Publisher Health

Long before the coronavirus hit, nutrition programs that served the nation’s older adults struggled to keep up with a growing demand. Often, they could not.

In Charlotte, N.C., and nine surrounding counties, for example, the waiting list for Meals on Wheels averaged about 1,200 people. But Linda Miller, director of the Centralina Area Agency on Aging, which coordinates the program, always assumed the actual need was higher.

She knew some clients skipped meals because they couldn’t travel to a senior center for a hot lunch every weekday; some divided a single home-delivered meal to serve as both lunch and dinner.

Some never applied for help. “Just like with food stamps, which are underused,” Ms. Miller said, “people are embarrassed: ‘I worked hard all my life; I don’t want charity.’”

In Northern Arizona, state budget cuts coupled with only modest increases in federal dollars through the Older Americans Act also produced waiting lists.

“We get flat funding and say: ‘Thank you! We didn’t get cut!’” said Mary Beals-Luedtka, director of the Area Agency on Aging that serves four largely rural counties there. “But flat funding is like a decrease. It’s not adequate.”

Covid-19 made the task immeasurably harder. Across the country, it shut down the senior centers and church halls that served meals to healthier, more mobile seniors. Then those closures, plus shelter-in-place policies and fears of exposure, drastically boosted the number of older people who needed meals delivered.

Many volunteers, also at risk because of age, stayed away. Sometimes, so did family members who had pitched in with shopping and cooking, now worried about infecting their elders.

The Arizona team scrambled to distribute 150 percent more meals at home last year than the year before. “My staff was reeling,” Ms. Beals-Luedtka said. “It was crazy.” She still has about 70 people on a waiting list.

Help has come, however. To the relief of administrators and advocates, the first three federal Covid recovery packages included substantial increases in funding for the Older Americans Act, which supports both congregant, or group, meals (which serve the majority of participants) and Meals on Wheels.

The fourth infusion and the largest by far, $750 million, will come from the American Rescue Plan that President Biden signed last month. It brings the total increase for senior nutrition services to $1.6 billion. In fiscal 2019, they received $907 million.

“It’s a victory and a validation of the value of this program,” said Bob Blancato, executive director of the National Association of Nutrition and Aging Services Programs. “Older adult malnutrition is an ongoing problem.”

Separately, a 15 percent increase for everyone who qualifies for food stamps, more formally the Supplemental Nutrition Assistance Program, will benefit an estimated 5.4 million older recipients.

For years, advocates for older adults have lobbied Congress for more significant federal help. Although the Older Americans Act has enjoyed bipartisan support, small annual upticks in appropriations left 5,000 local organizations constantly lagging in their ability to feed seniors.

From 2001 to 2019, funding for the Older Americans Act rose an average of 1.1 percent annually — a 22 percent increase over almost two decades, according to an analysis by the AARP Public Policy Institute. But adjusted for inflation, the funding for nutrition services actually fell 8 percent. State and local matching funds, foundation grants and private donations helped keep kitchens open and drivers delivering, but many programs still could not bridge their budget gaps.

At the same time, the number of Americans over 60 — the age of eligibility for O.A.A. nutrition and other services — grew by 63 percent. About one-quarter of low-income seniors were “food insecure,” meaning they had limited or uncertain access to adequate food.

And that shortfall was before the pandemic. Once programs hastily closed congregant settings last spring, a Meals on Wheels America survey found that nearly 80 percent of the programs reported that new requests for home-delivered meals had at least doubled; waiting lists grew by 26 percent.

Along with money, the Covid relief legislation gave these local programs needed flexibility. Normally, to qualify for Meals on Wheels, homebound clients must require assistance with activities of daily living. The emergency appropriations allowed administrators to serve less frail seniors who were following stay-at-home orders, and to transfer money freely from congregant centers to home delivery.

Even so, the increased caseloads, with people who had never applied before seeking meals, left some administrators facing dire decisions.

In Northern Arizona, about 800 clients were receiving home-delivered meals in February 2020. By June, that number had ballooned to 1,265, including new applicants as well as those who had previously eaten at the program’s 18 now-shuttered senior centers. Clients were receiving 14 meals each week.

By summer, despite federal relief funds, “I was out of money,” Ms. Beals-Luedtka said. She faced the grim task of telling 342 seniors, who had been added to the rolls for three emergency months, that she had to remove them. “People were crying on the phone,” she recalled. “I literally had a man say he was going to commit suicide.” (She reinstated him.) Even those who remained started receiving five meals a week instead of 14.

Now, Ms. Beals-Luedtka awaits an estimated $1.34 million from the rescue plan, which will largely eliminate the waiting list, increase the number of meals for each recipient and help local providers acquire and repair kitchen equipment as senior centers reopen.

In North Carolina last month, the Centralina agency, working with a food bank, started delivering grocery boxes — containing produce, canned food and other staples — to low-income seniors, using federal money from last year’s CARES Act. “They’re a huge hit,” Ms. Miller said. “I could never do that before.”

It may seem unnecessary for senior nutrition programs to accomplish anything beyond feeding hungry older people, but research has demonstrated their broader impact.

“Addressing nutritional needs isn’t good only for people’s quality of life,” said Kali Thomas, a researcher at Brown University whose studies have demonstrated multiple benefits to Meals on Wheels. “It improves their health.” These programs diminish loneliness and help keep seniors out of expensive nursing homes. They also may help reduce falls, although those findings were based on a small sample and did not achieve statistical significance.

Interestingly, Dr. Thomas’s research found daily meal deliveries had greater effects than weekly or twice-monthly drop-offs of frozen meals, a practice many local organizations have adopted to save money.

Frail or forgetful clients may have trouble storing, preparing and remembering to eat frozen meals. But the primary reason daily deliveries pay off, her study shows, is the regular chats with drivers.

“They build relationships with their clients,” Dr. Thomas said. “They might come back later to fix a rickety handrail. If they’re worried about a client’s health, they let the program know. The drivers are often the only people they see all day, so these relationships are very important.”

Congregant meals contribute to participants’ well-being, too, staving off food insecurity and providing socialization and healthier diets, a prepandemic evaluation found.

So while program administrators relish a rare opportunity to expand their reach, they worry that if Congress doesn’t sustain this higher level of appropriations, the relief money will be spent and waiting lists will reappear.

“There’s going to be a cliff,” Ms. Beals-Luedtka said. “What’s going to happen next time? I don’t want to have to call people and say, ‘We’re done with you now.’ These are our grandparents.”