[Senate Hearing 112-804]
[From the U.S. Government Publishing Office]
S. Hrg. 112-804
SENIOR HUNGER
AND THE OLDER AMERICANS ACT
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON PRIMARY HEALTH AND AGING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
ON
EXAMINING SENIOR HUNGER AND THE ``OLDER AMERICANS ACT''
__________
JUNE 21, 2011
__________
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
TOM HARKIN, Iowa, Chairman
BARBARA A. MIKULSKI, Maryland
JEFF BINGAMAN, New Mexico
PATTY MURRAY, Washington
BERNARD SANDERS (I), Vermont
ROBERT P. CASEY, JR., Pennsylvania
KAY R. HAGAN, North Carolina
JEFF MERKLEY, Oregon
AL FRANKEN, Minnesota
MICHAEL F. BENNET, Colorado
SHELDON WHITEHOUSE, Rhode Island
RICHARD BLUMENTHAL, Connecticut
MICHAEL B. ENZI, Wyoming
LAMAR ALEXANDER, Tennessee
RICHARD BURR, North Carolina
JOHNNY ISAKSON, Georgia
RAND PAUL, Kentucky
ORRIN G. HATCH, Utah
JOHN McCAIN, Arizona
PAT ROBERTS, Kansas
LISA MURKOWSKI, Alaska
MARK KIRK, Illinois
Pamela Smith, Staff Director
Lauren McFerran, Deputy Staff Director
Frank Macchiarola, Republican Staff Director and Chief Counsel
______
Subcommittee on Primary Health and Aging
BERNARD SANDERS, Vermont
BARBARA A. MIKULSKI, Maryland RAND PAUL, Kentucky
JEFF BINGAMAN, New Mexico RICHARD BURR, North Carolina
ROBERT P. CASEY, JR., Pennsylvania JOHNNY ISAKSON, Georgia
KAY R. HAGAN, North Carolina ORRIN G. HATCH, Utah
JEFF MERKLEY, Oregon LISA MURKOWSKI, Alaska
SHELDON WHITEHOUSE, Rhode Island MICHAEL B. ENZI, Wyoming (ex
TOM HARKIN, Iowa (ex officio) officio)
Ashley Carson Cottingham, Staff Director
Peter J. Fotos, Minority Staff Director
(ii)
C O N T E N T S
__________
STATEMENTS
TUESDAY, JUNE 21, 2011
Page
Committee Members
Sanders, Hon. Bernard, Chairman, Subcommittee on Primary Health,
and Aging, opening statement................................... 1
Paul, Hon. Rand, a U.S. Senator from the State of Kentucky....... 3
Franken, Hon. Al, a U.S. Senator from the State of Minnesota..... 5
Hagan, Hon. Kay R., a U.S. Senator from North Carolina........... 49
Witness--Panel I
Greenlee, Kathy, Assistant Secretary, Administration on Aging,
U.S. Department of Health and Human Services, Washington, DC... 6
Prepared statement........................................... 8
Witnesses--Panel II
Blancato, Robert, Executive Director, National Association of
Nutrition and Aging Services Program, Washington, DC........... 18
Prepared statement........................................... 20
Gordon, Kenneth E., Executive Director, Area Agency on Aging for
Northeastern Vermont, St. Johnsbury, VT........................ 25
Prepared statement........................................... 27
Brown, Kay E., Director, Education, Workforce and Income
Security, Government Accountability Office, Washington, DC..... 29
Prepared statement........................................... 31
Koren, Mary Jane, M.D., M.P.H., Vice President, Picker/
Commonwealth Fund Long-Term Quality Improvement Program, The
Commonwealth Fund, New York, NY................................ 38
Prepared statement........................................... 39
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
AARP......................................................... 53
Feeding America.............................................. 55
The Gerontological Society of America........................ 60
Hunger Free Vermont.......................................... 60
Meals on Wheels Association of America....................... 62
An Overview of Senior Hunger in the United States, James P.
Ziliak & Craig Gundersen................................... 70
Jeff Gordon, Inc., letter.................................... 72
(iii)
SENIOR HUNGER
AND THE OLDER AMERICANS ACT
----------
TUESDAY, JUNE 21, 2011
U.S. Senate,
Subcommittee on Primary Health And Aging,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:02 a.m. in
Room 430, Dirksen Office Building, Hon. Bernard Sanders,
chairman of the subcommittee, presiding.
Present: Senators Sanders, Hagan, Franken, and Paul.
Opening Statement of Senator Sanders
Senator Sanders. Good morning and welcome to a hearing of
the Committee on Health, Education, Labor, and Pensions
Subcommittee on Primary Health and Aging. Today's hearing is
addressing a very important issue and I want to thank everybody
for being here, especially our panelists.
I don't have to tell anybody in this room that our country
today faces some enormously serious problems, and one of them
is that, in a time of severe recession, high unemployment, and
increased poverty, how do we make certain that all of our
people, especially the most vulnerable, those unable to take
care of themselves, are able to maintain at least a minimal
standard of living.
In my view, the problem that we are discussing today, food
security among seniors, is both a moral issue and it is a
financial issue. So we're going to be going over both of those
aspects of the problem this morning. From a moral perspective,
it is clear to me that in this great Nation no one should go
hungry, especially those who are old and frail and unable to
take care of themselves. From a financial perspective, what is
also clear--and we will hear testimony about this this morning
from our panelists--is that investing in senior nutrition and
in well-designed senior programs in general saves money. Let me
repeat that: Saves money for the government, because when we do
that, when we make sure that our seniors have adequate
nutrition, among other things, at the end of the day those
seniors are not going to be ending up in a emergency room,
those seniors are not going to be ending up in a hospital when
they should not be in a hospital, and in many cases they're not
going to be ending up in a nursing home.
I think one of the main points that I want to make this
morning and we'll pursue with our panelists, is that investing
in seniors, making sure that seniors have the nutrition that
they need, is not only the right and moral thing to do; it is
the financially smart thing to do.
Today the situation in our country with regard to hunger
among seniors is not anything that we should be proud of and is
something that must be significantly improved. As the baby boom
generation transitions into their senior years, an ever-
expanding number of our Nation's seniors grapple with issues of
food insecurity and malnutrition. In fact, the hunger rates for
lower income seniors have more than doubled in recent years.
In the wake of the recession, there is a growing demand for
both home-delivered and congregate meal programs, and there is
evidence indicating that some of our poorest and most
functionally limited seniors are simply not getting the
nutrition they need.
Sometimes here on Capitol Hill, in this beautiful room, it
is hard to imagine that right now all over this country there
are hundreds of thousands, if not millions, of seniors sitting
alone, perhaps suffering from one or another degree of
dementia, confused about the medications they are taking, not
able to prepare the food that they need in order to take care
of themselves. But that is a reality that is going on in our
country and a reality that we as Americans have got to address.
It is estimated today that 5 million seniors face the
threat of hunger, 3 million seniors are at risk of hunger, and
1 million seniors go hungry because they cannot afford to buy
food. But in some cases it's not just money. In some cases it's
having the transportation to get to the store. In some cases
it's the ability to think through, when you're 85 or 90 and
alone, what kind of food you need and how you purchase it.
This issue is important again not only from a moral
perspective, but from a financial one as well. Persistent
hunger and malnutrition leads to multiple chronic diseases,
resulting in extended hospital stays and premature nursing home
placements. There are some studies out. They're not quite sure
about what percentages of seniors today who are in nursing
homes, and might not need to be in that expensive care, if they
had good nutrition and somebody visiting them on a regular
basis. That seems to me to be pretty dumb, not a good way to
spend Federal money.
Medicaid is paying for 70 percent of nursing home
residents' care in this country. At a time when we face
skyrocketing deficits, we must dedicate our efforts to funding
and finding inexpensive preventative measures to deal with
these issues. We, as a nation, do not do well with prevention.
We waste huge sums of money by taking care of people at the
end, at the end when they're in the hospital, when they're very
sick, rather than keeping them from getting sick.
In today's hearing we will also be discussing the simplest
of common sense solutions, ensuring that older Americans have
access to a prepared and nutritious meal. I have visited many
senior centers in Vermont and I just want to thank--not just in
Vermont, but all over this country, there are tens and tens of
tens of thousands of volunteers who are driving their cars,
delivering Meals on Wheels, taking care of seniors, doing all
kinds of wonderful things as volunteers, and I want to make it
clear that we are very, very appreciative of their efforts.
Today we have a wonderful panel. We're going to take a
comprehensive look at this issue, at the severity of the
problem, what makes sense, common sense solutions to that
problem. So I again want to conclude by thanking all of you for
being here and thanking our panelists for the presentations
they will shortly make.
Now I'd like to introduce Senator Rand Paul.
Senator Paul.
Statement of Senator Paul
Senator Paul. Thank you, Chairman Sanders.
As a physician who's cared for the elderly and impoverished
patients, I have a very real and personal concern for those
without the resources or the ability to provide for themselves.
It would be a great burden and motivation on every American's
heart that elderly individuals, however few, are in need.
Ensuring that no senior citizen goes hungry is an important
goal for our country. The consequences of malnutrition are
devastating. In addition to personal hardships, senior hunger
also costs taxpayers in the form of higher health costs.
Unfortunately, it's not as simple as waving a magic wand of
government and poverty's gone or hunger is gone. We've been
doing this a long time, with some success and some failure. The
Older Americans Act of 1965 was originally passed as part of
LBJ's Great Society war on poverty. Since 1965 the Federal
Government has invested over $51 billion in noninflation-
adjusted dollars in the Older Americans Act programs. We must
ask ourselves, if government is capable of ending poverty for
seniors why haven't we succeeded?
We should ask if private charity is also capable of feeding
the hungry and do government programs crowd out private
charity? We should ask why we have 70 duplicate Federal
programs for nutrition.
Today we are focusing our discussion on senior hunger and
nutrition services within the Older Americans Act. Nutrition
programs make up $818 million out of the $2 billion spent on
this program. We will be discussing multiple nutrition
programs, including the congregate meals program, home-
delivered meals program, nutrition services incentive grants,
etc. These programs are just a few of the dizzying array of
Federal programs related to domestic food assistance.
The GAO recently issued a report finding that there are
over 70 duplicate programs, 70 duplicate Federal programs,
dealing with nutrition. Eighteen of these duplicate Federal
programs are primarily dealing with nutrition and six of these
duplicate Federal programs are for seniors.
We have a chart here that gives you an idea of how we do
nutrition assistance. Like so much of government over the last
several decades, we just add more to it. We've got program
after program, a dizzying array, through this algorithm.
We must ask, what if this program didn't exist tomorrow?
Would people still get food from the government? Probably from
69 other programs they'd get food. For example, what if we did
food stamps, made the food stamps cover those that they're not
covering, give the money to States, let the States administer
it and get it to hungry people? It would be a heck of a lot
simpler.
The thing is that administration of programs, any program,
is notoriously inefficient the farther it is away from the
people. The closer it is to the people through the States, the
more efficient the program is. We should feed hungry people,
but we shouldn't feed people who have the resources to feed
themselves. We should feed hungry people that private charity
is not feeding, but we shouldn't feed hungry people that
private charity is feeding.
We should try not to duplicate ourselves? Why? Because we
spend $2 trillion we don't have, so we're having to borrow
money from China, borrow money from Japan, borrow money from
Russia. The list goes on and on. We do not have unlimited
resources, so we have to rethink what we've been doing for the
last 50 years.
We're in a big mess as a country. It doesn't mean we cannot
help those who need help, but we should be helping only those
who truly do need help.
Are we advertising these services? How much money do we
spend advertising? In my town there's somebody going all around
the State, they're advertising in the newspaper. You know, if
people need assistance, let them know where the assistance is,
but do we have to promote the programs and have a promotional
budget to promote the programs?
But I think we need to simplify these things. As a whole,
the government spent over $90 billion on food nutrition
assistance in 2010. This isn't including Medicaid. We are
spending an enormous amount of money and we need to spend it
more wisely. We need to cut out the duplication.
Meals on Wheels has a great history. My grandmother
delivered Meals on Wheels to people for most of her adult life.
When she could barely walk up the steps in Pittsburgh, she was
still taking meals to others who she thought were less
fortunate than herself.
There are good programs, but we must ask how many of these
programs can exist and might exist if we get the government out
of their way. MIT researchers Jonathan Gruber and Daniel
Hungerman have written an excellent paper finding that for
every dollar of Federal spending, there was a corresponding 3
percent reduction in charitable giving by the churches. Overall
they found that government or Federal spending led to an
overall 30 percent decline in charitable church giving.
There are many great programs out there. For example, Wal-
Mart Foundation made a $2 billion commitment to hunger relief
efforts in the United States through 2015, almost equal to
these Federal programs.
You have to ask yourself, if you had $100 who would you
give it to? Would you give it to the Federal Government to say,
``will you help some people with my $100,'' or would you give
it to the Salvation Army or to a private charity that does a
much better job, that's much more efficient, and gets people
and does help people in your area, and you can go and see the
help directly?
You have to ask the difference also, is there a difference
between charity, private charity, and the nobility of private
charity, and then sort of the bureaucratic malaise of a
transfer program that involves transferring wealth from one
group to another.
In the remarks that we will hear today, we will find out
that only 13 percent of the people getting assistance from the
OAA are said by the group who is making this determination,
which may or may not be the most objective, that only 13
percent of them would not be able to get this without OAA's
assistance. In other words, 87 percent of them could, either
through food stamps or through other programs or, since there
really doesn't seem to be a financial indication for why you
get this assistance, they could be affording to get their food
on their own.
