The Real Hunger Games
Volunteers fill bags with food at a foodbank in Cleveland, Ohio. (AP Photo/Amy Sancetta)
Eva Perdue, her legs wrapped in a black- and-white-checked blanket, a bright red kerchief tied in her hair, sits on a couch in her small house near downtown Atlanta that Habitat for Humanity built. She once worked as a housekeeper at a Georgia state mental facility but quit nine years ago to care for a sick husband. Now 64 and widowed, Perdue herself is sick. “Curses of the liver and high blood pressure,” she says. She has little money to buy any food, let alone healthy food: $98 is all she has after bills are paid from her $848 monthly Social Security check plus $68 worth of food stamps.
The morning I visited Perdue, she had eaten for breakfast the breading from two corn dogs, washed down with a cup of tea. The corn dogs she gave to her 18-year-old grandson, who lives with her. Too much salt, she said. “I can eat cereal. But I have no milk.” A gallon would cost $3 or $4, which Perdue did not have. Lunch might be a small salad with some rust-tinged cabbage and carrots from a convenience store up the street. She wasn’t sure about supper or what she’d eat the next day—if she ate at all.
Perdue tried to get help from Meals on Wheels Atlanta. In mid-April of 2012, she was twenty-seventh on a waiting list of 120. In November, she was still on the list, which had grown to 198. Her daughter finally found another program.
Such is the world of food rationing for the elderly—the hidden hunger few ever see. Tenille Johnson, one of two case managers at Meals on Wheels Atlanta, said there were others on the list who were even more in need than Perdue. In 2012, the program served 106,000 meals—up from 84,000 three years before—and it will serve about 114,000 this year. “We’ve been able to up our game and reduce the waiting list to between 145 and 160 seniors, but the need has outpaced us,” says executive director Jeffrey Smythe. “The numbers are going up more quickly than we projected. We have waiting lists all over the metro Atlanta area, even in suburban counties.”
The reason is simple: there’s not enough money from federal, state or local governments to support most of the country’s meal programs, or from private organizations that fund those like Smythe’s. In 1965, when people in need ranked higher on the nation’s list of priorities, Congress enacted the Older Americans Act, which still provides a smorgasbord of programs like transportation, case management and personal care administered through the federal Area Agencies on Aging. A major goal was to help seniors remain in their homes. In 1972, President Nixon strengthened that commitment. Meals supported by federal dollars would be available at community centers. And in 1978 came meals delivered to the homes of those who could no longer shop or cook.
Throughout the 1970s, funding was in sync with need, but not after that. Numbers tell the story. While funding for home-delivered meals increased 43 percent from 2001 to 2011, the number of seniors facing the threat of hunger rose 87 percent in that period. At the same time, prices for food, gasoline and other services increased 27 percent. Looked at another way, inflation-adjusted per capita spending on home-delivered meals for people over age 60 (the eligible population) declined from $4.16 in 2001 to $3.67 in 2011, nearly a 12 percent decrease. That has meant a reduction in the number of seniors served from about 941,000 in 2005 to 856,000 in 2011. Why the disconnect? “This is a discretionary program, and [more funding] hasn’t been the discourse permitted in recent Congresses,” says Edwin Walker, deputy assistant secretary in the US Administration on Aging.
Eating, however, is not discretionary, but more and more seniors are going hungry. In 2005, some 5 million people over age 60—about 11 percent of America’s senior population—faced the threat of hunger, according to a study by the Meals on Wheels Association, the nation’s largest trade group for meal providers. In 2012, that number was almost 15 percent. “Between 2001 and 2010, we have seen a 78 percent growth in the number of seniors facing hunger,” says Enid Borden, founder and president of the National Foundation to End Senior Hunger. While the threat is more prevalent among blacks and Hispanics, the largest increases have been among whites, particularly women, those in rural areas, the “young old” between 60 and 69, and the poor and near-poor with incomes in the $12,000 to $23,000 range. Many, once solidly in the middle class, now find themselves with little money as old age robs their savings.
