Five times a week for nearly 20 years, Meals on Wheels program coordinator Leisa Cotten would bring warm meals to the immobile and elderly of Cochise County, in the rural southeast corner of Arizona. But for the past decade, she’s had to switch it up. Now she delivers frozen meals, five at a time, once a week. “I haven’t seen you in a while” says Mark, one of Cotten’s clients (and whose name we have changed here), as she walks into his trailer. “Cutbacks,” Cotten replies, rearranging his freezer to fit the five white microwavable trays into the top row. “You coming back next week?” he asks. “I should be,” Cotten says.
In 2011, the first cohort of the 75 million baby boomers turned 65. Over the next 18 years, they will continue to age, and the country’s population pyramid will grow increasingly vase-shaped. Caring for the tens of millions of boomers is a demographic challenge without precedent in the United States. Meals on Wheels, among the most iconic and popular social programs in America, should be gearing up to deal with the impending increase in demand. But instead, the program faces funding shortfalls and service cutbacks. This year, its programs served 23 million fewer meals than in 2005. One estimate shows that less than a fifth of eligible seniors can actually avail themselves of home-delivered meals because of limited resources. Today, Cotten has a single assistant to help her serve a county larger than Connecticut. In 1987, she oversaw a staff of 36 that served thousands of meals a year. And her program isn’t the only one—today, Meals on Wheels programs around the country are withering just as Americans need them more and more.
Few anti-poverty programs have the virtuous sheen and cultural cache of Meals on Wheels. The home-delivered meal service, which in various iterations has fed millions of frail seniors over seven decades, enjoys a singular spot in the imagination of would-be American altruists, a hybrid of soup-kitchen ladling and escorting veterans across streets. Public figures (and Fight Club anti-heroines) avail themselves of the glow. Politicians constantly include Meals on Wheels in press flyers, and in March, Colin Kaepernick donated $50,000 to Meals on Wheels America—a charitable rebuke to those critical of his civil rights activism.
MOWA is the umbrella organization that oversees and advocates for the thousands of individual Meals on Wheels chapters, which are run by local service organizations, like Catholic Community Services, in Cotten’s case. In aggregate, chapters receive a third of their funding from a provision of the Older Americans Act signed into law by President Nixon in 1972, and the rest comes from state and local governments, corporate donations, and individual donations. MOWA prides itself on facilitating a “successful public-private partnership.” (Some programs, like Cotten’s, do not officially affiliate with MOWA but still benefit from their advocacy and receive federal funding.)
Advocates claim that the services Meals on Wheels chapters provide are multipotent: Home visitors bring not just food to frail seniors but also offer companionship and referrals to social services. The deliveries also encourage clients to perform “activities of daily living” like housework and dressing themselves as they prepare for guests. “We’re required to observe everything: their verbal and visual ability, emotional health, their skin color,” Cotten said. “If we notice anything—if they’re unstable walking—we call a case manager. If it’s critical, we call 911.” Ninety percent of seniors on the program say that Meals on Wheels “makes them feel more safe and secure.”
But virtue and a sense of safety aren’t enough to pay for lunch. Broadly speaking, we underfund social programs for the elderly. Less than 2 percent of corporate, community, and foundation donations go to programs related to aging, which has been a problem for Meals on Wheels programs. “There’s more and more competition for a smaller share of donations,” said Ellie Hollander, CEO of MOWA. For more than a decade—in which both political parties have had their shots at controlling Congress and the White House—federal funding for the OAA has been flat while the cost of food and inflation have both increased and tens of millions of baby boomers retire.
To Democrats, the OAA is important but low on their list of priorities. After gaining control of Congress and the White House in 2008, they spent their political capital on a stimulus bill, financial reform, health care reform, and cap and trade. All of these policies are orders of magnitude more expansive than the OAA, and some, like health care reform, overlap with the services that the OAA provides. Admittedly, the OAA got a 22 percent funding boost in 2009 as part of the stimulus and a comparable bump in 2010 for a senior jobs program. But in 2011, after Democrats lost control of the House, the OAA funding returned to its baseline of about $1.9 billion, where it’s stayed since. In March of 2016, 30 Democratic Senators signed a letter circulated by Vermont Sen. Bernie Sanders calling for a “minimum 12 percent increase”—a sincere gesture without any chance of passing. After 2011 budget negotiations, caps were placed on nonmandatory spending, which includes Meals on Wheels. The program may carry political currency, referenced in wish lists and attack ads, but it rarely ends up in congressional debate.