The question is really, do we need duplicate programs?
Should we not be trying to get rid of duplication at the
Federal Government level? Should we not be simplifying these
programs? Should we not be sending these programs back to the
States so they can have better oversight, so we can have less
bureaucrats in the middle, less overhead, and more efficient
distribution of services?
These aren't questions that are just philosophic questions.
These are questions that have to and will have to be answered
because we as a country are out of money and we cannot just
keep adding on program after program.
Thank you, Mr. Chairman.
Senator Sanders. Thank you.
Senator Franken.
Statement of Senator Franken
Senator Franken. I want to get to our witnesses and don't
want to take too long, but make no mistake about it, the Older
Americans Act saves money. It leverages money. It saves money.
It allows seniors to stay in their homes who wouldn't otherwise
be able to stay in their homes.
So when we're talking about duplicative programs, Meals on
Wheels and congregate dining aren't duplicative; they're part
of the same program. Let's not get too confused here. I was a
member of the Special Committee on Aging last Congress, and
because I'm a member of the HELP Committee--I'd like to thank
the chairman for holding today's hearing on this very important
issue to Minnesota seniors and across the country, and the
ability to participate--I'm not a member of this subcommittee,
but I'm a member of the HELP Committee and I was a member of
the Special Committee on Aging, and as such I asked my staff to
start going around the State and doing listening sessions on
the Older Americans Act, because I knew we were going to be
reauthorizing it. And I personally have done six or seven. I
did one this last weekend in Burnsville, MN, at a great place
called Ebenezer Ridge's.
I cannot tell you how important this is to those seniors. I
would ask the Ranking Member, have you been to listening
sessions with these seniors? Because--and I thank your
grandmother for doing what she did. Your grandmother was
volunteering.
This is leveraging volunteers, and they are--Meals on
Wheels is a wonderful program. I think we'll have witnesses
speaking about what it costs to deliver Meals on Wheels. Your
grandmother was probably reimbursed for travel.
It is sometimes the only point of contact that these
seniors have during the day and breaks their isolation and how
many Meals on Wheels volunteers have found a senior in actual
dire trouble and saved their lives?
I love the volunteers that I've met in the listening
sessions that I've done. I also loved the professionals who
implement the program.
What I'd like to emphasize is the actual savings that this
program creates. There are seniors who are able to live in
their homes as they would prefer, rather than have to go to a
nursing home, and but for this program--but for Meals on
Wheels, but for congregate dining, but for those who provide
eldercare, many of whom are seniors themselves, like your
grandmother, Senator Paul, who are very moving in their
testimony, who say that this is a spiritual thing that they do,
providing care for other seniors who need it--this is a program
that saves and leverages money to save the Federal Government
money, and it is a very successful program and I'm pleased to
be participating in today's hearing.
Senator Sanders. Thank you very much, Senator Franken.
Now we're going to hear from our first witness. Kathy
Greenlee is the Assistant Secretary for the Administration on
Aging, U.S. Department of Health and Human Services. Assistant
Secretary Greenlee served as Kansas's Secretary of Aging and
State Long-Term Care Ombudsman. She also recently served on the
board of the National Association of State Units on Aging.
Ms. Greenlee, thank you very much for being with us this
morning.
STATEMENT OF KATHY GREENLEE, ASSISTANT SECRETARY,
ADMINISTRATION ON AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES, WASHINGTON, DC
Ms. Greenlee. Thank you, Chairman Sanders. It's good to see
you again. I appreciate you holding the hearing. I also want to
acknowledge Senator Paul. I'm very glad that your subcommittee
is paying particular attention this morning to hunger, a very
important subject.
I would also like to say, ``hi'' to Senator Franken. I
commend you. I know of the work that you've been doing in
Minnesota as you've gone around the State to gather
information, and I just want to thank you for that work as
well.
I appreciate the opportunity to testify at this hearing
about hunger, the senior nutrition programs, and the Older
Americans Act. The Older Americans Act plays a critical role in
helping many of our most vulnerable seniors maintain their
health, their well-being, and independence, avoiding more
costly hospital or nursing home placement, as you mentioned,
Senator Sanders.
Hunger and food insecurity is a serious problem among many
older Americans. Research that was sponsored by the Meals on
Wheels Association found that nearly 6 million seniors faced
the threat of hunger in 2007. We know that, through science-
based research, that adequate food and nutrition is vitally
important for promoting health, decreasing the risk of chronic
disease, maintaining functionality, and helping older adults
maintain their independence at home and in their communities.
The Older Americans Act nutrition programs have been one of
the core elements of our national strategy for reducing food
insecurity among the elderly for nearly 40 years. As you have
mentioned, there are three different food programs that we
administer at the Administration on Aging, three different
strategies for dealing with senior hunger.
One is the Congregate Nutrition Service. This provides
meals in a group setting, such as senior centers. In my
experience, many elected officials at every level are familiar
with senior centers, have seen the valuable services that are
provided, not just the food, but also other wellness and other
activities, and companionship for seniors as they participate.
In fiscal year 2009, more than 92 million meals were provided
to nearly 1.7 million seniors in a congregate senior center
setting.
The second program is, of course, the home-delivered meals
program. Some people know this as the Meals on Wheels program.
Meals on Wheels is certainly a critical partner in our attack
against senior hunger. There are also other home-delivered
meals programs, and all of the meals programs that are
providing to home-bound individuals do so to individuals who
are home-bound due to illness, disability, or geographic
isolation. The home-delivered meals is often the first in-home
service that someone requests and serves as the primary access
point to other critical home and community-based services.
In fiscal year 2009, nearly 149 million home-delivered
meals were delivered, 149 million, to more than 880,000 home-
bound individuals.
Our third strategy and nutrition program, I think, is not
as well known as the congregate meals or home-delivered. That's
the Nutrition Services Incentive Program. This is an incentive
program that is distributed based on performance the year
before, number of meals served the year before. It gives the
area agencies on aging and the meal providers access to
commodities programs administered at the U.S. Department of
Agriculture, either cash to purchase commodities or commodities
themselves.
It's important to note that our programs and the older
adults who participate in these nutrition programs are low
income, but income itself is not the only objective. It's not
the only measure of need for nutrition services. We certainly
target programs to people who are low income, but there are
many seniors who are functionally impaired, meaning they can no
longer drive to a grocery store, they can no longer physically
carry their groceries, they can no longer see, they can no
longer actually prepare the meal, which makes this program very
different from a program that provides access to groceries.
This is a program that provides access to prepared meals,
because at some point many people can no longer cook for
themselves. They have physical inability to prepare their own
food.
Our services through the Older Americans Act are targeted
and they have always been meant to serve people who are older,
poorer, more likely to live alone, more likely to be
minorities, in poor health, in poor nutritional status,
functionally impaired, and at higher nutritional risk.
Our performance data indicates that the Older Americans Act
programs are effective. Fifty-eight percent of congregate and
ninety-three percent of home-delivered meal recipients say that
the meals enable them to live in their communities longer. The
majority of nutrition program recipients receive more than half
of their total food intake for the day from our programs.
As much as we love the nutrition program, I believe it's
also important that in many instances nutrition alone is not a
sufficient support. There are other individuals who need other
kinds of support that we provide in order to help them maintain
their health and stay out of hospitals and nursing homes.
Older Americans Act programs help older Americans with
severe disabilities remain independent. The programs are
efficient and they build system capacity. For every Federal
dollar the Older Americans Act funds, communities and States
leverage nearly $3 in other funding.
As a former Secretary of Aging in Kansas and finishing my
second year as the U.S. Assistant Secretary for Aging, I have
seen firsthand how these programs support the values we all
share, supporting independence, maintaining health, helping
people that are the most vulnerable among us, and providing
respite care for families as they continue to take care of
their loved ones.
Chairman Sanders, I look forward to continuing to work with
you as we talk about this program and other programs that we
administer at the Administration on Aging, and to continue to
engage with members of your committee as we talk about the
reauthorization of the Older Americans Act.
Thank you.
[The prepared statement of Ms. Greenlee follows:]
Prepared Statement of Kathy Greenlee
Thank you, Chairman Sanders, Ranking Member Paul, and members of
the Subcommittee on Primary Health and Aging, for the opportunity to
testify at this important hearing on hunger, senior nutrition programs
and the role of the Older Americans Act (OAA) in helping some of our
most vulnerable seniors maintain their health and well-being in their
homes and communities, avoiding more costly hospital and nursing home
care.
Hunger and food insecurity is a serious problem among many older
Americans. Research sponsored by the Meals on Wheels Association of
America in 2008 found that nearly 6 million seniors faced the threat of
hunger in 2007.\1\ Half of these at-risk seniors had incomes above the
Federal poverty line. These individuals and households, at some time
during the year, had difficulty providing nutritionally adequate and
safe foods due to a lack of resources. Yet, study after study show that
adequate food and nutrition is vitally important for promoting health,
decreasing the risk of chronic disease, maintaining functionality, and
helping older adults remain independent at home, and in their
communities.
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\1\ ``The Causes, Consequences, and Future of Senior Hunger in
America.'' James P. Ziliak, Ph.D., Gatton Endowed Chair in
Microeconomics and Director of the Center for Poverty Research,
University of Kentucky; Craig Gundersen, Ph.D., Associate Professor,
Department of Human Development and Family Studies, Iowa State
University. Sponsored by the Meals on Wheels Association of America.
March 2008.
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OAA nutrition services programs have been one of the core elements
of our national strategy for reducing food insecurity among the elderly
for nearly 40 years. These vital community-based programs, which serve
persons aged 60 and over, provide access to meals in a group setting or
delivered to the home, a service that is not provided by other Federal
nutrition programs.
As currently authorized, OAA nutrition services programs include:
Congregate Nutrition Services (Title III-C1): Provides
funding for the provision of meals and related services in a variety of
congregate settings, which help to keep older Americans healthy and
prevent the need for more costly medical interventions. Established in
1972, the program also presents opportunities for social engagement and
meaningful volunteer roles, which contribute to overall health and
well-being. In fiscal year 2009, more than 92 million meals were
provided to nearly 1.7 million seniors in a variety of community
settings.
Home-Delivered Nutrition Services (Title III-C2): Provides
funding for the delivery of meals and related services to seniors who
are homebound due to illness, disability or geographic isolation.
Established in 1978, home-delivered meals are often the first in-home
service that an older adult receives, and serve as a primary access
point for other home and community-based services. In fiscal year 2009,
nearly 149 million home-delivered meals were provided to more than
880,000 homebound individuals.
Nutrition Services Incentive Program (NSIP) (Title III-A):
Provides additional funding to States, Territories, and eligible tribal
organizations that is used to provide meals. Funds are awarded to
States and Tribes based on the number of meals served in the prior
Federal fiscal year. States and Tribes have the option to purchase
commodities directly from the U.S. Department of Agriculture with any
portion of their award if they determine that doing so will enable them
to better meet the needs of the older persons they serve.
Although many of the older adults who participate in both the
congregate and home-delivered programs are low-income, income alone is
not an adequate measure of need for nutrition services. Many of the
recipients of this assistance are functionally impaired, meaning that
they may not be able to drive to a grocery store, carry their
groceries, stand for even short periods of time, or they may have hands
that are too affected by arthritis to prepare a meal. In other words,
provision of groceries is not sufficient to eliminate food insecurity
and hunger in this population.
In sum, each year the OAA nutrition services programs help more
than 2.5 million older adults, many of whom are functionally impaired
and are at risk of serious health consequences, receive the meals they
need to stay healthy and decrease their risk of disability.
OAA Nutrition Programs Effectively Target Those With Special Needs.
The OAA does not require that all people be served, nor is it means
tested, but it does require that services be targeted. The OAA
nutrition programs are generally targeted to those with the greatest
levels of food insecurity, including those who are poor or near poor,
socially isolated, functionally impaired, and in poor health. Serving
Elders at Risk, a national evaluation of the Administration on Aging's
(AOA) nutrition program clients, found that recipients of this
assistance are older, poorer, more likely to live alone, more likely to
be minorities, in poorer health and nutritional status, more
functionally impaired, and at higher nutritional risk than older
individuals in the general population.\2\
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\2\ Serving Elders at Risk--National Evaluation of the Elderly
Nutrition Program, 1993-95, pp. 117-18.
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Based on data gathered through fiscal year 2009 and via the 2009
National Survey of Older Americans Act program participants, we know
the following about the participants in the OAA nutrition programs:
For the home-delivered meals programs:
4 percent are in poverty and 52 percent are at high
nutritional risk;
24 percent do not have enough money or food stamps to
purchase enough food to eat;
63 percent rely on their home-delivered meal for one-half
or more of their total food for the day;
17 percent report they choose between purchasing food and
medications;
55 percent of white, 63 percent of African-American and 38
percent of Hispanic home-delivered meal participants report their
health as fair to poor.
For the congregate meals programs:
34 percent are in poverty and 19 percent are at high
nutritional risk;
13 percent do not have enough money or SNAP benefits to
purchase enough food to eat;
58 percent rely on their congregate setting meal for one-
half or more of their total food for the day;
27 percent of white, 38 percent of African-American and 26
percent of congregate meal participants report their health as fair to
poor.
AOA's annual performance data further demonstrate that these
programs are an efficient and effective means for helping seniors
remain healthy and independent in their homes and in the community.
Ninety-one percent of home-delivered meal clients rate service as good
to excellent. In addition, the number of home-delivered meal recipients
who have severe disabilities (those with three or more impairments of
activities of daily living) totaled more than 357,000 in fiscal year
2009. This level of disability is frequently associated with nursing
home admission, and demonstrates the extreme frailty of a significant
number of persons served by the home-delivered meals program.
