Seniors in need

According to research done by the Meals on Wheels Association of America, nearly 6 million seniors faced the threat of hunger in 2007, and 11.4% of all seniors experienced some form of food insecurity. The group sees no reprieve in the future. The association estimates that by 2025, 9.5 million seniors in the United States will experience some form of food insecurity, which is about 75% higher than the number in 2005.

Part of the growing problem of senior food insecurity is the increase in the number of citizens who qualify for senior nutrition programs. The minimum age requirement for most programs is 60. In 2010, about 13% of the United States population was 65 years or older, according to the U.S. Census Bureau. By 2025, the percentage of people who will be 65 years or older is estimated to be 17.9.

Senior nutrition programs, many of which are run through a county’s aging services department, were created by the Older American Act (OAA) of 1965. The act was designed to help reduce hunger and food insecurity, among other initiatives such as promoting socialization in older individuals. Senior nutrition programs receive funding from both federal and state sources.

The OAA created several senior nutrition programs, including Congregate Nutrition Services (CNS), in 1972. CNS provides meals and other nutrition-related services to older Americans in a variety of settings including senior centers. Also created under the OAA was Home-Delivered Nutrition Services, in 1978, which provides home-delivered meals to individuals who are homebound due to illness, disability or geographic isolation.

In fiscal year 2009, the Administration on Aging, which manages the OAA programs, said about 38% of meals served in OAA nutrition programs, or 92.5 million meals, were served at congregate meal sites. Sixty-six percent of total participants, or 1.7 million people, in OAA programs are served at congregate feeding sites. Conversely, 62% of total meals are served by Home-Delivery Nutrition Services to about 34% of participants.

Like many other industries, OAA nutrition programs have faced trying fiscal times during the past year because of the economy.

According to Beth Batman, program administrator for the Oklahoma Department of Human Services, Aging Services Division, programs funded under the OAA Act’s Title III programs, which include Congregate Nutrition Services and Home-Delivered Nutrition Services, receive 85% of their funding from federal sources and 15% from state sources.

Although federal funding did rise from fiscal year 2009 to fiscal year 2010, the increase is significantly less than the increase in funding between fiscal year 2008 and 2009, according to data from the Administration on Aging. Funding for all Title III programs increased $9.7 million in 2010, compared with a $51.7 million increase in 2009.

Twelve states received less federal funding in fiscal year 2010 than in 2009. No state received less funding in 2009 than it did in 2008.

Some states, however, have cut budgets for senior nutrition programs.

The Sooner State: One such state is Oklahoma. Last year the state legislature cut $7.4 million from the state’s senior nutrition programs. A last-minute reprieve saw that amount reduced by $5 million, meaning the programs lost $2.4 million.

According to Batman, the number of nutrition sites decreased from 254 a couple of years ago to 215 this year due to budget cuts. Local businesses or churches have reopened some of the closed nutrition sites, but Batman’s team no longer oversees those sites.

Closing nutrition sites was not the only consequence of the budget cuts.

“The biggest repercussion of the budget cuts is more frozen meals are being provided versus hot meals,” Batman says. For example, she says that some clients on the home-delivered meals program have received three hot meals a week and two frozen meals. “We’ve had a variety of frozen meals delivered to our office to try and none of them comes close to a hot meal.” Batman says a sizable percentage of people aren’t eating the frozen meals or are not happy with the frozen meals, saying they prefer the hot meals.

Some congregate feeding sites also are no longer open five days a week, as they were before the cuts, but Batman says the majority of the sites will remain open five days a week.

Another cut has been in the amount of travel allowed for the department’s 18 registered dietitians. Each dietitian used to visit every one of the sites for which he or she was responsible every month. Since the budget cuts, the dietitians have been visiting each site once a quarter.

Batman says the state’s Department of Human Services has always overmatched the federal funds, meaning the department has traditionally given more money than federal law requires. When the state made budget cuts, the overmatch also was cut.

Another byproduct of the budget cuts has been a reduction in the number of labor hours the department can pay for at the congregate nutrition sites. “In small rural areas, many times there are not a lot of people available to work for us,” she says. “Many sites have the same seniors who are eating with us working for us. They are already eligible for our meal programs and now we have to cut back on their hours,” she says.

