
Inter-Faith Association’s radar. The meals he’d been getting for about a decade
stopped.
Heinz,
Metropolitan’s CEO, said the association is usually able to start and stop
meals for short hospital stays. But, Heinz said, the association didn’t hear
from Milligan and kept trying to deliver meals for a time while he was in the
hospital, then notified the Aging Commission of the Mid-South he wasn’t home.
As is standard procedure, Metropolitan officials said, a staff member from the
commission made three attempts to contact him and left a card at the blind
man’s home.
But
nothing happened when he got out of the hospital this spring. In mid-May, a
nurse referred him for meal delivery. Still, he didn’t get meals because he
faced a waitlist already more than 1,000 names long.
After
questions from Kaiser Health News, Heinz looked into Milligan’s case and
realized that, as a former client, Milligan could get back on the delivery
schedule faster.
But
even then the process still has hurdles: The aging commission would need to
conduct a new home assessment for meals to resume. That has yet to happen
because, amid the wait, Milligan’s health deteriorated.
A Murky
Future
As the
Older Americans Act awaits reauthorization this fall, many senior advocates
worry about its funding.
In
June, the U.S. House passed a $93 million increase to the Older Americans Act‘s
nutrition programs, raising total funding by about 10% to $1 billion in the
next fiscal year. In inflation-adjusted dollars, that’s still less than in
2009. And it still has to pass in the Republican-controlled Senate, where the
proposed increase faces long odds.
U.S.
Rep. Suzanne Bonamici, an Oregon Democrat who chairs the Civil Rights and Human
Services Subcommittee, expects the panel to tackle legislation for
reauthorization of the act soon after members return from the August recess.
She’s now working with colleagues “to craft a strong, bipartisan update,” she
said, that increases investments in nutrition programs as well as other
services.
“I’m
confident the House will soon pass a robust bill,” she said, “and I am hopeful
that the Senate will also move quickly so we can better meet the needs of our seniors.”
In the
meantime, “the need for home-delivered meals keeps increasing every year,” said
Lorena Fernandez, who runs a meal delivery program in
Yakima, Wash. Activists are pressing state and local governments to ensure
seniors don’t starve, with mixed results. In Louisiana, for example,
anti-hunger advocates stood on the state Capitol steps in May and
unsuccessfully called on the state to invest $1 million to buy food from
Louisiana farmers to distribute to hungry residents. Elsewhere, senior
activists across the nation have participated each March in “March for Meals”
events such as walks, fundraisers and rallies designed to focus attention on
the problem.
Private
fundraising hasn’t been easy everywhere, especially rural communities without
much wealth. Philanthropy has instead tended to flow to hungry kids, who
outnumber hungry seniors more than 2-to-1, according to Feeding America.
“Ten
years ago, organizations had a goal of ending child hunger and a lot of
innovation and resources went into what could be done,” said Jeremy Everett,
executive director of Baylor University’s Texas Hunger Initiative. “The same
thing has not happened in the senior adult population.” And that has left
people struggling for enough food to eat.
As for
Milligan, he didn’t get back on Meals on Wheels before suffering complications
related to his dialysis in June. He ended up back in the hospital. Ironically,
it was there that he finally had a steady, if temporary, source of food.
It’s
impossible to know if his time without steady, nutritious food made a
difference. What is almost certain is that feeding him at home would have been
far cheaper.
Laura
Ungar: lungar@kff.org,
@laura_ungar
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