Additionally, data from AOA's 2009 national survey of elderly
program participants show that the nutrition services programs are
effectively helping seniors improve their nutritional intake and remain
at home: 73 percent of congregate and 85 percent of home-delivered meal
recipients say they eat healthier meals due to the programs, and 58
percent of congregate and 93 percent of home-delivered meal recipients
say that the meals enabled them to continue living in their own
homes.\3\
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\3\ 2009 National Survey of Older Americans Act Participants.
http://www.data.aoa.gov, select AGID.
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For the majority of program participants, the program provides more
than one-half or more of their total food intake and enables them to
continue living in their own homes.
AOA continues to build upon the successes of the senior nutrition
programs and further increase their effectiveness by implementing a
multi-year, comprehensive evaluation. In addition to providing detailed
information on how the nutrition programs currently operate at the
State and local levels, the evaluation is designed to measure the
programs' effects on food insecurity and hunger, social isolation and
the health and well-being of program participants. AOA is working with
the Centers for Medicare and Medicaid Services (CMS) to identify an
appropriate comparison group of non-participants and measure healthcare
utilization and cost. The evaluation will answer how and why program
results are achieved.
The OAA nutrition programs are a good investment in reducing food
insecurity. To help address hunger and food insecurity among older
Americans during the economic downturn, $100 million in funding was
provided as part of the American Recovery and Reinvestment Act of 2009
to the OAA senior nutrition programs. Since March, 2009, this
supplemental funding has provided more than 22 million meals to help
combat food insecurity among more than 1.1 million older Americans.
The nutrition programs help to support family caregivers, who
provide most of the care for older adults. The provision of a home-
delivered meal, which includes not only a meal, but also a mid-day
contact, may allow a family caregiver to continue to work and provide
care for a loved one in the morning before work and in the evening.
Home-delivered meals provide a critical service as a part of a formal
comprehensive and coordinated service system that individualizes care
for older adults and their families.
Congregate meals provide a daily social interaction that is also a
gateway to volunteer opportunities and civic engagement, other home and
community-based services, and a meal that promotes health and reduces
the risk of chronic disease. Nutrition services are not simply access
to food, but to a system that meets social service, health, and food
security needs.
Nutrition services are but one component of a larger system of both
formal and informal supports authorized by the OAA that help older
individuals maintain their health at home and out of hospitals and
nursing facilities. In fiscal year 2009, nearly 11 million older
Americans and their family caregivers have been supported through the
OAA's comprehensive home and community-based system. These services
include: transportation; case management; information and referral; in-
home services such as personal care, chore, and homemaker assistance;
community services such as adult day care; support for family
caregivers; protections against elder abuse; nursing home ombudsmen who
serve as advocates for residents of long-term care facilities; legal
assistance; pension counseling and assistance programs; prevention and
reporting of waste, fraud and abuse in the Medicare and Medicaid
programs, and a host of other supports that are tailored to meet
individual needs.
This nationwide network of community-based assistance complements
medical and health care systems, helps to prevent hospital re-
admissions, provides transport to doctor appointments, and supports
some of life's most basic functions, such as assistance to elders in
their homes by delivering or preparing meals, or helping them with
bathing.
This assistance is especially critical for the nearly three million
seniors who receive intensive in-home services, half a million of whom
meet the disability criteria for nursing home admission but are able to
remain in their homes, in part, due to these community supports. An
analysis of the OAA's program data reveal that, through fiscal year
2009 (the most recent year data are available), most indicators have
steadily improved.
OAA programs help older Americans with severe disabilities
remain independent and in the community: One approach to measuring the
value of OAA's programs is the newly developed nursing home predictor
score. The components of this composite score are predictive of nursing
home admission based on scientific literature and AOA's Performance
Outcome Measurement Project (POMP) which develops and tests performance
measures. The components include such items as percent of program
recipients who are transportation disadvantaged and the percent of
congregate meal individuals who live alone. As the score increases, the
prevalence of nursing home predictors in the OAA service population
increases, meaning AOA is reaching those most in need of help. In 2003,
the nursing home predictor score of program participants was 46.57. In
fiscal year 2009, this score increased to 61.0.
OAA programs are efficient: The national aging services
network--comprised of 56 State and territorial units on aging, 629 area
agencies on aging, 246 Indian tribal and native Hawaiian organizations,
nearly 20,000 direct service providers, and hundreds of thousands of
volunteers--is providing high-quality services to the neediest elders,
and is doing so in a prudent and cost-effective manner. AOA and the
national aging services network have significantly increased the number
of persons served per million dollars of OAA funding. Without
controlling for inflation, OAA programs have increased efficiency by
over 36 percent between fiscal year 2002 and fiscal year 2009, serving
8,524 clients per million dollars of funding in fiscal year 2009
compared to 6,103 clients served per million dollars of AOA funding in
fiscal year 2002. This increase in efficiency is understated, since the
purchasing power of a million dollars in 2009 is significantly less
than in 2002 due to inflation.
OAA programs build system capacity: One of the main goals
of OAA program funding is to encourage and assist State agencies and
area agencies on aging to concentrate resources in order to develop
greater capacity, and foster the development and implementation of
comprehensive and coordinated systems. This capacity-building at the
State and community level is evidenced by the fact that for every
dollar of Federal OAA funding provided, States and communities leverage
nearly $3 in other funding from other sources.
Taken as a whole, AOA's performance measures and indicators form an
interconnected system of performance measurement akin to the three legs
of a stool (efficiency, outcomes and targeting) holding up AOA's
mission and strategic goals that include:
1. Empowering older people, their families, and other consumers to
make informed decisions about, and to be able to easily access,
existing health and long-term care options;
2. Enabling seniors to remain in their own homes with a high
quality of life for as long as possible through the provision of home
and community-based services, including supports for family caregivers;
3. Empowering older people to stay active and healthy through Older
Americans Act services and the preventative care benefits under
Medicare;
4. Ensuring the rights of older people and prevent their abuse,
neglect and exploitation; and
5. Maintaining effective and responsive management.
As the former Secretary of Aging in Kansas, and now having the
honor to serve as the U.S. Assistant Secretary for Aging and listening
to individuals and families in a variety of settings, I have seen
firsthand how the OAA reflects the American values we all share:
Supporting freedom and independence;
Helping people maintain their health and well-being so
they are better able to live with dignity;
Protecting the most vulnerable among us; and
Providing basic respite care and other supports for
families so that they are better able to take care of loved ones in
their homes and communities for as long as possible, which is what
Americans of all ages overwhelmingly tell us they prefer.
For more than a year, we have received reports from more than 60
listening sessions held throughout the country, and received online
input from interested individuals and organizations, as well as from
seniors and their caregivers, about the reauthorization of the OAA.
This input represented the interests of thousands of consumers of the
OAA's services. We continue to encourage ongoing input and discussions.
During our input process we were consistently told that, as it is
currently structured, the OAA is very helpful, flexible and responsive
to people's needs. We also heard a few themes, I will mention two
today:
FIRST: Improve program outcomes by:
Embedding evidence-based interventions in disease
prevention programs;
Encouraging comprehensive, person-centered approaches;
Providing flexibility to respond to local nutrition needs;
and
Continuing a strong commitment to efforts to fight fraud
and abuse.
SECOND: Remove barriers and enhancing access by:
Extending caregiver supports to parents caring for their
adult children with disabilities;
Providing ombudsman services to all nursing facility
residents, not just older residents; and
Using Aging and Disability Resource Centers as single
access points for long-term care information to public and private
services.
Let me give three brief examples of areas we would like to discuss
as you consider legislation:
Ensuring that the best evidence-based interventions for
helping older individuals manage chronic diseases are utilized. These
have been effective in helping people adopt healthy behaviors, improve
their health status, and reduce their use of hospital services and
emergency room visits.
Improving the Senior Community Service Employment Program
(SCSEP) by integrating it with other seniors programs. The President's
2012 budget proposes to move this program from the Department of Labor
to the Administration on Aging at HHS. We would like to discuss
adopting new models of community service for this program, including
programs that engage seniors in providing community service by
assisting other seniors so they can remain independent in their homes,
while also continuing to support community organizations that rely on
SCSEP participants for their valuable work contributions.
Combating fraud and abuse in Medicare and Medicaid by
making permanent the authority for the Senior Medicare Patrol Program
(SMP) as an ongoing consumer-based fraud prevention and detection
program--and by using the skills of retired professionals as volunteers
to conduct community outreach and education so that seniors and
families are better able to recognize and report fraud and abuse.
The Older Americans Act has historically enjoyed widespread,
bipartisan support. One of its great strengths is that it does not
matter if an individual lives in a very rural or frontier area, or in
an urban center--the programs and community-based supports it provides
are flexible enough to meet the needs of individuals in diverse
communities and settings. Based in part upon the extensive public input
we received, we believe that the reauthorization can strengthen the OAA
and put it on a solid footing to meet the challenges of a growing
population of seniors, while continuing to carry out its critical
mission of helping elderly individuals maintain their health and
independence in their homes and communities. We look forward to working
with this subcommittee as the reauthorization process moves forward.
Thank you again, Chairman Sanders and members of the subcommittee
for your leadership on these important issues and for your invitation
to testify today. We look forward to working with this subcommittee as
the reauthorization process moves forward. I would be happy to answer
any questions.
Senator Sanders. Ms. Greenlee, thank you very much for your
testimony.
Let me begin the questioning in two ways. No. 1, it seems
to me that if we provide nutrition, if we provide
socialization, if we are monitoring the well-being of people
who are frail and elderly, that at the end of the day we save
money by keeping people out of the emergency room, out of the
hospital perhaps, out of nursing homes. Is that true?
Ms. Greenlee. Yes, sir. Our evidence shows that to be true.
Senator Sanders. Do you want to comment on that in general?
Why does it in your judgment make sense to invest in these
programs as a way in fact to save Federal money at a time of a
huge deficit?
Ms. Greenlee. Almost every person as they age will need
supports of some sort to remain independent. The data shows
between two-thirds and 75 percent of all of us will need help
to stay independent. As I said in my testimony, often the first
type of support that's requested is nutrition. But there are
other supports that individuals need. By and far--by
overwhelming evidence, the least expensive place to deliver
services is in someone's home. People will need services.
Staying in the home is least expensive.
The Older Americans Act programs are far more effective and
efficient than a Medicaid home and community-based waiver or
very expensive congregate care, such as a skilled nursing home.
They are a good investment. As you mentioned, it's also what
people want. I think the fiscal policy and the people policy
are aligned to support in-home services.
Senator Sanders. Let me stay on that theme. My
understanding is that there are many seniors who are in nursing
homes today
because they are not able to get the nutrition they need if
they stayed at home. Is that your understanding?
Ms. Greenlee. Senator, yes, but I'd like to qualify and
expand your statement. As you said in your opening, lack of
nutrition often leads to other chronic disabling conditions.
What we find is that people who have multiple chronic
conditions, disabling conditions, are more likely to enter a
nursing home. It's a contributing factor among other
contributing factors that leads to frailty and poor health,
which is a predeterminant for nursing home admission.
Senator Sanders. Let me ask you this. Can you give us a
rough estimate as to how many seniors today as we speak are not
getting the nutrition that they need?
Ms. Greenlee. Senator, I've seen some recent studies that I
could provide your staff--I think we have--that shows the
amount of food insecurity varies by State, from as much as 12
percent of seniors in a State to as little as 3 percent of
seniors in a State. There are millions and millions--the
numbers I have seen are 8 or 9 million--seniors who are without
food, food insecure.
But there are also increasing categories that expand from
there, to people who have instability and inability to get
food. There are many, many million seniors who don't have
enough to eat or have access to the resources.
Senator Sanders. Let me stop at that point. Senator Paul.
Senator Paul. Thank you for your testimony, Ms. Greenlee.
In your testimony you cite that only 13 percent of participants
in the congregate meals program don't have enough money or food
stamps to purchase enough food to eat. I guess the converse of
that is 87 percent of the participants that you're helping
already have enough money to buy their own food?
Ms. Greenlee. Senator, we do find that the people who
participate in congregate meals usually have more resources,
are less frail. All of the people who participate, both home-
bound and in the congregate, are encouraged to provide
contributions, and our total client contributions for the meals
programs always exceeds on average more than the third program
that I mentioned. $170 to $180 million a year we get from
seniors themselves as we encourage them to participate, and
most do.
Senator Paul. Meals on Wheels originally was a private
program?
Ms. Greenlee. Not to my understanding, Senator. It was
passed in the 1972 amendments to the Older Americans Act.
Senator Paul. Actually, I think there were originally Meals
on Wheels programs that were private and relied on private
funding from churches and other groups. There was an example
actually in the 1980s from the Twin Cities area, Meals on
Wheels of Benton Harbor, MI. After operating for 4 years with
small monthly deficits offset by charitable donations, the
program was forced to close once a duplicate OA program
siphoned off half of its clients. Meals on Wheels was operating
on people paying for their meals and OAA came in with free
meals and competed actually with the private Meals on Wheels
program.
I think there is some crowding-out phenomenon. The other
thing is we all have sympathy for the elderly. I mean, we're
all going to be old some day and we hope that there will be
someone there to help us. Is part of your eligibility
questioning--I guess income is not part of the eligibility?
Ms. Greenlee. That's correct, it's not a means-tested
program.
Senator Paul. Eligibility is not dependent on whether any
of your family members live near you? You don't ask them if
their daughter lives down the street or anything like that?
