Meal programs for older adults have long been underfunded. The new economic recovery plan will help.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.Nicole Carey, left, and Tameika Drye, center, prepared meals for delivery to seniors and others at Cabarrus Meals on Wheels in Concord, N.C.Travis Dove for The New York TimesThe 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.Amanda Buck, right, a volunteer with Cabarrus Meals on Wheels, delivered a meal to Gloria Grooms, a former caregiver in Kannapolis, N.C.Travis Dove for The New York TimesIn 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.”

The number of older adults who use cannabis is on the rise, and some health experts are concerned.For years, Harry B. Lebowitz spent the cocktail hour at his home in Delray Beach, Fla., sitting in his backyard overlooking a lake and smoking a joint while his partner relaxed with her vodka and club soda.Mr. Lebowitz, 69, a mostly retired businessman, qualified for a state medical marijuana card because he suffered from anxiety, sleep apnea and back pain. He credits cannabis with helping to wean him off several prescription drugs.Then came Covid-19, heightening both his anxiety and his boredom. “It was like the world stopped,” Mr. Lebowitz said. “We’re all suffering from some form of PTSD, all of us.”He found himself smoking several times a day instead of once, and downing three to five shots of añejo tequila daily, too.Even before the pandemic, researchers were reporting on the growing popularity of cannabis among older adults, although the proportion using it (or at least acknowledging its use) remained small.Last spring, an analysis based on the National Survey of Drug Use and Health found that marijuana use in the prior year among people over 65 had jumped 75 percent from 2015 to 2018, from 2.4 percent of that group to 4.2 percent. By 2019, use had reached 5 percent.“I would expect it to continue to increase sharply,” said Dr. Benjamin H. Han, the lead author of the analysis. The data showed use rising particularly among women and among people with higher education and income.A team using a different national data set documented a similar trend last fall. From 2016 to 2018, the proportion of men ages 65 to 69 who reported using marijuana or hashish within the past month had climbed to 8.2 percent from 4.3 percent. Among women, it grew to 3.8 percent from 2.1 percent.“It’s rare to see that much change in a three-year period,” said William Jesdale, an epidemiologist at the University of Massachusetts. “It shocked us.”Maybe it shouldn’t be so surprising, though. During that period, “you had the backlash against opioids,” said Donna M. Fick, a researcher who directs the Center of Geriatric Nursing Excellence at Penn State. With addiction and overdoses so prevalent, “clinicians are wary of prescribing them to older adults anymore, so people are looking for a solution.”The inexorable increase in legalization plays a part, too. In November, voters in four states (Arizona, Montana, New Jersey and South Dakota) approved recreational use; the Virginia Legislature did the same last month, with the governor expected to sign the bill.That would bring the total to 16 states, plus the District of Columbia, that permit “adult use” marijuana. Mississippi and South Dakota legalized medical cannabis in November, too, joining 34 other states.“It’s easier to get and it’s also less stigmatized,” Dr. Jesdale said. With less punitive policies and just-say-no rhetoric, “people who used in their youth and may have stepped away might have come back, now that it’s not Demon Weed anymore,” he added.There are no data yet on how the pandemic, with its stress and isolation, affected use among older people. But legal cannabis sales grew by 20 percent last year, according to the National Cannabis Industry Association. Leaf411, a nonprofit, nurse-staffed information hotline, received 50 percent more calls, most from older adults.Researchers therefore expect the numbers will show greater geriatric use. Mental health surveys of older people last year showed rising anxiety and depression, conditions frequently cited as reasons to try cannabis.“I’ve definitely seen my patients who were stable returning for tuneups,” said Eloise Theisen, president of the American Cannabis Nurses Association and a geriatric nurse-practitioner in Walnut Creek, Calif. “Their anxiety was worse. Their insomnia was worse.”The effects of the pandemic varied, of course. Ileane Kent, 80, a retired fund-raiser in Lantana, Fla., has vaped nightly for years, “just to chill out,” she said.She became a legal user for the first time in June, because she no longer wanted to risk entering her supplier’s house. With a medical marijuana card, and as a longtime breast cancer survivor — “Honestly, they don’t turn anyone away,” Ms. Kent said — she now patronizes a dispensary whose Covid protocols she finds more reassuring.Barbara Blaser, 75, a nurse who worked at a dispensary in Oakland, Calif., had for years dealt with pain and anxiety after extensive surgery. She had come to rely on five milligrams of edible cannabis, in the form of one chocolate-covered blueberry, each morning and each evening. But after being laid off last year, she no longer faced a stressful commute or spent hours on her feet, so her use has diminished.Still, the $17.5 billion legal cannabis industry keeps seniors squarely in its marketing sights. Major retailers offer dispensary discounts of 10 to 20 percent on “Silver Sundays” or “Senior Appreciation Days.” Some offer older customers free delivery.Older customers at Bud and Bloom, a cannabis dispensary in Santa Ana, Calif., in 2019.Jae C. Hong/Associated PressThe pandemic suspended promotions like the free bus that ferried customers from a retirement development in Orange County, Calif., to a dispensary in nearby Santa Ana called Bud and Bloom, which offered them a catered lunch, new product information and a senior discount. But Glen Turiano, a general manager at the dispensary, hopes to revive the service this summer.Trulieve, another retailer, similarly plans to resume its monthly Silver Tour, which sent a cannabis advocate to assisted living facilities across Florida, where he told residents how to qualify for and use medical cannabis. Green Thumb has reached potential older users at a senior recreational center in Waukegan, Ill.; at a Lunch & Learn event at Century Village in Deerfield Beach, Fla.; and at senior health expos in Pennsylvania.All of which makes health care professionals who treat seniors uneasy. “Older people need to know that the data is very unclear about the safety of these medications,” Ms. Fick said. “Whether or not they actually help is also unclear.”A recent review in JAMA Network Open, for instance, looked at clinical trials of cannabinoids containing THC, the psychoactive ingredient in marijuana, and found associations with dizziness and lightheadedness, and with thinking and perception disorders in users over 50. But the authors called the associations “tentative” because the studies were limited and included few participants over 65.A major 2017 report from the National Academy of Science, Engineering and Medicine found evidence that cannabis could alleviate nausea and vomiting from chemotherapy, muscle spasms from multiple sclerosis and certain kinds of sleep disorders and chronic pain, although researchers deemed its effect “modest.” But evidence for a long list of other conditions, including neuropathic pain, remains limited or insufficient.