Republican reservations are varied. On one side of the spectrum is Kentucky Sen. Rand Paul, who expressed skepticism about the efficacy of the entire OAA during a 2011 hearing on senior hunger. Other Republicans equivocate. In September, Rep. Martha McSally, who represents Leisa Cotten in Cochise County, pushed for a $14.2 million increase for senior services under the OAA. A press release touted her support for Meals on Wheels, even though her amendment technically funded different programs. This month, McSally voted for several versions of a GOP tax bill, which, among many cuts, removed $1.7 billion in funding from Meals on Wheels and other social programs. That’s like giving clients a packet of crackers and then taking away their steak.
What’s more, advocates for older Americans are wary of using the modest political power they have. AARP, though formidable, is notoriously reluctant to throw its weight behind all but what it deems the most important fights, like the repeal of the Affordable Care Act. Its membership also skews more affluent than those who receive Meals on Wheels. MOWA doesn’t have the money or activated constituency to command much clout on its own. “Many people who in fact most use and need social benefits are simply not voting at all,” observed Alec MacGillis, writing in 2015 about the decline of the safety net. MOWA officials are more likely to get a meeting with a first-year legislative aide instead of a senator. Plus, the organization is determined to maintain its nonpartisan appeal, making it less inclined to weaponize its reputation against the politicians who pay only lip service. (MOWA also has an interest in not alienating its clients or the volunteers on whom it relies.)
Compounding the problem, the data on Meals on Wheels haven’t been robust until recently. A literature review in 2015 found that most studies related to home-delivered meal programs were small, unrigorously designed, and measured “self-reported dietary intake,” an unreliable metric. (Try measuring what you eat for a week.) Though senior nutrition advocates swore by the program, the lack of data made it harder to argue for more funding and may be the reason the OAA’s nutrition program has floundered. For many poverty programs, robust data are necessary for survival but not sufficient. Meals on Wheels programs are stuck in an appropriations purgatory where many don’t receive enough money to stay at capacity, much less expand, but they’re too adored to be cut much without political reprisal.
Better data has emerged in the past five years—and its delivered a compelling case for the programs. In 2013, Kali Thomas, a public health researcher at Brown University, published a paper that found “if all states had increased by 1 percent the number of adults age 65 or older who received home-delivered meals in 209 under title III of the OAA, total annual savings to states’ Medicaid programs could have exceeded $109 million.” Most of the savings would come from keeping seniors in their homes and out of nursing homes, which are more expensive. Ninety-two percent of Meals on Wheels recipients say the service lets them live at home. The Medicaid savings were uneven—some states saved millions while other lost out—but Meals on Wheels likely saves billions in Medicare spending too. In 2016, Thomas found that receiving home-delivered meals was correlated with a 30 percent decrease in falls for seniors who’ve fallen before. Falls—in which seniors can break a hip, or worse—cost Medicare $31 billion in 2015 alone. What’s more, collaboration between MOWA and Brown University found that rates of hospitalization and emergency-room use decreased for patients getting Meals on Wheels compared to those who weren’t. For context, one night in the emergency room costs the same as a year of home-delivered meals. This evidence is in line with macroscopic public health findings that countries that spend more on social services than health services tend to have longer life expectancies and decreased rates of premature mortality.
Meals on Wheels could help address the greatest health care and demographic challenge Americans face this century—that is, if it were treated as more than a pet program or hollow political prop. Until then, millions of seniors will starve in the richest country in history.
As we left Mark’s trailer, I asked Cotten what happens when Meals on Wheels can’t afford to bring a client food anymore. “We do everything we can to avoid that,” she said. “We don’t want to play God.” Many branches have stopped adding to their waitlists—some hundreds long—because they don’t want to offer false hope. Today, Meals on Wheels has become something all too familiar to the program—a 70-year-old everyone claims to love but few actually care for.