Ms. Greenlee. No, sir, I don't believe that's done.
Senator Paul. I mean, I would think that the thing is that
if three of your kids live in town and one's a doctor, one's a
lawyer, and one's an accountant, maybe they ought to help you
before the taxpayer helps you. These are just common sense
things, if I ran a welfare program in my little town in
Kentucky, that I would ask. I would also probably ask if you've
got a million dollars in the bank.
It's the same way when you go to a nursing home. Sure we
have sympathy for people, but should the government be the
first one lining up so the kids can get the million dollars
that granddad has?
So there's a lot of things. These questions have to be
asked. You should ask, and if you want to help people who
cannot help themselves by all means let's do it, but let's help
them with one program. Let's not have program after program
after program, and let's not have a program that helps 87
percent of people who can help themselves. We can't afford it.
Basically, this is a small program with regard to Federal
programs, but it's still $818 million that we don't have. We've
got to borrow it from somewhere. We've got to pay interest to
China to borrow this money. It's not really a matter of whether
or not we have sympathy. We all have sympathy. We just have
different ideas of how to go about addressing the sympathy.
While I want to help people, I want to also have programs
that ask questions: Do you have money in the bank, do you have
kids that could be doing this? And is the government replacing
the idea of what families should do? Is government replacing
the idea of what charities should do? These are fundamental
questions and not idle questions, in the sense that we have to
ask these questions because we're out of money.
Do you have a comment?
Ms. Greenlee. Yes, sir, I have a couple of comments, both
with regard to your statement and your opening comment. Two
things I would suggest as we talk about duplication and the
value of this program, that I'd be glad to work with you on for
consideration. Of the various Federal programs that provide
food assistance to seniors, this is the only one that provides
prepared meals. I think that's an important component to
understanding the value of the program.
The second observation that I have is that the structure of
this program from the Federal level to the local level is very
different from any other Federal program that I'm aware of. We
have a very small Federal agency that administers money
directly to the States and the territories, 250 tribal
organizations, 650 area agencies on aging, providing services
to thousands of providers and tens of thousands of volunteers.
It's a pyramid, and the broad base is the community.
The design of the Older Americans Act for this program and
all the other services is community integration to support
faith organizations and other local organizations. It was never
designed to be an entire and overwhelming Federal response to
nutrition, but an important component of a Federal ally, which
is what I believe we have demonstrated that we are.
Senator Sanders. Thank you, Senator Paul.
Senator Franken.
Senator Franken. Let me ask you about this, because again
I've done a lot of listening sessions around the State of
Minnesota and so many testified to the effect of this program
in allowing people to stay in their homes. There are other
parts of the Older Americans Act--respite care you mentioned,
which is relieving a daughter who is taking care of a parent
who is staying in the home and the daughter is taking care of
her dad or her mom who is very old and would have to go into a
nursing home were it not for the daughter taking care of her or
him. And then there's respite care, like 4 hours a week of
respite care that actually makes it possible for this child to
do this. That keeps a parent out of a nursing home.
I think that, Senator Paul, you should understand the
leveraging here and what this does, what this program does,
because if it weren't for this program we'd have to borrow more
money from the Chinese.
Let me ask you this. Would it be cost-efficient for the
Older Americans Act to hire bureaucrats to track down daughters
and sons who live within--what mile radius would it be
effective? Would it be a 3-mile radius? Would it be a 5-mile
radius? Would we have to put rules and regulations in order?
How would you do that? Do you think that would be cost-
effective, if the Older Americans Act got into hiring a big
bureaucracy to find out exactly how much each senior who is
trying to stay in their home, what resources they had available
to them? How would you do that?
Ms. Greenlee. Senator, if I can make a couple of points.
Eighty percent of the long-term care in this country is
provided by the family. That has not ever changed. There are
always family members around, at least for most people that are
fortunate. Eighty percent have family support.
The Older Americans Act was not designed to be a means-
tested entitlement program. It was always designed to be
flexible and to provide only the services that an individual
needed at that point in time and as they became more frail.
We have met those targets. We have reached people who are
older, who are poorer. We have reached a higher percentage of
people of color than the average population and people in worse
health. So we know that the targeting is effective, that we can
get to the people for whom the services are best designed.
We do not do a comprehensive assessment in order to give
people eligibility for services. We target the services to the
people who most need them instead.
Senator Franken. Do you think other programs in the Federal
Government can learn from the Older Americans Act and from what
you guys do?
Ms. Greenlee. Certainly, because I think this is a cost-
effective way to help provide supports. It's a light touch
rather than a huge Federal program. It provides the supports
that someone needs. We actually are the people who have always
done house calls, who go to someone's home and make an
assessment and give them just that amount of support.
Senator Franken. Well, I so compliment what you do. I again
believe that this is a program that saves the taxpayers money
by leveraging what you do and by allowing seniors to stay in
their home, which they want to do. And if not for your program,
they wouldn't be able to.
So I would only recommend to members of our body who aren't
familiar with the Older Americans Act to do some research
actually on the ground in their States, instead of relying on
statistics provided for them by various groups, and to actually
see this as it works on the ground, because I can't tell you
how inspiring it is, not only to see the help that is provided,
but to hear from those people who you are leveraging, the
volunteers, what it means to them and how it keeps them
involved--many of them are seniors--and what they get out of
it.
It is a program that is a pyramid and at the bottom is the
community. And I want to thank you for your work.
Ms. Greenlee. Thank you, Senator.
Senator Sanders. Thank you, Senator Franken.
Senator Paul.
Senator Paul. I had one follow-up question. I think it's
curious that only in Washington can you spend $2 billion and
claim that you're saving money. Here's a thought: Perhaps the
$2 billion we spend on OAA, if we subsumed that into another
program and didn't spend it, that might be saving money. But to
simply say that we're taking money and saving money that would
be spent otherwise--I think the idea or notion that spending
money in Washington somehow is saving money really kind of
flies past most of the taxpayers.
Now, what I would say, though, is that--or the question I
actually have is, with food stamps can you buy these home-
delivered meals, Ms. Greenlee?
Ms. Greenlee. I always think of food stamps as primarily
buying groceries, but I'm understanding----
Senator Paul. Apparently you can.
Ms. Greenlee [continuing]. You can buy some home-delivered
meals.
Senator Paul. You can. The USDA fact sheet in your binder
says that you can take food stamps and you can buy home-
delivered meals. So if the sole purpose of this is to have
prepared meals and nobody else is providing them, we could
privatize Meals on Wheels and let food stamps buy the thing and
save $2 billion, and then we really would be saving money.
Thank you.
Senator Sanders. Let me just make a comment and maybe ask
you a question. Senator Paul has suggested that only in
Washington can people believe that spending money actually
saves money. I think that is the kind of philosophy which
results in us spending almost twice as much per person on
health care as any other country on Earth. Because we have
millions and millions of Americans who can't get to a doctor on
time, some of them die, some of them become very, very ill.
They end up in the emergency room, they end up in the hospital,
at great cost, rather than making sure they have access to a
doctor.
The point is--and I think we have a bit of a difference
here--I believe--I think Senator Franken has spoken to the
fact--that prevention, keeping people healthy, taking care of
their needs at home, does actually save money; and that if you
deny those resources you're leaving a senior citizen home today
alone, isolated, confused about medicine, not getting the
nutrition they need, you know what happens to that person? That
person collapses. That person ends up in emergency room, that
person ends up in a nursing home, at much greater cost to the
system.
My own belief is, Ms. Greenlee, we have got to do a lot
more. Our goal should be that no senior in this country goes
hungry, that we do everything that we can to keep seniors out
of nursing homes and in their own homes if that's what they
choose by making sure that we have people visiting them, making
sure they're doing well with their medications, making sure
that they're getting the nutrition and the food that they need.
I happen to believe that intelligently investing in the
needs of our people does in fact save us substantial sums of
money.
Ms. Greenlee, yes.
Senator Franken. I just want to say one thing. I want to
make it very narrow, very narrow. Does the Older Americans Act
save the American taxpayer money by allowing--and I'm going to
say it as clearly as I can, because I don't think this is--I
think Minnesotans understand this, and when I was in
Minnesota--and again, I would urge any Senator who has their
doubts about this to actually go to a senior center and
actually go on the ground and ask about this.
Here is my very precise question: Does the Older Americans
Act save taxpayers money by allowing seniors to stay in their
homes, as opposed to going to nursing homes?
Ms. Greenlee. Yes, Senator.
Senator Franken. Thank you. Do you want to expand on that?
Ms. Greenlee. I guess my expanded answer would be that I
believe the program from the very inception was designed to
target outreach to individuals who were most at risk for spend-
down to Medicaid and most at risk for nursing home admission,
and everything that we can do to help invest in the community
and less expensive services, help people stretch their own
assets, help people avoid Medicaid, is a wise investment,
because once they receive Medicaid services, regardless of
their setting, they're much more expensive.
Senator Franken. Are there people in actual other places
besides Washington, DC, that understand that, like in the
States where this is administered?
Ms. Greenlee. I think in Kansas we have figured that out,
yes.
Senator Franken. Yes. In Minnesota, too.
Senator Sanders. Senator Paul wanted to make another
comment.
Senator Paul. I appreciate the great and very, I think,
collegial discussion, and we do have different opinions. Some
of us believe more in the ability of government to cure
problems and some of us believe more in the ability of private
charity to cure these problems.
I guess what I still find curious is, though, that if we
are saving money with the $2 billion we spend, perhaps we
should give you $20 billion. Is there a limit? Where would we
get to--how much money should we give you in order to save
money? So if we spend Federal money to save money, where is the
limit? I think we could reach a point of absurdity.
Thank you.
Senator Franken. I think you just did.
Senator Sanders. I would suggest, Senator Paul, that when
you have seniors in this country who are dealing with food
insecurity who are not getting the nutrition that they need, my
guess is that the government is wasting substantial sums of
money by not taking care of those seniors, who will end up in
emergency rooms, in hospitals, and in nursing homes.
So you asked that question. My answer is I don't want to
see one senior in this country go hungry. It's the morally
right thing to do, and from a fiscally conservative point of
view saving government money in my view, it is the right thing
to do.
Thank you very much for your testimony.
Ms. Greenlee. Thank you. Thank you, Senators.
Senator Sanders. If we can have our second panel.
Let me thank all of the panelists for being with us. Each
and every one of you are working hard on this issue and we
appreciate the work that you do.
Let's begin with Robert Blancato. Mr. Blancato is the
executive director of the National Association of Nutrition and
Aging Services Programs. Mr. Blancato is also the national
coordinator of the Elder Justice Coalition and was appointed by
President Clinton to serve as executive director of the 1995
White House Conference on Aging. He was subsequently appointed
to serve on the Policy Committee for the 2005 White House
Conference on Aging.
Mr. Blancato, thank you very much for being with us.
STATEMENT OF ROBERT BLANCATO, EXECUTIVE DIRECTOR, NATIONAL
ASSOCIATION OF NUTRITION AND AGING SERVICES PROGRAMS,
WASHINGTON, DC
Mr. Blancato. Thank you, Chairman Sanders, Senator Paul,
Senator Franken. Thank you for the opportunity to testify. My
name is Bob Blancato, executive director of the National
Association of Nutrition and Aging Service Programs.
We appreciate this first hearing being focused on the
nutrition programs, the largest and most visible in the Older
Americans Act, serving 2.6 million older adults daily with more
than 236 million meals each year. Next year we celebrate their
40th anniversary. This year we want to see these programs
strengthened, their dollars protected, and continue to achieve
their three purposes: reduce hunger and food insecurity,
promote the health and well-being of older individuals, and
promote socialization to prevent isolation.
Senior hunger is a growing reality. The Leadership Council
of Aging Organizations estimates hunger among older people
increased by 20 percent in the past decade. The Meals on Wheels
Foundation says there were nearly 6 million seniors facing the
threat of hunger in 2007. Feeding America estimates 3 million
food-insecure older adults. The American Dietetic Association
Journal notes 2.5 million older Americans are at risk of
hunger. And an AARP paper notes that between 2006 and 2008 the
number of poor and near-poor older adults, who did not know
where their next meal would come from, doubled, from 5 to 10
percent.
The Older Americans Act is one solution as the largest
national food and nutrition program specifically for older
adults. One in ten in the congregate program today has more
than three IADLs, which can be a precursor to a senior going
hungry.
The second purpose is to promote the health and well-being
of older adults. The dangers of poor nutrition are well-
documented. Risks include premature nursing home admission and
increased and longer stays in hospitals. Eighty-seven percent
of older adults have one or more of the most common chronic
diseases: hypertension, coronary heart disease, and diabetes.
In those aged 45 to 64, diabetes alone more than triples the
risk of nursing home admission. These three diseases can be
prevented or treated through access to appropriate nutrition
services. The Older Americans Act is one solution. Its meals
must and do provide at least one-third of the dietary reference
intakes for older adults. In about 60 percent of participants
this meal is one-half or more of their total food for the day,
and for minority older adults the percentage is even higher.
Further, more than one-third of home-delivered meals
participants today have three or more limits of activities of
daily living, which is a precursor for nursing home placement.
Each day they remain in the home-delivered program, we
potentially save money in Medicare and Medicaid.
The final purpose of this act is to promote socialization,
to try and prevent isolation and loneliness.
Nutrition programs run well because of the millions of
hours of service provided by volunteers, which in turn produce
savings. Almost 25 percent of seniors in the CSET program help
other seniors, mostly in nutrition and senior center programs.