“It’s hard to weigh the benefits and the risks,” Dr. Han said. As a geriatrician and addiction medicine specialist at the University of California, San Diego, he fears for older patients already susceptible to fall injuries, to interactions from taking multiple drugs and to cognitive impairment.“I worry about any psychoactive substance for older adults,” he said. Moreover, his study showed that cannabis use is increasing among seniors who drink alcohol, a combination that is potentially riskier than using either substance alone.Like other health care professionals whose patients try cannabis, he advocates a “start low, go slow” approach, asking them to monitor the results and report side effects. He also warns patients who haven’t used much weed since the 1960s and 70s that THC concentrations are often stronger now than in their youth.“Older adults generally need less, because their metabolism has slowed,” Ms. Theisen said. That also means that “they can have a delayed onset, so it’s easier to over-consume, especially with products that taste good,” she continued. She urges older adults to consult health care professionals knowledgeable about cannabis — who, she acknowledges, are in short supply.More research into the pros and cons of cannabis use would help answer these questions. But since marijuana remains a federally outlawed Schedule I drug, mounting studies can prove difficult. So its growing use among older people constitutes an uncontrolled experiment, with caution advised.Mr. Lebowitz said he is regaining his equilibrium. Recognizing that he was drinking too heavily, and disliking the resulting hangovers, he has backed off the booze. “It’s really not my drug of choice,” he said.But he is still smoking somewhat more marijuana — preferring strains called Dorothy, White Fire and Purple Roze — than before the world stopped.

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storythe new old ageCan Long-Term Care Employers Require Staff Members to Be Vaccinated?As legal experts and ethicists debate, some companies aren’t waiting.Joe Pendergast, a resident of Juniper Village, a nursing home in Bensalem, Pa., with Kevin Birtwell, a wellness nurse manager there. All staff members at Juniper are required to be vaccinated.Credit…Kriston Jae Bethel for The New York TimesMarch 5, 2021, 5:00 a.m. ETFor much of the winter, Meryl Gordon worried about the people caring for her 95-year-old mother, who was rehabbing in a Manhattan nursing home after surgery for a broken hip.“Every week they sent out a note to families about how many staff members had positive Covid tests,” said Ms. Gordon, a biographer and professor at New York University. “It was a source of tremendous anxiety.”Ms. Gordon feels reassured now that her mother is fully vaccinated and has returned to her assisted living facility. But what about the two home care aides who help her 98-year-old father, David, in his Upper West Side apartment?Neither has agreed to be vaccinated. David Gordon’s doctor has advised him to delay Covid vaccination himself because of his past allergic reactions.Ms. Gordon has not insisted that the caregivers receive vaccinations. “You’re reluctant to do something that could cause you to lose the people you rely on,” she said. But she remains uneasy.It’s a question that many long-term care employers, from individual families to big national companies, are confronting as vaccines become more available, although not available enough: In a pandemic, can they require vaccination for those who care for very vulnerable older adults? Should they?Some employers aren’t waiting. Atria Senior Living, one of the nation’s largest assisted living chains, has announced that by May 1 all staff members must be fully vaccinated.Silverado, a small chain of dementia care homes, most on the West Coast, mandated vaccination by March 1. Juniper Communities, which operates 22 facilities in four states, has also adopted a mandate.“We felt it was the best way to protect people, not just our residents but our team members and their families,” said Lynne Katzmann, Juniper’s chief executive. Of the company’s nearly 1,300 employees, “about 30 individuals have self-terminated” because of the vaccination requirement, she reported.Juniper’s experience supports what public health experts have said for years: Vaccine mandates, like those that many health care organizations have established for the flu vaccine, remain controversial — but they do increase vaccination rates. As of Feb. 25, 97.7 percent of Juniper residents had received two vaccine doses, and so had 96 percent of its staff members.Tamara Moreland, executive director at Juniper Village in Bensalem. The company operates 22 facilities in four states and reports about 30 “self-terminations” of its nearly 1,300 employees.Credit…Kriston Jae Bethel for The New York TimesThat stands in stark contrast to staff vaccinations in many facilities. The Centers for Disease Control and Prevention has reported that during the first month of vaccine clinics in nursing homes, only 37.5 percent of staff members received the first shot, along with 77.8 percent of residents.The results of opinion surveys vary, depending on who is asked and when. In January, a Kaiser Family Foundation analysis found that 29 percent of health care workers expressed doubts about vaccination.A national recruiting platform for health care companies, myCNAjobs.com, last month polled 250 companions, aides and nursing assistants in facilities and in home care; it interviews thousands more daily. It estimates that 35 percent plan to be vaccinated, 20 percent do not and more than 40 percent remain unsure.The Coronavirus Outbreak