The Real Hunger Games
Eva Perdue experienced hunger as a kid in the 1950s. She was one of sixteen children whose father, a community activist, drove for Martin Luther King Jr. There wasn’t much money then, she remembered. “You ate what you had and didn’t complain.” Elders today do the same, rarely asking for handouts, even though their cupboards are bare and refrigerators empty. In Pine Bluff, Arkansas, I met Pauline Kolb, 84, who had worked as a nurse and a beautician and loved to cook and bake for her husband and three boys. Now thin, with white hair and weepy eyes, she spends her days in a wheelchair reading. Pushing her way through the kitchen doorway is a struggle. A toaster oven is her stove, and a grab hook substitutes for the hands that can no longer reach into her nearly empty cupboards. In the refrigerator were some eggs, bread, butter spread, milk, Coffee-Mate, cranberry juice, shriveled grapes, chicken patties and frozen meals from a hospital her daughter-in-law had brought over. Two of the trays were months out of date. It was lunchtime, but Kolb didn’t know what she would be eating. “I eat some, but not too much like most people,” she said, as if to justify her meager stock of groceries.
Her daughter-in-law had tried to get her into the program run by the Area Agency on Aging of Southeast Arkansas, but Kolb was not high on the list. In Pine Bluff, hungry elders are scored according to their social isolation, ability to cook, nutritional intake, outside activities and health condition. “We’ve got your name on the waiting list,” an agency vice president, Barrie Hardin, assured her. “Hopefully we’ll be able to do something in the future.” As we walked out the door, leaving Kolb to think about what she would eat that day and the next, Hardin told me: “It’s good I don’t make home visits. I’d want to give everybody a meal.” An uncertain budget and the two-inch stack of applications for meals on her desk make that impossible. “It’s sad to boil it down to a couple of sheets of paper and one home visit. You have to have some mechanism to decide who gets a meal and who doesn’t. It’s a terrible burden to be the final word on whether they eat or not.”
Meals for the elderly, whether provided in senior centers or delivered to people’s homes, are not usually defined as means-tested welfare programs like food stamps, but the Older Americans Act allows programs to give food only to the neediest. That, combined with the funding squeeze, has turned home-delivered meals (as well as other OAA programs) into de facto welfare programs, though without the stigma the word “welfare” brings to other programs serving those in need.
The decrease in services “is unprecedented in the history of North Carolina,” says Blair Barton-Percival, director of the Piedmont Regional Council Area Agency on Aging in Greensboro. “There are 15,000 seniors waiting for all services.” In Maryland, Michelle McDonald, a case manager with Meals on Wheels of Central Maryland, says, “People are waiting for others to die to get services they need.” Often they need more than food. This summer in Baltimore, 84-year-old Aaron Abrams was number 13,164 on a registry for in-home services under Maryland’s Medicaid waiver program, which allows states to provide long-term care services, including meals, in the home instead of in a nursing facility.
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The National Association of Area Agencies on Aging says nearly 60 percent of all Older Americans Act programs had waiting lists in 2010, but the ones for home-delivered meals are particularly urgent, since food is so basic to good health. A goal of the Affordable Care Act was to prevent disease and make people healthier. It’s hard to see how that can happen without adequate food. With the sequester cuts, the home-delivered meal program has $11.3 million less to feed the elderly, lowering its federal appropriation for fiscal year 2013 to slightly less than $206 million, down from nearly $217 million for the previous year. Both numbers are peanuts compared with the $29 billion for the National Institutes of Health. The vast sums poured into the NIH have made it possible to live longer, but many can’t afford the basics to live those lives.
Kathy Pontin, who for thirty years has directed meal programs in New Haven and Bridgeport, Connecticut, is no stranger to waiting lists and funding crises. In 2011, there were 269 people on the list for home-delivered meals in New Haven. Pontin cut service through attrition and by growing the lists. Now she must cut again, this time by 5 to 6 percent, to comply with the sequester. That’s 5,500 fewer meals over the next fiscal year. Because of the way federal funding formulas work, a decline in meals often means less money for the following year. “This sets off a downward spiral,” Pontin says. “You wind up qualifying for less and less money the less you serve.” She says it’s easier to reduce service through attrition or the assessment process, which, of course, means longer waiting lists. “You don’t want to call a client and say, ‘Guess what, you won’t have a meal anymore.’”
In some parts of the country, homebound elderly can pay out of pocket, but that’s tough for many seniors. In Bridgeport before the recent recession, there were 60–100 people paying $184 a month for two meals a day, five days a week. Now there are just twenty-five— an all-time low. In New Haven, there are only four. At a senior housing complex in Trumbull, I met 87-year-old Lillian Kehoe, a wisp of a woman who weighed 99 pounds, down from 124. She had just gotten a meal delivery after a three-month wait. Her 63-year-old daughter, Daryl Benedetto, had considered paying, but the $8.50 per meal was “quite high,” she said. “I’m a single person, and frankly, when I heard the price of meals, I was thinking I could step up to the plate and provide them without spending $8 a day.” Finally she heard the good news that her mom was off the waiting list. Still, Benedetto said, her eyes filling with tears, “I was feeling guilty I didn’t do the $8.” It used to be that families pooled money to pay for parents’ meals until a slot opened, Pontin explained, but “the recession has turned that upside down.”
Sometimes families pay privately for a while but stop as their retirement savings ebb. Anna and Arlan Eisenhart, ages 91 and 89, began meal service from Meals on Wheels of Central Maryland in 2009. When I visited them a year ago in their neat trailer home in Baltimore County, Arlan, who had worked as a tool-and-die maker, had discontinued his meal service. His wife, who once packed pickles in a factory and now has heart disease, diabetes and other ailments, “ate like a bird,” he said. They didn’t need two meals a day, five days a week, for both, he told me. Later Arlan confided, “It was too expensive, and I dropped it”—an admission that program directors everywhere say is hard for seniors to make. The Eisenharts barely scrape by on their monthly Social Security checks—$1,765 between them—mostly because of medical expenses. They have no Medigap insurance to cover what Medicare doesn’t pay. “The reason we don’t have anything extra like that is we can’t afford it,” Arlan said. Earlier this year, Anna dropped her meal too. There were still no available slots for free meals.
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