But these programs are in tough shape today. Based on a
survey we did, higher energy, especially gas, and food prices
and loss of volunteers is causing cutbacks in services. Wayne
County, MI, just started its first waiting list in 31 years.
Fiscal year 2012 funding for nutrition programs must grow above
fiscal year 2011 levels. If not, there will be real
consequences involving our most vulnerable older adults.
Let me offer a few recommendations for the reauthorization:
A 5-year extension with sufficient authorization levels to
allow the programs to meet current and future need. Let's add
seniors susceptible to hunger into the targeting language which
directs resources to the neediest older adults. Let's protect
our nutrition dollars, rethink the existing transfer authority,
since almost $40 million came out of nutrition for other
services, some not related to nutrition. We cannot afford that
any more.
Let's enhance the current flexibility in how local
decisions are made about funds used in the nutrition program,
but preserve the integrity of the separate, congregate, and
home-delivered meal program. Let's have a nutrition resource
center to improve the work in the field. Let's provide greater
access to fresh fruits and vegetables and greater flexibility
for meal planning to reflect cultural considerations.
Let's integrate the aging network, especially nutrition
providers, into the community-based care transition programs
that are evolving.
Finally, let's increase the opportunities for communities
to serve meals to seniors and children in community facilities.
I have more in my written statement of recommendations. But
let me put a face on this issue to close with. Theresa is 83
years old. She went to a congregate program when she became a
widow. She became a volunteer, has been in the program now for
17 years. A 68-year-old man in the congregate program for 7
years that has allowed him to stretch his dollars and still get
prescription drugs that he needs. Mary at 92 is home-bound, has
vertigo, and cannot stand up to cook, and she's been receiving
home-delivered meals for 6 years. Claudette, age 67; her
husband had a heart attack. Home-delivered meals for him allows
her to continue to work.
Mr. C was at San Antonio senior center since August 2010.
He was well-dressed and engaged with others. Suddenly, a
dramatic decline in his appearance. Staff asked and he admitted
he was now homeless, living in his car. He was connected to
adult protective services and now lives in an apartment, has
gained 8 pounds, and has his friends and a safe haven.
The Older Americans Act nutrition programs are all about
value, to those it serves and to the volunteers who work in its
program. An emerging value is how much it has and will save
Medicare-Medicaid costs in the future.
A final thought: The act enjoys a long and bipartisan
history in this body and in the House. We hope it will
continue. Take time to visit the nutrition programs in your
State and see for yourself why this is such a good investment
that provides countless returns.
Thank you.
[The prepared statement of Mr. Blancato follows:]
Prepared Statement of Robert Blancato
Chairman Sanders, Senator Paul, thank you for the opportunity to
testify before your subcommittee. My name is Bob Blancato and I am the
executive director of the National Association of Nutrition and Aging
Services Programs, NANASP. We are a national membership organization
representing community-based providers of congregate and home-delivered
nutrition services for the elderly as well as other professionals in
the aging network.
Our more than 600 members along with many others in the national
aging network, including registered dieticians, appreciate your
dedicating this first Older Americans Act hearing to the nutrition
programs. They are the largest and most visible programs in the act.
They operate in every State. They serve more than 2.6 million older
Americans daily with more than 236 million nutritious meals served each
year. A critical component--whether the meal is delivered to one's home
or served at a congregate site--is the daily personal contact with the
older adult.
Nutrition services in the Older Americans Act include the
congregate and home-delivered meals programs along with NSIP, the
Nutrition Services Incentive Program. Congregate meal programs operate
in a variety of sites, such as senior centers, community centers,
schools, and adult day care centers. Besides meals, services include
nutrition screening and education and nutrition assessment and
counseling as appropriate. The program also presents opportunities for
social engagement and meaningful volunteer roles, which contribute to
overall health and well-being. Home-delivered meals provide meals and
related nutrition services to older individuals that are homebound.
Home-delivered meals are often the first in-home service that an older
adult receives, and the program is a primary access point for the other
home and community-based services. NSIP provides additional funding to
States, Territories and eligible Tribal organizations that is used
exclusively to purchase food, and may not be used to pay for other
nutrition-related services or for State or local administrative costs.
States may choose to receive the grant as cash, commodities or a
combination of cash and commodities.
Next year, we will celebrate the 40th anniversary of the signing
into law of the Nutrition Program for the Elderly Act as the 1972
amendments to the Older Americans Act. Our goal for the 2011
reauthorization process is making the nutrition programs stronger, by
protecting its Federal dollars and ensuring the programs address all
three of its main purposes which are to:
1. Reduce hunger and food insecurity;
2. Promote the health and well being of older individuals by
assisting them to access nutrition and other disease prevention and
health promotion services to delay the onset of adverse health
conditions resulting from poor nutritional health; and
3. Promote socialization, community service and prevent isolation
of older individuals.
Before we look to the future, we find nutrition programs across the
country confronting tough times because of this economy. A recent
survey we did of our membership indicated that for any of them, either
rising gas or food prices is causing cutbacks in services and is
contributing to loss of volunteers. I was informed that Wayne County,
MI was recently forced to start its first waiting list for home-
delivered meals in 31 years.
It was only 2 years ago when the Older Americans Act nutrition
programs received an additional $100 million from the ARRA bill when
the programs were confronting these same challenges. We can readily see
the challenges have not gone away. It is critical that fiscal year 2012
funding for the OAA nutrition programs be allowed to grow from fiscal
year 2011 levels or else there will be real consequences involving
older and frailer adults.
Returning to the purposes, the first of which is to reduce hunger
and food insecurity, I testified at a Senate Special Committee on Aging
hearing on this topic in March 2008. The crisis of food insecurity
continues. The terms used to describe the crisis include hunger, food
insecurity, food insufficiency and malnutrition. No matter what term is
used, it is harmful to the older person it impacts.
The Leadership Council of Aging Organizations (LCAO) estimates that
hunger among older persons increased by 20 percent in the past decade.
The Meals on Wheels Association of America Foundation states that as of
2007, there are nearly 6 million seniors facing the threat of hunger, 1
million more than in 2001. Another estimate from Feeding America
indicates there are 3 million food insecure seniors in the United
States. According to an article in the March 2010 Journal of the
American Dietetic Association, about 2.5 million older Americans are at
risk of hunger and 750,000 suffer from hunger due to financial
constraints. A brief issued by the Food Security Institute of the
Center on Hunger and Poverty at Brandeis University indicates that
national estimates of food insecurity among older Americans range from
5.5 to 16 percent. A more recent study on hunger among older adults in
New York City done by the Council of Senior Centers and Services points
to a 35 percent rate of food insecurity. Separate work done by the U.S.
Department of Agriculture points to especially high rates among those
ages 60 to 64. This is important since eligibility for Older Americans
Act title III programs is 60. In addition, the USDA Food Insecurity
Report found that 884,000 households with older persons living alone
are food insecure and older persons living alone represents one of the
fastest growing populations in our Nation.
The important point is that while the Older Americans Act is not
the only solution; it remains the largest national food and nutrition
program specifically for older adults. Also, according to the American
Dietetic Association (ADA), these programs reach less than one-third of
older adults in need of its program and services. Those it reaches tend
to live alone, tend to be minorities and tend to have two or more
chronic health problems. These are all elements along with lack of
transportation and living in food deserts of what are the common causes
of hunger among older adults.
In addition, according to AOA data, more than one out of every 10
seniors served in the congregate program have more than three
impairments of activities of daily living (IADLs) which can be a
precursor to a senior going hungry since two of the most commonly
reported limitations is the inability to cook meals or shop. The number
climbs to over 70 percent for home-delivered meal program participants.
A fundamental outcome of the reauthorization must be to better
target the resources of the nutrition program to ensure it is reaching
those older Americans most susceptible to hunger.
What does hunger and food insecurity mean to our Nation and the
Federal Government? It means that older adults who are malnourished and
often isolated are more likely to end up with more expensive and
unnecessary hospital and nursing home stays. It means more doctor
visits, home health care and other services. It also means we are
letting members of our greatest generation suffer in their golden
years.
The second purpose of the nutrition programs is to promote the
health and well-being of older individuals to delay the onset of
adverse health conditions which can lead to placement in nursing homes
and long-term care facilities.
Consider that 87 percent of older adults have one or more of the
most common chronic diseases--hypertension, coronary heart disease and
diabetes. According to a 2006 American Medical Association article, in
those aged 45-64, diabetes more than tripled the risk of nursing home
admission.
According to the ADA, these three common chronic diseases are
preventable or treatable in part through access to appropriate
nutrition services including meals, nutrition screening and assessment,
counseling and education.
Again, the OAA nutrition programs are not the only solution but the
meals it provides every day must provide at least one-third of the
Dietary Reference Intakes for older adults.
As we look to reauthorize the OAA, we should consider the potential
cost savings that could be achieved for Medicaid and Medicare if we
invest more in programs like the nutrition programs. According to the
AOA 2009 State Program Reports on Home-delivered Meal Clients, the
average percent of clients who have three or more ADL (Activities of
Daily Living) impairments is 35.19 percent and in West Virginia and
Iowa the percentage exceeds 80 percent. Having three or more ADLs is
normally a precursor for being admitted to a nursing home. The
difference in cost between a home-delivered meal and a day in a nursing
home is dramatic. If we are able to keep these individuals in their
homes, we will achieve genuine savings. An investment in the nutrition
programs today most certainly can produce a strong return on the
investment in terms of savings to Medicare and Medicaid in the future.
The final purpose of the nutrition programs is the promotion of
socialization of older individuals. When older adults tell us stories
about the importance of the congregate nutrition program, they tell it
in the context of the program providing nourishment for the body and
the soul. One of the fastest growing segments of the older population
is those who live alone. In fact, according to AOA, 48 percent of all
women over the age of 75 now live alone. The OAA nutrition program
provides seniors, especially those who live alone, with an opportunity
to interact each day with other older adults. This can help to avert
greater isolation and loneliness for these older adults.
There are many other outstanding cost-savings outcomes from the
Older Americans Act nutrition programs. The programs are targeted to
the older person in their own communities. They rely very heavily on
volunteers who commit millions of hours of service which mean millions
of dollars in savings. In addition, the nutrition programs have a
critically important relationship with low-income seniors employed by
SCSEP (Senior Community Service Employment Program) which do their
community service work in nutrition programs. In fact in the case of
one of the larger national SCSEP contractors, Senior Service America,
24 percent of all the community service hours were in service to the
elderly with about half of these hours being provided to senior centers
and nutrition programs.
The programs provide more than just a meal. Programs include
engaging and actionable nutrition education programs intended to
educate and inform older adults on how best to ensure proper nutrition
when they are not at the programs.
This reauthorization is important to both strengthening the core
service programs in the act as well as to modernize the act for the
future. In addition to our call for a 5-year reauthorization of the act
with sufficient authorization levels to allow the program to meet
current and future needs, we recommend the following:
Protect nutrition dollars. It is time to rethink the
transfer authority currently in the statute. The authority has been a
one-way street. Most all of the money transferred comes from one
program, the congregate nutrition program. Based on fiscal year 2009
data, more than $78 million was transferred out of the congregate
program. Half of this went for the home-delivered meals program. We
think that is appropriate so communities can direct their nutrition
programs to where older adults need them. The other half went for title
III B services. Some, but not all of these funds were used to support
services not related to nutrition. That has to change. In these
difficult fiscal times, we cannot afford to take $39 million in funds
intended for nutrition and have them go elsewhere. Only services that
relate directly to nutrition, including transportation or senior
centers should be funded under the transfer authority. Otherwise the
transfers between B and C should be eliminated entirely.
As the Leadership Council of Aging organizations
recommends, we should enhance the current flexibility in the allocation
of senior nutrition program funding in local communities while
preserving the integrity of the separate congregate and home-delivered
meals programs.
Additional recommendations, some of which are included in the
Leadership Council of Aging Organizations (LCAO) 2011 OAA Consensus
Document include:
Building the link between nutrition and health, and
establish a set aside of funds under title III D for nutrition-related
evidence-based health promotion programs.
Authorize a Nutrition Resource Center that will identify
ways to increase cost-effective food and nutrition services in home and
community-based social and long-term care systems serving older adults.
We see this as a public private partnership.
Better enforce existing law that State Units on Aging
solicit the expertise of a registered dietitian and work to have more
RDs on the staff of SUAs.
Provide greater access to fresh fruits and vegetables
through senior farmers markets, urban gardening and farm-to-table
programs.
Promote greater flexibility for meal planning including
cultural considerations and preferences while maintaining current
requirements on meal requirements being met.
Look for and provide support for best practices in
nutrition programs that have succeeded in recruiting and retaining
first wave boomers who are at risk for malnutrition in addition to
existing clientele.
Invest in the opportunity to use title III C funds not
only to serve the current population in need but also to transform
congregate home-delivered nutrition services to meet the nutrition
needs of the burgeoning numbers of older individuals seeking to remain
healthy in their communities.
Improve data collection in the title III C nutrition
programs, particularly measures of unmet need, such as waiting lists.
Currently, according to a report by the National Health Policy Forum,
data on the unmet need for nutrition services are elusive and national
data on waiting lists does not exist.
Better recognize the essential role of transportation in
the provision of nutrition services.
Develop through language a stronger role for the nutrition
programs to aid in the fight against elder abuse, especially in the
areas of education, raising awareness and helping to detect and report
elder abuse.
In addition, NANASP supports:
Aging and Disability Resource Centers (ADRCs)-nutrition
screening questions and routinely making appropriate referrals for full
nutrition assessments for those determined to be at nutritional risk.
