What’s a simpler idea than Meals on Wheels? Older, lower-income people who have trouble driving, cooking or shopping — or paying for food — sign up with a local agency. Each day, volunteers or paid staff come by and drop off a hot lunch. Federal and state dollars and local charities foot the bill.
At the Mobile Meals of Essex headquarters in my town in New Jersey on a recent morning, staffers were stuffing slices of whole wheat bread, pints of low-fat milk and containers of sliced peaches into paper bags. Next, they would ladle the day’s entree — West Indian curried chicken with brown rice and broccoli — onto aluminum trays.
Drivers in vans would fan out through the county, from downtown Newark through the sprawling suburbs, delivering the meals to 475 clients.
The benefit goes beyond food, of course. When his clients answer the door, often using walkers and canes, “I ask them how their morning’s going,” said a driver, Louis Belfiore, who would make 31 stops this day. “I give them their meal, I say, ‘Have a good day.’ They tell me, ‘You have a nice day, too.’”
This may represent the only face-to-face social interaction some homebound people have in the course of a day. And if they don’t come to the door, a series of phone calls ensues. “We’ve had people yell back, ‘I’m on the floor and I can’t get up.’ It doesn’t happen only in commercials,” said Gail Gonnelli, the program’s operations director.
Meals on Wheels advocates have always believed that something this fundamental – a hot meal, a greeting, another set of eyes – can help keep people in their homes longer.
But they didn’t have much evidence to point to, until a couple of Brown University health researchers crunched numbers — from Medicare, states and counties, the federal Administration on Aging and more than 16,000 nursing homes — from 2000 to 2009, publishing their findings in the journal Health Services Research.
The connection they discovered between home-delivered meals and the nursing home population will come as welcome news (though not really news) to Meals on Wheels believers: States that spent more than the average to deliver meals showed greater reductions in the proportion of nursing home residents who didn’t need to be there.
The researchers call these people “low-care” residents. Most people living in nursing homes require around-the-clock skilled care, and policymakers have been pushing to find other ways to care for those who don’t. Still, in 2010 about 12 percent of long-term nursing home patients — a proportion that varies considerably by state — didn’t need this level of care.
“They’re not fully dependent,” explained a co-author of the study, Vincent Mor. “They could be cared for in a community setting, whether that’s assisted living or with a few hours of home care.”
That’s how most older people prefer to live, which is reason enough to try to reserve nursing homes for those who can’t survive any other way. But political budget cutters should love Meals on Wheels, too. For every additional $25 a state spends on home-delivered meals each year per person over 65, the low-care nursing home population decreases by a percentage point, the researchers calculated — a great return on investment.
“We spend a lot on crazy medical interventions that don’t have as much effect as a $5 meal,” Dr. Mor concluded. With this data, “we’re able to see this relationship for the first time.”
(Co-author Kali Thomas — herself a volunteer Meals on Wheels driver in Providence, R.I. — has compiled a state by state list, posted on the Brown University LTCfocus.org Web site, showing how much states could save on Medicaid by delivering more meals.)
Sadly, though, appropriations for home-delivered meals are not increasing. The program served more than 868,000 people in 2010, the latest numbers available. But federal financing through the Older Americans Act has been flat for most of the decade, while food and gas costs — and the number of older people — have risen.
Given current budget pressures, advocates hope they can just hold the line (the “sequester” cuts to the federal budget are still looming unless Congress and the White House can reach agreement on the debt limit and a spending plan). Already, “we’ve seen millions and millions fewer meals,” said Tim Gearan, senior legislative representative at AARP. “Cuts from five-day service to three-day service. A lot more frozen food, which can be inappropriate for people who can’t operate ovens and microwaves. It’s been hard to watch.”
My urban/suburban county, Ms. Gonnelli said, maintains a waiting list: There are always about 65 seniors who qualify for Meals on Wheels, but there is no money to provide the food.
It can be a big step for an older person or his family to acknowledge that they need this kind of basic help and apply. It must be difficult, I said to Ms. Gonnelli, who has run the program for 15 years, to tell applicants she can’t help feed them.
“You have no idea,” she said.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