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Meanwhile, waiting lists for food have been growing for years all over the country. They will stretch even longer as sequestration slices budgets even more this fall. I first examined this problem for The Nation fifteen years ago, when I reported that the federal government’s commitment to feeding the homebound elderly had waned, with flatlined funding or small increases in appropriations [see Lieberman, “Hunger in America,” March 30, 1998]. There was increasing pressure to cover the shortfalls by competing for financial handouts from local philanthropic organizations. That has created a divide between richer meal programs that have funding sources in their communities and poorer ones that do not. Fundraising is easier in San Francisco, for example, than in rural communities.
Little has changed in the last fifteen years, except that the need has grown larger. Waiting lists have sprouted in parts of the country that didn’t have them before. Mary Alice Rountree, who heads the Caddo Council on Aging in Shreveport, Louisiana, told me her program had the largest waiting list in northwest Louisiana in 2012—between 200 and 300 people were on it, even though her program was serving more than 1,000 meals a day. But a HUD community development grant that paid for hundreds of meals had just disappeared. Without money from private sources, Rountree says, her waiting list would be greater than 500, and she could serve only 600 to 700 meals.
Even in places like New York City, which “provides more support than any other jurisdiction in the country,” according to the city’s commissioner on aging, Lilliam Barrios-Paoli, the increase in poverty among seniors (currently one-fifth of the city’s elderly are poor) will strain capacity. The city and state provide 90 percent of the city’s $31 million budget for home-delivered meals; the rest comes from the federal government. Even though state and local funding has been substantial, the private group City Meals on Wheels has had to supply some 2 million weekend, emergency and holiday meals to fill the gap.
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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”We’re cutting the very basic needs of human beings at a time when we’re cutting healthcare costs,” says Christie Hinrichs, president of Tabitha Health Care Services, a meal provider in Lincoln, Nebraska. “We know the increase [in hunger] will be an increase in healthcare costs.” The sequester may save $11 million, but the Center for Effective Government (formerly OMB Watch) calculates the government could spend nearly $500 million more in Medicaid payments to nursing homes as a result of the cuts. Malnutrition is one of the greatest contributors to costly hospital and nursing home admissions and readmissions. At the same time, Medicare is trying to reduce readmissions by penalizing hospitals that have too many patients returning. Many seniors on waiting lists have just come from the hospital and need food to help them heal. Without it, program directors say, they may return to the hospital. The current Beltway mindset, however, assumes that such perversities are perfectly reasonable. At a Senate subcommittee hearing two years ago, Rand Paul told witnesses, “The idea or notion that spending money in Washington somehow is saving money really flies past most of the taxpayers.” Paul’s solution: the “nobility of private charity.”
Seniors have always had to rely on charity. Even in the 1960s and ’70s, at the peak of federal funding, it was always assumed private funds would leverage federal and state dollars. But as the national commitment has shrunk and needs have swollen, programs have become more dependent on private funds, which don’t come close to filling the gap.
Last year the fundraising gala sponsored by Meals on Wheels of Central Maryland brought in $150,000, nowhere near the amount it needs to close its budget gap. “Fundraising is like spitting in the ocean,” says Barbara Levin, director of client services. “It can’t make up the money from the federal government.” Many funders don’t see hungry old people as compelling as hungry kids, says grants manager Toni Gianforti, adding, “Most funders prefer to do something a lot splashier.” That’s why you see customers signing their names on fliers pasted on the walls of Goodburger in New York City advertising that they “took a bite out of childhood hunger” with a portion of the price they paid for burgers and fries given to Share Our Strength’s Dine Out for No Kid Hungry campaign. That’s why you find the label, saying “Child Hunger Ends Here,” on Reddi-wip and Egg Beaters, made by ConAgra Foods, part of the company’s twenty-year campaign to wipe out hunger among children. Kids appeal to advertisers. Old people at the end of life do not.