A study that can determine how many seniors who are served
by the act are at risk of being institutionalized without the nutrition
program, determine the savings to Medicaid and based on this evidence
then direct a portion of the dollars saved to be reinvested in the OAA.
It is possible that some of this information might be included in the
ongoing evaluation of the nutrition programs being conducted by AOA.
The exact parameters of this proposed study could await the release of
the evaluation.
Build the capacity of and funding for the Native American
Nutrition Programs in order to better strengthen their ability to serve
the complex and urgent needs of elders in Indian Country.
In advance of the 2012 reauthorization of the Farm bill,
consider conducting joint hearings with the Agriculture Committee on
the nutrition programs in each act that benefit older adults and work
for better coordination.
Expand the definition of nutrition education to include
screening, assessment and counseling and extend this education to
caregivers of older adults served by the OAA.
Finally, we recognize that one of the more promising
elements of the Affordable Care Act is the Community Based Care
Transitions Program to support community-based organizations partnering
with eligible hospitals to help patients safely transition between
settings of care. A commitment of $500 million was announced recently
by HHS. We believe some of these community-based organizations should
be from the existing aging network in programs which feature nutrition
services which are viewed as being important to a successful transition
of care from a hospital back to the community.
We hope this subcommittee might consider a broader hearing that
could examine approaches that could strengthen the aging network's
future role, responsibility and resources in home and community-based
care, especially through the Medicaid program.
The success of the OAA nutrition programs is often best captured by
what seniors themselves say. I have recently obtained a few of these
stories either by visiting a program or through those sent in by NANASP
members.
This first story was provided by our NANASP President Paul Downey:
San Diego, CA--Peggy Shannon, 63, was laid off from her job
as an administrative assistant during the economic downturn in
2008. It was the first time since she turned 16 that she was
without a job. Eventually her unemployment ran out forcing
Peggy to take early retirement (with penalty) which put her
income at about $850--below the Federal Poverty Level. She made
drastic cuts in spending and was having to choose between
paying for medications or food. Peggy was extremely worried
about having regular, nutritious, meals because of her severe
diabetes. The stress of the situation caused her to lapse into
a deep depression where she isolated herself in her apartment
and cried most of the time. Her deep pride and embarrassment
over her situation prevented her from reaching out to family
and friends.
Finally, in desperation with her blood sugar at dangerous
levels, she came to Senior Community Centers for food after
reading an article about the agency's new Gary and Mary West
Senior Wellness Center. The center serves two meals per day,
365 days per year. Peggy began coming every day for the food
and to have her blood sugar levels checked by the facility's
nurse. Because of her limited income, Peggy was not able to
make the donation for the meals. She insisted on ``paying'' for
them by volunteering to assist with clerical work. That led to
her becoming an active member of the Civic Engagement program
where she mentors other seniors facing similar challenges. It
also connected her with one of the Senior Community Centers'
collaborative partners, San Diego State University, which
provides interns and faculty in the West Center. Peggy was able
to secure a job working 15 hours a week for SDSU.
Peggy emphatically states that Senior Community Centers saved
her life and credits the meals for motivating her to come in
for help. This is a classical it is ``more than just a meal''
story.
Another story I was told by an I&R/A (Information and Referral/
Aging) specialist from Wayne County, MI when I presented at the annual
conference of the Alliance of Information and Referral Systems (AIRS).
She found a voicemail on a Monday morning from an 88-year-old man who
had left the message on a Sunday. He said he needed food, had no
friends or family and only had enough food to last the day. The
response on Monday was to provide him with a chore worker who could go
to the grocery store, but the man's condition worsened and an ambulance
was called. The man ended up first in the hospital and after 3 days, a
doctor's recommendation was to transfer the man to a skilled nursing
home. According to the I&R/A specialist, if the man ``had access to
this crucial service, he may have had a better chance at avoiding
placement in a skilled nursing facility.''
The I and R specialist also noted, ``Then to show how older people
through voluntary contributions value the nutrition programs comes this
hand written note just signed Meg.''
I have been in rehab for 2 months after falling and
fracturing my hip so I have lost contact with the outside world
almost. My husband said he had 3 pickups but he did not give me
the paper that accompanied the delivery. If I have shortchanged
you on this check, I apologize and will catch up on the next
check.
Another story provided by one of our members involved an 87-year-
old man who had normally called once a month for transportation
services so he could come to town and pay his bills. On his most recent
call he said ``I don't think I am long for this world.'' When asked
why, the man said he was starving. He was invited to the congregate
site and initially showed up weighing 109 lbs but standing 6 feet tall.
He finally agreed to attend the center three times a week during which
time he was advised of other benefits for which he might be eligible.
According to the program director,
``The congregate meal program helped to improve the man's
nutritional health; however, it did much more by opening the
door to so many other benefits that will continue to benefit
him and help him to live independently. He is more than just
units of service provided and dollars spent. His life has been
forever changed.''
I appreciate the opportunity to present this testimony and these
testimonials on the value of the Older Americans Act and especially its
nutrition programs. That is the story of this act throughout its
history. It is about the value it provides to those it serves. It is
about the value of the volunteers who work in the program and perhaps
most importantly; it is about the value it represents to our present
and future Federal budgets. The Older Americans Act enjoys a long
bipartisan history in this body and in the House. We hope that can
continue to allow a strong reauthorization bill to be enacted which
does more than just extend the program but also modernizes it to meet
today and tomorrow's needs.
Senator Sanders. Thank you.
Mr. Blancato. Thank you very much, Mr. Blancato.
Our next panelist is Ken Gordon. I have known Ken for many,
many years. Ken is the executive director of the Area Agency on
Aging for Northeastern Vermont, what we call the Northeast
Kingdom, which is in fact one of the most rural and lowest
income areas in the State of Vermont.
Ken serves on the boards of the Community of Vermont
Elders, the Northeastern Vermont Regional Hospital, and the
National Association of Area Agencies on Aging.
Mr. Gordon, thanks very much for being with us.
STATEMENT OF KENNETH E. GORDON, EXECUTIVE DIRECTOR, AREA AGENCY
ON AGING FOR NORTHEASTERN VERMONT, ST. JOHNSBURY, VT
Mr. Gordon. Thank you, Chairman Sanders, Ranking Member
Paul, and members of the subcommittee, for the opportunity to
testify today. I am honored to be able to speak on behalf of
those who depend upon the senior meal programs authorized by
the Older Americans Act and the thousands of staff and
volunteers who make these programs possible.
My name is Ken Gordon. I do serve as the executive director
for the Area Agency on Aging for Northeastern Vermont. We're a
small nonprofit organization serving older adults in Vermont's
remote Northeast Kingdom. While the back country of Vermont is
beautiful, it's a difficult place to grow old. The winters are
harsh, food and fuel costs are high, and, like elsewhere in the
country, senior hunger remains a vexing problem.
The disturbing reality we face is that hunger is a growing
problem among seniors, affecting nearly 6 million older adults
each year. The seniors who are served by this program have
worked hard throughout their lives. They've paid taxes, they've
responded to the call for military service, they've volunteered
in their communities, and they've made possible the quality of
life that we all enjoy today. And now, at the end of their
lives, they are struggling to make ends meet.
Increasingly, we see many seniors being forced to choose
between paying for food, fuel, rent, or prescription medicines.
Seniors on fixed incomes are particularly vulnerable, as food
is often the first expense to be cut when prices rise.
In Vermont and across the country, Older Americans Act
nutrition programs play a critical role in combating senior
hunger. In 2008, the act's nutrition programs served over 240
million meals to approximately 2.6 million older adults and
family caregivers. These programs work well because they are
collaborative in nature. Participants contribute according to
their means. Donors provide supplemental funding. State and
local governments match Federal dollars. Churches and other
community groups allow the use of their facilities, and
volunteers provide much of the labor that makes these programs
so successful.
One of our senior meal recipients, a 92-year-old widow and
retired teacher from St. Johnsbury, VT, by the name of Maybell
Peck, has described the home-delivered meals she received as a
real lifesaver, and for many, many people across the country
they are precisely that. Senior meals provide life-sustaining
nutrition for hundreds of thousands of older adults each day.
Without this service, many seniors would be left hungry and
alone. Often these programs provide the only true meal of the
day for many older adults.
The volunteers and staff who deliver these meals also
perform a valuable check-in service to ensure the safety of the
senior and are sometimes the only human contact that the senior
may have all day.
It is absolutely critical that we invest in these programs
as they serve as an important lifeline for some of the most
vulnerable, isolated, and frail people living in our
communities.
Ms. Peck also told us that the meals give her a sense of
power, and in many respects these meals do empower older adults
to remain living at home. The programs help older adults and
family caregivers to remain in control of their own lives. They
help the Medicare and Medicaid programs to avoid the cost of
unnecessary hospital care and nursing home placements, and they
serve as the foundation upon which our Medicaid waiver home and
community-based care programs rest. They also serve an
important role in the management of chronic disease.
While the Older Americans Act nutrition programs have made
a meaningful difference in the quality of life for millions of
older Americans, the programs face enormous challenges and are
operating under extraordinary stress. Demand for these
programs, particularly in the category of home-delivered meals,
has grown significantly in recent years. Funding for these
programs has not increased in relation to the sharp rise in
food and fuel costs we have all experienced, nor has it
reflected the increased demand that these programs are
contending with.
In response to these challenges, additional Federal support
for the act's Federal nutrition programs is vital. Greater
flexibility within the act to develop innovative approaches to
service delivery and that provide the flexibility to address
local priorities is also critical to sustaining these programs.
Last, while the Older Americans Act nutrition programs
address a critical need, in the view of many they represent
something far more important. They reflect the sacred
obligation that many of us learned early in our lives to honor
and respect our elders. These are the people that made our
lives possible and whose labor and sacrifice led to the quality
of life that we all enjoy today. Collectively, we share in the
obligation to ensure that our elders' basic needs are met and
that our country's senior citizens are able to live their lives
with the independence and dignity that all Americans deserve.
Thank you.
[The prepared statement of Mr. Gordon follows:]
Prepared Statement of Kenneth E. Gordon
Thank you Chairman Sanders, Ranking Member Paul and members of the
Subcommittee on Primary Health and Aging for the opportunity to testify
at today's hearing regarding the issue of senior hunger and the
reauthorization of the Older Americans Act (OAA). I am deeply honored
to be able to speak on behalf of both the older adults and family
caregivers who depend upon the senior meal programs authorized by the
Older Americans Act, and the thousands of staff and volunteers who make
these programs possible throughout our country.
My name is Ken Gordon. I have the privilege of serving as the
executive director of the Area Agency on Aging for northeastern
Vermont. We're a small, non-profit social service organization serving
older adults and family caregivers in the far northeastern corner of
the State, an area bordering Canada to the North, and the State of New
Hampshire to the East. It's a rural and heavily wooded area that is
home to about 10,000 senior citizens.
While the back country of Vermont is beautiful, it's a difficult
place to grow old. The winters are harsh, food and fuel costs are high,
and public transportation is often lacking. And, like elsewhere in the
country, senior hunger remains a vexing problem for older Vermonters.
Despite the extraordinary progress we have made in this country over
the past 75 years in combating poverty and poor health among older
adults, we still face the startling reality that nearly 6 million
seniors (or over 11 percent of all older adults) from across the United
States face the threat of hunger each year.
Unfortunately, hunger among senior citizens is a growing problem.
According to the U.S. Census, senior hunger in Vermont and many other
States has risen dramatically in recent years. Seniors at the greatest
risk of hunger are individuals age 60-64 and those living alone in
rural areas. Front-line providers are reporting even greater rates of
food insecurity since the onset of the economic downturn because family
members are less able to help.
The seniors we serve come from all walks of life, both rich and
poor. Aging has a way of humbling us all to the realities of birth,
death and our short time on this earth. But the majority of the people
we serve are older adults of modest means who have played by the rules.
They've worked hard throughout their lives, paid taxes, responded to
the call for military service, volunteered in their communities and
made possible the quality of life we enjoy today. And now, at the end
of their lives, they are struggling to make ends meet.
Increasingly, as gasoline, home heating fuel and food prices
continue to rise, we see many of the seniors we work with being forced
to choose between paying for food, fuel, rent or prescription
medicines. Seniors on fixed incomes are particularly vulnerable to
price increases. Because food is often the most flexible part of a
household budget, it is frequently the first expense to be cut when
prices rise.
Hard times are also forcing many of the seniors we work with to
choose foods that have limited nutritional value in place of fruits,
vegetables, whole grains, low fat dairy products and lean proteins. As
we know, there are important consequences associated with the food
choices we make, and this is particularly the case for older adults.
Over 90 percent of seniors have one or more nutrition-related chronic
conditions such as heart disease, diabetes, or high blood pressure that
makes their food choices a critical factor to their health and well-
being.
In Vermont, and across the country, Older Americans Act nutrition
programs play a critical role in combating senior hunger. In concert
with the Supplemental Nutrition Assistance Program (SNAP), food
commodity programs, community food shelves and other initiatives, they
form a hunger ``safety net'' for older adults and their families. In
2008, the act's congregate and home-delivered meal programs served over
240-million senior meals to approximately 2.6 million older adults and
family caregivers. The Older Americans Act nutrition programs are
extraordinarily popular among seniors because there is little, if any,
stigma associated with them, and the eligibility determination process
is straight forward and relatively easy to negotiate.