Batman says the department is finding ways to save money so that the funding they do receive can go to feeding more seniors. Three nutrition projects combined their offices and staff to function as one large office. The same number of sites are still run through the consolidated group. The move saved $115,000.

The Golden State: California’s budget problems, which started last year, have caused quite a headache for the Moreno Valley-based Family Service Association’s senior nutrition programs. According to Dave Renno, senior nutrition director, the association has not received any of its federal or state funding for 2010-2011. According to Renno, federal funding is distributed by state agencies, and because the state hasn’t approved a budget, the state agencies have not released the monies from either federal or state funds.

“Since January, we have been running off loans,” Renno says. “The counties are still making payments for 2010, but they have little money to play with. It’s going to come to a point where they won’t have any money to play with.”

Further complicating budgeting problems are the growing number of seniors who need the association’s services. “Because of the economy, our needs are getting larger,” he says. “It is also spiking because the number of eligible seniors is increasing.”

Last year, the nutrition services department received $150,000 from the American Recovery and Reinvestment Act. That money was used to take people off the waiting list and add them to the senior nutrition programs. About 200 clients were added last year to the association’s 1,500 clients already on the home-delivered meal program.

The Family Service Association is a nonprofit organization, meaning it could not roll over any of the stimulus funds to 2010 because that would be considered profit. This meant that in order to continue serving the new clients, the association would have to receive an increase in state and federal funds of at least $150,000.

“We can’t tell these people that we can’t feed them anymore,” Renno says. Instead, the department is cutting back on its weekend service—about 90% of the clients on the home-delivered meals program receive weekend deliveries.

Starting last month, Renno says all weekend meals, with the exception of hospice clients, have been stopped.

“The last thing we want is to get to May 2011 and be out of money for meals,” he says. “We have to manage our money to get to the end of the year, and unfortunately we had to cut the weekend service. People were upset, but when we explain to them the situation they are much more understanding.”

The Sunshine State: At the Marion County Senior Services in Ocala, Fla., Christopher Gardner, nutrition coordinator, says there have not been any cuts to the number of nutrition sites or the number of people the programs are serving. He has, however, seen a decrease in the amount of contributions from program participants.

Meals are free for participants of both home-delivered meals and congregate sites. A donation is requested at the program’s 12 congregate feeding sites. “What we’ve seen because of the economy is there is a decrease in the people who are donating money to continue these programs in the coming years,” Gardner says.

Gardner estimates that contributions are between 5% and 10% less this year while the number of participants has remained the same.

Gardner says he serves between 150 and 175 meals each day at the congregate sites. He adds that the sites have the capacity to serve more seniors. The nutrition sites are open between 9 a.m. and 1 p.m., with the meal served at noon. The meals are provided by GA Foods, a St. Petersburg-based company that provides entire frozen meals to senior nutrition programs across the state.

“It’s a wholesome nutritious meal,” Gardner says. “It has all parts of every food group. They get a dessert, piece of bread, milk, a protein, vegetables and a starch.”

Gardner also has 26 sites, 16 of which are run by volunteers, from which meals are delivered for home-delivered clients. About 400 meals are served each day. The meals are delivered five days a week. “Our goal is to get the home-delivered clients to the congregate sites to maintain their independence at home rather than going to a nursing home or being cared for,” Gardner says.

Some home-delivered clients receive a weekly stock of frozen meals instead of receiving a hot meal each day. A client must be approved for this service, meaning they have to prove that they have the ability and knowledge on how to heat up the meals.

Another program that started four years ago is Pets on Wheels. “We noticed that the clients were feeding their pets with the meals that we provided for them to eat,” Gardner says. Home-delivered clients can now receive up to eight pounds of animal food each week for their pets.

Adding Revenue Streams: Directors find profit in Meals on Wheels programs.

While many senior nutrition programs are run through a city or county’s senior services agency or aging committee, some non-commercial operators are running Meals on Wheels (MOW) programs at their locations.