Ashley McCumber, who heads Meals on Wheels of San Francisco, spends 75 percent of his time raising money to stay on top of increased demand. “This is not a mission where it’s hard to ask people for support,” he says. “The biggest challenge is getting them to understand how big we are and what we do.” When I reported on San Francisco’s program in 1998, there were 411 names on its waiting list. Today, there are about 100. “Between then and now, we were committed to making sure people were not on the list longer than thirty days,” McCumber told me.
Aggressive fundraising, which accounts for about 60 percent of the program’s budget (the rest comes from government agencies), has made that possible, and so have San Francisco’s chefs and wine makers. In April, the annual Star Chefs & Vintners Gala raised a record $2.1 million for homebound hungry seniors. And that has made it possible to increase the number of meals served from 623,000 in 2007 to about 1.2 million today. Still, despite the money pouring in, McCumber is uneasy about what that means. “Is it OK for the government to hand over its obligation to feed its people to the private sector?” he asked. “In most areas of the country, the dollar-for-dollar match from the private sector is not the same.” He means, of course, that richer programs like his can perhaps keep up with increasing need, but others, like the one in Pine Bluff, Arkansas, cannot. There, Barrie Hardin says, “we can’t raise $100,000 in our part of the state. We have no economic base. It’s difficult to get people to give.”
So in San Francisco, 89-year-old Levi Harper gets a noon meal, but in Wabbeseka, Arkansas (pop. 255), 86-year-old William Hart is on a waiting list. Both are African-Americans who picked cotton as kids, served in the Navy during World War II, held a variety of jobs during their working lives and now live alone. Harper hobbles along with a walker and spends most of his hours in a big mechanical chair. “I stopped using the stove eight or nine years ago,” he said. “I got so unsteady on my feet, I didn’t trust myself handling hot pots.” Hart has crippling arthritis and can barely walk. He tells me he prepares his meals depending on what’s in his kitchen. There wasn’t much. When I asked if he was hungry, he replied, “Yeah.” As if to prove he had food, he thrust into my hand some grocery receipts (a friend drives him to the store every three weeks). They show he spends no more than $100 on each trip.
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Home-delivered meal programs are emblematic of others born during the Great Society, victims of a relentless campaign in recent decades to malign government aid, cut spending and allow all responsibility for even the most basic needs to fall to the private sector. Meal program directors continue to plead their case to members of Congress, taking them on deliveries and demonstrating that meals are cost-effective and necessary for good health, but funding never really increases. In some ways the programs are victims of their own success: they’re so good at what they do that few pay attention to the growing need for their services. Kathy Pontin says the politicians in her service area, Representative Rosa DeLauro and Senator Richard Blumenthal, are supportive, but they tell her there’s not much they can do in a deadlocked Congress.
The idea of giving a little bit more of the nation’s vast wealth to the elderly, especially those in dire need, has suffered in the drive by conservative think tanks to demonize old people—the “greedy geezer” meme. Last winter on the CBS Evening News, Goldman Sachs CEO Lloyd Blankfein, who earned $26 million last year, said, “You’re going to have to undoubtedly do something to lower people’s expectations—the entitlements and what people think they’re going to get. Because they’re not going to get it.” He was talking about Social Security and Medicare, but home-delivered meals are entitlements too; smaller Social Security checks and paying more for medical care means less money for food.
Meanwhile, when Michelle McDonald of the Central Maryland meals program checked back with the Eisenharts in July, she learned that the couple still could not pay privately for the one meal a day that was feeding both of them. “It’s pretty rough around here,” Arlan Eisenhart told her. McDonald asked what they were eating. “We’re not eating much of anything at all,” Arlan replied. “It’s pretty hard for me to stand up and make anything. I try the best I can. Sometimes the best isn’t good enough.”