As those of you who have visited the senior nutrition programs in
the communities you serve already know, the programs work well because
they are collaborative efforts that rely on a partnership between the
individuals receiving services, families, private donors, the State and
Federal Governments, faith-based organizations and the community at-
large. Participants are asked to contribute according to their means
through a system of anonymous, voluntary contributions, and they do. In
2009, seniors and their families in Vermont contributed more than
$800,000 towards the cost of operating these programs. Private
foundations and corporate donors regularly provide supplemental funding
to support these programs, State and local governments provide their
``match'' to Federal dollars, churches and other community groups lend
their facilities to the cause, and volunteers provide much of the labor
that makes these programs so successful.
As an aside, I'd like to invite you all to visit the Area Agencies
on Aging, senior centers and meal programs in your home communities, to
learn for yourselves about these programs and to meet the individuals
they serve.
One of our senior meal recipients, a 92-year-old widow and retired
homemaker from St. Johnsbury, VT, by the name of Maybell Peck, has
described the home-delivered meals she received as a real ``life
saver''. And for many, many people across the country, home-delivered
meals are precisely that.
Senior meals provide life-sustaining nutrition for hundreds of
thousands of older adults each day. Without this service, many seniors
would be left hungry and alone. Often, these programs provide the only
true meal of the day for many, if not most, of those individuals
participating in the program. The volunteers and staff who deliver
meals also perform a valuable ``check-in'' service to ensure the safety
of the senior, and are sometimes the only human contact that a person
may have for long stretches of time. It is absolutely critical that we
invest in these programs, as they serve as an important lifeline for
some of the most vulnerable and frail people living in our communities.
It is also important for policymakers to understand who is being
served by these programs. In our case, the majority of those being
served are older men and women, age 75+, who are living alone on very
modest incomes. Many of these seniors are unable to drive, have
disabilities, suffer from multiple chronic health conditions, and do
not have the physical ability to shop or prepare a meal. Often, they
literally have no other way to feed themselves, and are completely
reliant upon this service in order to remain living at home.
Mrs. Peck also told us that the meals she received gave her a sense
of ``power,'' and in many respects these meals do empower older adults
to remain independent and living at home. Senior nutrition programs
help older adults and family caregivers to remain in control of their
own lives, while helping the Medicare and Medicaid programs avoid the
significant costs of unnecessary hospital care and nursing home
placements.
It's been said that an army marches on its stomach. And, to a large
degree, the same can be said about our efforts to manage chronic health
conditions and to provide seniors and people with disabilities with
alternatives to nursing home care. The Older Americans Act senior
nutrition programs form the foundation upon which our Medicaid Waiver
home and community-based care programs rest and are essential to these
programs' continued success. They are also an important part of the
chronic care initiatives that have been initiated in recent years by
the Centers for Medicare and Medicaid Services that have been proven to
enhance the quality of life for those who participate in them and save
taxpayer dollars, too.
challenges
While the Older Americans Act nutrition programs have made a
meaningful difference in the quality of life for millions of older
Americans, the programs face enormous challenges and are operating
under extraordinary stress.
Demand for these programs, particularly in the category of home-
delivered meals, has grown significantly in recent years as the
population ages, and a growing number of States turn to more cost-
effective and consumer-preferred home and community-based alternatives
to nursing home care.
Increasingly, because of the rising cost of living, seniors are
less able to support these programs via their contributions. Declining
participant contributions are the norm for most senior meal programs in
the area we serve. A similar trend has been reported nationally.
Funding for these programs has not increased in relation to the
sharp rise in food and fuel costs in recent years, nor has it reflected
the increased demand that these programs are experiencing as a result
of the economic downturn. Additionally, providers in rural and frontier
communities face particular challenges in the face of rising gasoline
prices.
In response to these challenges, continued Federal support for the
Older Americans Act senior nutrition programs is critical. Additional
funding to ensure the viability of these programs in the future as the
number of older adults grows dramatically is essential to the well-
being and security of the Nation's older adults and family caregivers.
Additional flexibility within the act to develop innovative approaches
and that provides States and Area Agencies on Aging with the
flexibility to address local priorities is also critical to sustaining
these programs in the future.
Lastly, while the Older Americans Act nutrition programs address a
critical need, and they pay for themselves many times over in the form
of avoided health care costs, in the view of many, these programs
represent something more important. They reflect the sacred obligation
that many of us learned early in our lives to honor and respect our
elders. These are the folks who made our lives possible and whose labor
and sacrifice led to the quality of life that we enjoy today.
Collectively, we share in both the obligation and the responsibility to
ensure that our elders' basic needs are adequately addressed, and that
our country's senior citizens are able to live their lives with the
independence and dignity that all Americans deserve.
Senator Sanders. Thank you very much, Mr. Gordon.
Our third witness is Kay Brown. Ms. Brown is a director in
the Government Accountability Office's Education Workforce and
Income Security Team. Throughout her 25-year career at GAO, Ms.
Brown has focused on improving government performance in
delivering benefits and services to low-income people and
vulnerable populations.
Ms. Brown, welcome.
STATEMENT OF KAY E. BROWN, DIRECTOR, EDUCATION, WORKFORCE AND
INCOME SECURITY, GOVERNMENT ACCOUNTABILITY OFFICE, WASHINGTON,
DC
Ms. Brown. Chairman Sanders, Ranking Member Paul, and
Senator Franken, I'm pleased to be here today to discuss our
recent work on food insecurity among older adults and the
nutrition programs available to assist them. These programs
play a vital role in the health and well-being of one of our
Nation's most vulnerable groups.
I will cover two points: the prevalence of food insecurity
and receipt of nutrition assistance; and second, the extent to
which nutrition assistance programs show signs of inefficiency
or overlap.
First on food insecurity and receipt of assistance: About a
fifth of low-income older adults, those with incomes of less
than $20,000 per year, were food insecure in 2009. These adults
were uncertain of having or unable to acquire enough food
because they lacked resources. A smaller but still significant
number had their eating patterns disrupted and their food
intake reduced because they couldn't afford enough food.
Some of these older adults received help to alleviate food
insecurity, but many did not. For example, in 2008 only about
11 percent reported receiving home-delivered or congregate meal
services.
Based on our work, we know that requests for elderly
nutrition assistance have grown, particularly since the
recession, and are expected to continue to grow. Requests for
home-delivered meals are growing faster than those of
congregate meals.
For my second point, I'd like to step back and look more
broadly at the network of the Nation's nutrition assistance
programs. Last year the Federal Government spent more than $90
billion on domestic food assistance programs to serve not only
older adults, but other vulnerable populations as well. There
are 18 different programs administered by three separate
Federal departments. The benefits are delivered through a
complex network of multiple State offices, local governments,
and nonprofit organizations. These 18 programs emerged
piecemeal over the last several decades to address a variety of
needs, often to target benefits to specific groups at high risk
of malnutrition.
Having multiple food assistance programs has some benefits.
The programs provide various points of entry to help increase
access and provide a range of choices for recipients. However,
this arrangement can also result in overlap among programs and
inefficient use of resources, as similar people access similar
benefits from different programs.
For example, the elderly nutrition program, as we've heard,
provides home-delivered and congregate meals primarily to
individuals aged 60 and older. But low-income older adults can
also access programs offering similar benefits that are
administered by USDA. They might receive commodities from the
commodity supplemental food program, the emergency food
assistance program, or the senior farmers market program. They
might receive meals through the adult and child care food
program. And many are eligible for electronic benefits redeemed
in authorized stores through the largest program, SNAP, which
was formerly called food stamps.
Most of the Nation's 18 programs each have their own
specific and often complex administrative procedures that
Federal, State, and local organizations must follow to receive
funding. Further, program eligibility rules often require
applicants who seek assistance from multiple programs to submit
separate applications for each one.
Finally, not enough is known about the effectiveness of
many of these programs. Research suggests that participation in
7 of the 18 programs, and that includes the elderly nutrition
program and SNAP, is associated with positive health and
nutrition outcomes consistent with the program goals. However,
little is known about the effectiveness of the remaining 11
programs because they have not been well-studied.
In conclusion, many older adults benefit from these
programs. However, given the growing demand and the current
constraints on our Nation's resources, it is vital to take
steps to ensure that benefits and services go to those most in
need, as efficiently as possible, and through programs that we
know work.
We have made recommendations to HHS, focused on identifying
those most in need, and to USDA, focused on improving
efficiencies. But continued oversight will be critical.
This concludes my prepared statement.
Thank you.
[The prepared statement of Ms. Brown follows:]
Prepared Statement of Kay E. Brown
Mr. Chairman, Ranking Member Paul, and members of the subcommittee,
we appreciate the opportunity to discuss our recent work on food
insecurity among older adults and the nutrition assistance programs
available to assist them, including nutrition assistance programs
authorized under the Older Americans Act of 1965 (OAA).\1\ This work
can help inform government policymakers as they address the needs of
one of our Nation's most vulnerable populations while ensuring the
efficiency and effectiveness of Federal programs given rapidly building
fiscal pressures facing our national government. While the economy is
still recovering and in need of careful attention, widespread agreement
exists on the need to look not only at the near term but also at steps
that begin to change the long-term fiscal path as soon as possible
without slowing the recovery. Our recent work can help with this by
identifying potential inefficiency and overlap among programs. At the
same time, there is recognition that the services provided by the OAA
can play an important role in helping older adults remain in their
homes and communities. As the Congress takes steps to address the
fiscal challenge, it will be important that these steps are balanced
with efforts to ensure the health and well-being of older adults.
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\1\ Pub. L. No. 89-73, 79 Stat. 218 (codified as amended at 42
U.S.C. 3001-58ff ).
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My testimony today is based on two recent reports, our April 2010
report on domestic food assistance \2\ and our February 2011 report on
the unmet need for services under the OAA.\3\ My testimony highlights
key findings from each of these reports related to: (1) the prevalence
of food insecurity and the receipt of nutrition services among older
adults; and (2) the extent to which nutrition assistance programs show
signs of inefficiency or overlap. This statement will discuss some of
the challenges related to ensuring the most efficient provision of
services, and suggest how better information could help policymakers
address overlap and duplication among programs while ensuring those
most in need have access to services.
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\2\ GAO, Domestic Food Assistance: Complex System Benefits
Millions, but Additional Efforts Could Address Potential Inefficiency
and Overlap among Smaller Programs, GAO-10-346, (Washington, DC: April
15, 2010).
\3\ GAO, Older Americans Act: More Should Be Done to Measure the
Extent of Unmet Need for Services, GAO-11-237, (Washington, DC:
February 28, 2011).
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To address the objectives, we drew upon our April 2010 report and
our February 2011 report. In this work, we employed an array of
methodologies including analysis of administrative data on program
expenditures and participation and national self-reported data on food
security status; a nationally representative survey of local agencies
that administer nutrition assistance programs funded by OAA \4\; an
analysis of studies on program effectiveness; a review of relevant
Federal laws and regulations and agency documents; and interviews with
relevant experts, Federal officials, and staff of local agencies. We
conducted our work in accordance with generally accepted government
auditing standards. Those standards require that we plan and perform
the audit to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence we obtained provides a
reasonable basis for our findings and conclusions.
---------------------------------------------------------------------------
\4\ We conducted a survey of 125 local agencies, with 99 agencies
(79 percent) responding. The percentages cited from this survey are
subject to margins of error no more than plus or minus 12 percentage
points at the 95 percent confidence level.
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On March 1, 2011, we issued a report outlining opportunities to
reduce duplication across a wide range of Federal programs raising
attention to these issues.\5\ That report was prepared in response to a
new statutory requirement that GAO identify and report annually on
Federal programs, agencies, offices, and initiatives--either within
departments or governmentwide--that have duplicative goals and
activities.\6\ In that work, we also considered fragmentation and
overlap among government programs or activities as these can be
harbingers of unnecessary duplication. Fragmentation of programs exists
when programs serve the same broad area of need but are administered
across different Federal agencies or offices. Program overlap exists
when multiple agencies or programs share similar goals, engage in
similar activities or strategies to achieve them, or target similar
beneficiaries. Unnecessary duplication of program services can occur
when two or more programs are engaged in the same activities or provide
the same services to the same beneficiaries, and this can in turn
result in inefficient service delivery and unnecessary program costs.
Reducing or eliminating duplication, overlap, or fragmentation could
potentially save billions of tax dollars annually and help agencies
provide more efficient and effective services. These actions, however,
will require some difficult decisions and sustained attention by the
Administration and Congress.
---------------------------------------------------------------------------
\5\ GAO, Opportunities to Reduce Potential Duplication in
Government Programs, Save Tax Dollars, and Enhance Revenue, GAO-11-
318SP, (Washington, DC: March 1, 2011).
\6\ Statutory Pay-As-You-Go Act of 2010, Pub. L. No. 111-139, 21,
124 Stat. 8, 29-30 (codified at 31 U.S.C. 712 note).
---------------------------------------------------------------------------
in recent years nearly a fifth of low-income older adults were food
insecure and most did not receive assistance from meals programs
despite increased demand
Analysis of data from the Current Population Survey's (CPS) Food
Security Supplement shows that in 2009, about 19 percent of households
with adults ages 60 and over with low incomes--under 185 percent of the
poverty line--were food insecure. These adults were uncertain of having
or unable to acquire enough food because they lacked resources. In
comparison, slightly less than 15 percent of all households were food
insecure. A small but significant portion of households with older
adults had very low food security in 2009--about 8 percent of those
with households under 185 percent of poverty and about 14.5 percent of
those with incomes under the poverty line. In these households, one or
more household members' eating patterns were disrupted and their food
intake reduced, at least some time during the year because they could
not afford enough food. (See Figure 1.)