“Better than the post office:” One example can be found at 35-bed Northfield Hospital & Clinics in Minnesota. The hospital’s nutrition services department has run a MOW program since the 1970s. According to Elizabeth Berry, nutrition services director, the program, which is run by volunteers, delivers meals to up to 60 clients seven days a week, 365 days a year. “I say we are better than the post office,” Berry says.

MOW meals are the same meal that the hospital’s patients receive. It consists of an entrée, a potato, vegetable, bread, salad or fruit and a dessert. A beverage choice of milk or juice is also included. “We can accommodate some of the special diets because we prepare the meals through the hospital,” Berry says.

Unlike many senior nutrition programs, the MOW program at Northfield does not have a minimum age requirement. Berry says that most of the clients are older than 60; those who are younger have either been recently released from the hospital or have some kind of disability.

“Our only real limitation is we don’t go outside the city limits,” Berry says. “Most of our people are doing this on their lunch hour.” The volunteer drivers are provided through local organizations like churches. Each organization selects a week and is responsible for arranging volunteers. There are five delivery routes, each operated by one driver. It takes a driver about an hour to pick up the food at the hospital, deliver the meals and return to the hospital. In order to ensure the hot foods stay hot and cold foods stay cold, each driver delivers no more than 12 meals.

The meals are packaged in disposables so that the clients do not have to worry about keeping track of dishes to return to the driver the next day. Clients can select a five-day-a-week package or a seven-day-a-week package. “Our numbers on the weekend are down a little bit,” Berry says. “Sometimes a lot of clients will opt for the five days a week and have a family member check in on them on the weekends.”

Berry says most of the MOW clients are private pay, meaning they pay $5 for each meal. Some clients have been referred to the program through an assistance program or social services agency. The hospital bills the agencies for those clients’ meals. Private pay clients receive a monthly bill through the hospital.

“Our numbers have been down just a little bit and I don’t know if it’s been a reflection of the economy or not,” she says. “We’re at 48. A little over a year ago, we had a waiting list. With seniors, money is a big thing. If a son or daughter is trying to get their elderly parents on the program, a lot of times the parents say, ‘I don’t need that or I’m not going to pay for that.’”

She adds that there have been cases where both a husband and wife will order meals and after a couple of weeks on the program, they will reduce the order in half and they will split the meals. “I think if they perceive money is tight, food is one of the first things they will do without, unfortunately,” Berry says.

Opportunities for growth: Julie Farris, director of student nutrition for 14,000-student Rockwall Independent School District in Texas, also provides food for a Meals on Wheels program.

Rockwall County, at 12 square miles, is the smallest county in Texas. As Rockwall’s population grew, it became clear that the county needed its own Meals on Wheels program. Rockwall’s residents were receiving meals from a neighboring county’s program.

“The woman that was director of the program in the other county knew the district’s superintendent,” Farris says. “She didn’t want to have to build a kitchen and do everything to create a new operation. She was looking at a more cost-effective way of obtaining meals. She asked the superintendent if he thought [the district’s foodservice department could make the meals]. He said sure, and we started providing the meals in 2004.”

Rockwall ISD’s foodservice department partnered with the Rockwall County Committee on Aging, which runs the MOW program. The committee provides the volunteers and transportation for the program. “We plan for the routes to be not much more than 45 minutes to an hour so that the food stays hot or cold,” Farris says. “They do all the configuring of how the routes are run. My staff and their staff come together at meal times to make sure the counts are right. Because my assistant director is an R.D., we are able to provide any special-needs diets.”

Farris’ department started out making meals for 25 people a day; now they average 125 meals a day.

The meals are produced at the district’s alternative high school. “We placed it specifically at a school that had a lower volume and also was more flexible with its lunch times,” Farris says. “The MOW meals are picked up and taken out by the volunteers before the regular lunch starts for the students. It’s not something I would put at an elementary school that had to start lunch at 10:30 a.m.”

Farris says the location also works well because the volunteers have access only to the dining room and not the rest of the building, so she doesn’t have to worry about security concerns.

Farris charges the committee $3.25 for each meal. The meal is normally the same meal that is served in the high school that day.

Farris doesn’t know of any other districts in Texas that are providing the meals for a MOW program, but she says it makes sense for her district because it has the kitchen capacity to produce the meals.