Older adults can and do access a number of resources to help
alleviate food insecurity; however, many low-income older adults likely
to need assistance from meals programs did not receive it, according to
2008 data. Through our analysis of information from the CPS, we found
that in 2008 approximately 9 percent of an estimated 17.6 million low-
income older adults \7\ received home-delivered or congregate meals
services including those provided by the OAA Elderly Nutrition Program:
Home-Delivered and Congregate Meals Services (Elderly Nutrition
Program) \8\ and other organizations such as churches or nonprofits.\9\
However, many more older adults did not receive these meals services,
but likely needed them due to food insecurity, difficulties with daily
activities, and/or limited social interaction, as shown in table 1.\10\
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\7\ Our analysis of meal program recipients and non-recipients was
limited to those living in households below 185 percent of the poverty
threshold because the CPS did not collect generalizable information for
individuals with higher incomes. In addition to people age 60 and over,
younger spouses living with people age 60 and over and people with
disabilities of all ages in housing facilities occupied primarily by
older people where congregate meals are served or who live with someone
age 60 and over are also eligible for meals services through title III.
42 U.S.C 3030g-21(2)(I). Our estimates of older adults who are likely
to need meals services also include these additional individuals. An
estimated 31 percent of people age 60 and over were below 185 percent
of the poverty threshold.
\8\ 42 U.S.C. 3030e and 3030f. Nutrition services authorized
under Title III Part C of the OAA are designed to provide balanced and
nutritious meals at home or in a congregate setting. Home-delivered
meals, commonly referred to as ``Meals on Wheels,'' are typically
provided to individuals who have health difficulties that limit their
ability to obtain or prepare food. Congregate meals are served at a
variety of sites, such as schools and adult day care centers, and serve
older adults' social interaction needs, in addition to nutrition.
\9\ The CPS asked seniors whether they received home-delivered or
congregate meals, but did not specify the source of the meals.
\10\ We aligned our definition of likely need with two of the three
key purposes of the Elderly Nutrition Program as described in the OAA:
(1) reducing hunger and food insecurity and (2) promoting
socialization. 42 U.S.C. 3030d-21. Given available data, we could not
estimate the number of older adults likely to need services based on
the third purpose of promoting health and well-being. Unless otherwise
noted, our estimates of low-income older adults likely to need or
receive meals services have a maximum confidence interval of +/^3.2
percentage points of the estimate.
Table 1: Percentages of Low-Income Older Adults With Each Characteristic of Likely Need and Percentages Who Did
and Did Not Receive Meals Services
----------------------------------------------------------------------------------------------------------------
Did not
Received receive Received Did not Received Received
Characteristics of likely need Have each home- home- congregate receive either neither
characteristic delivered delivered meals congregate type of type of
meals meals meals meal meal
----------------------------------------------------------------------------------------------------------------
Food security:
Food secure................. 81.4 3.3 96.7 5.7 94.3 8.3 91.7
Food insecure............... 18.6 7.4 92.6 4.9 95.1 11.1 88.9
Number of impairments \1\:
None........................ 65.2 2.3 97.7 5.1 94.9 6.9 93.1
One......................... 18.0 3.6 96.4 6.3 93.7 8.8 91.2
Two or more................. 16.8 11.5 88.5 6.4 93.6 16.7 83.3
Social isolation \2\:
Less isolated............... 31.8 2.5 97.5 6.1 93.9 7.9 92.1
More isolated............... 41.4 5.0 95.0 5.0 95.0 9.0 91.0
Missing \3\................. 26.8 4.5 95.5 5.8 94.2 9.7 90.3
----------------------------------------------------------------------------------------------------------------
Source: GAO analysis of 2008 CPS data.
\1\ To identify older adults likely to need meals programs based on potential difficulties preparing or
obtaining food, we used four CPS questions that identified functional impairments, such as difficulty doing
errands alone, serious difficulty walking or climbing stairs, or difficulty dressing or bathing.
\2\ We defined likely need for more social interaction as answering ``no'' to all of the questions in the CPS
civic engagement supplement that asked about the older adult's participation in social activities. However,
such survey data do not capture more qualitative aspects of an individual older adults' likely need for social
interaction such as personality and individual preference. The data also do not allow us to identify
individuals who may interact socially outside of organized groups and activities.
\3\ CPS questions related to social isolation were asked at a different time in the survey cycle than questions
about receipt of meals services. Therefore, approximately 27 percent of the older adults with low incomes in
our sample provided information about participation in meals programs, but not about participation in social
groups. As a result, we could not measure whether they were more or less socially isolated.
It should be noted that there are many reasons why older adults may
not receive nutrition assistance through the Elderly Nutrition Program.
They may not know about the available services, may not have access to
services due to limited supply in their area, may receive informal
assistance from family or neighbors, or may choose to remain self-
sufficient rather than request government benefits. In addition, some
older adults may choose to participate in a separate program instead,
such as the Supplemental Nutrition Assistance Program (SNAP), formerly
known as Food Stamps, where they can purchase their preferred foods.
Requests for Elderly Nutrition Program services have increased and
demand will likely continue to grow. Through our survey of area
agencies on aging (local agencies) conducted during the summer of 2010,
we found that an estimated 79 percent of agencies had seen increased
requests for home-delivered meals, and 47 percent had seen increased
requests for congregate meals since the start of the economic downturn.
Further, requests for OAA services are increasing as more seniors stay
in their homes longer rather than move to assisted living facilities or
nursing homes, according to agency officials. According to U.S. Census
data, more than 9 million more Americans were 60 years and older in
2009 than in 2000, and the Census Bureau projects that population group
will continue to grow.
Further, demand for Elderly Nutrition Program home-delivered meals
is growing compared to congregate meals. In our 2010 survey, an
estimated 22 percent of agencies reported they were generally or very
unable to serve all clients who request home-delivered meals, compared
to an estimated 5 percent of agencies who were generally or very unable
to serve all clients who requested congregate meals. To adjust to these
changes in requests for services, most State and some local agencies
utilized the flexibility provided by the law to transfer OAA funds
among title III programs.\11\ Agencies most commonly transferred funds
from congregate meals to home-delivered meals or other title III
services. Nationally, from fiscal year 2000 through fiscal year 2008,
States collectively transferred an average of $67 million out of the
congregate meal program each year (see Figure 2).
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\11\ OAA title III authorizes a supportive services and senior
centers program that covers, for example, health, transportation,
ombudsman, nutrition, and education services, as well as home-delivered
and congregate meals programs. 42 U.S.C. 3030d. The OAA provides
states with some authority to transfer Federal funding allocations
among programs. A state may transfer up to 40 percent of allocated
funds for the home-delivered meals programs to the congregate meals
program, or vice versa, and the Assistant Secretary of Aging can grant
a waiver for a State to transfer an additional 10 percent. 42 U.S.C.
3028(b)(4). In addition, a state may transfer up to 30 percent of
allotted funds for Part B support services (such as transportation and
home-based care) to the meal programs and vice versa, and the Assistant
Secretary may grant a waiver of the 30 percent limit. 42 U.S.C.
3028(b)(5) and 3030c-3(b)(4).
actions needed to reduce administrative overlap among domestic food
assistance programs
In part because food insecurity is a national problem that affects
not only older adults but also many other vulnerable groups, the
Federal Government spent more than $90 billion on domestic food
assistance programs in 2010. This represents an increase of
approximately 44 percent over 2008 spending, driven largely by
increased spending on the SNAP. We identified 18 different Federal
programs that provide nutrition assistance, programs that emerged
piecemeal over the past several decades to address a variety of needs.
Agency officials and local providers have indicated that the multiple
food assistance programs work together and provide various points of
entry to the system to help increase access to food for vulnerable or
target populations at high risk of malnutrition or hunger. Those
officials and providers told us that, since no one program alone is
intended to meet a household's full nutritional needs, the variety of
food assistance programs can help households fill gaps and address the
specific needs of individual members. However, we have previously
reported signs of overlap and inefficient use of resources in the
delivery of benefits through these programs. In addition to the
Departments of Agriculture (USDA), Health and Human Services (HHS), and
Homeland Security (DHS) multiple State and local government and
nonprofit organizations work together to administer a complex network
of programs and providers.
We have found that some of these programs, including those serving
older adults, provide comparable benefits to similar or overlapping
populations. For example, the Elderly Nutrition Program administered by
the Administration on Aging (AOA), provides home-delivered and
congregate meals primarily to individuals 60 years and older.
Separately, other programs administered by USDA, including the
Commodity Supplemental Food Program, targets a similar population,
providing food to older adults, as well as women, infants and children
who are also served by the Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC) program. In addition, individuals
eligible for groceries through the Commodity Supplemental Food Program
or services through the Elderly Nutrition Program may also be eligible
for groceries through the Emergency Food Assistance Program and for
targeted benefits that are redeemed in authorized stores through the
largest program, SNAP. In fact, a recent AOA report conducted by
Mathematica \12\ found that 7 percent of congregate meal recipients and
16 percent of home-delivered meal recipients were also receiving SNAP
benefits. The availability of multiple programs with similar benefits
helps ensure that those in need have access to nutritious food, but can
also increase administrative costs, which account for approximately a
tenth to more than a quarter of total costs among the largest of these
programs. In addition, our previous work has shown that overlap among
programs can lead to inefficient use of Federal funds, duplication of
effort, and confusion among those seeking services.
---------------------------------------------------------------------------
\12\ Allison Barrett and Jody Schimmel, Mathematica Policy
Research, ``Multiple Service Use Among OAA Title III Program
Participants,'' September 2010 (Research Brief).
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We have found in previous work that despite the potential benefits
of varied points of entry, program rules related to determining
eligibility often require the collection of similar information by
multiple entities.\13\ For example, an older adult might apply for
congregate meals through the Elderly Nutrition Program at their local
area agency on aging, electronic benefits through SNAP at the Health
and Human Services office, and vouchers for fresh fruit and vegetables
through the Senior Farmers' Market Nutrition Program at a local food
bank. Most of the 18 programs have specific and often complex
administrative procedures that Federal, State, and local organizations
follow to help manage each program's resources. According to our
previous work and State and local officials, rules that govern these
and other nutrition assistance programs often require applicants who
seek assistance from multiple programs to submit separate applications
for each program and provide similar information verifying, for
example, household income. This can create unnecessary work for both
providers and applicants and may result in the use of more
administrative resources than needed.
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\13\ GAO, Domestic Food Assistance: Complex System Benefits
Millions, but Additional Efforts Could Address Potential Inefficiency
and Overlap Among Smaller Programs, GAO-10-346, (Washington, DC: April
15, 2010).
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Moreover, not enough is known about the effectiveness of many of
these programs. Research suggests that participation in 7 of the 18
programs--including the Elderly Nutrition Program and SNAP--is
associated with positive health and nutrition outcomes consistent with
programs' goals.\14\ For example, studies on the Elderly Nutrition
Program found that the program increases socialization and may have a
positive effect on food security. In addition, research suggests the
program improves participants' dietary and nutrient intake--an outcome
related to the program's goal of promoting the health and well-being of
older individuals by assisting such individuals to gain access to
nutrition and other disease prevention and health promotion services to
delay the onset of adverse health conditions resulting from poor
nutritional health or sedentary behavior. However, little is known
about the effectiveness of the remaining 11 programs because they have
not been well-studied.
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\14\ The other programs that show outcomes consistent with many of
their program goals include: WIC, the National School Lunch Program,
the School Breakfast Program, Nutrition Assistance for Puerto Rico, and
the Special Milk Program.
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Agencies do regularly collect performance and other data on
nutrition assistance programs but these data are not sufficient to
determine program effectiveness and do not always provide all the
information needed to effectively and efficiently manage their
programs. Agency data show that the 11 less-studied programs provide
food and nutrition assistance to millions of individuals and households
each year--an outcome related to their goals--however, this alone does
not demonstrate the overall effectiveness of these programs. Other
data--such as on need and unmet need for services--could help agencies
better target limited resources and more efficiently serve their target
populations but agencies often do not have this information. For
example, while the OAA requires AOA to design and implement uniform
data collection procedures for States to assess the receipt, need, and
unmet need for title III services,\15\ AOA does not provide
standardized definitions or measurement procedures for need and unmet
need that all States are required to use. Instead, AOA provides States
with non-binding guidance on these issues and an assortment of tools
and resources that they can use to evaluate need and limited
information about measuring unmet need. States use a variety of
approaches to measure need and measure unmet need to varying extents,
but no agencies that we spoke with fully estimate the number of older
adults with need and unmet need in their service area. Such information
could help providers make informed decisions about serving those most
in need as the number of older adults increases and resource
constraints are likely to continue.
---------------------------------------------------------------------------
\15\ 42 U.S.C. 3012(a)(26).
---------------------------------------------------------------------------
In April 2010, we recommended that USDA, as the principal
administrator of the Federal Government's food assistance programs,
identify and develop methods for addressing potential inefficiencies
among food assistance programs and reducing unnecessary overlap among
its smaller food assistance programs while ensuring that those who are
eligible receive the assistance they need. These methods could include
conducting a study as a first step; convening a group of experts;
identifying which of the lesser-studied programs need further research
and taking steps to fill the research gap; or identifying and piloting
proposed changes.
Further, in February 2011 we recommended that, to help ensure that
agencies have adequate and consistent information about older adults'
needs and the extent to which they are met, the Secretary of Health and
Human Services partner with other government agencies that provide
services to older adults and, as appropriate, convene a panel or work
group of researchers, agency officials, and others to develop
consistent definitions of need and unmet need and to propose interim
and long-term uniform data collection procedures for obtaining
information on older adults with unmet needs for services provided from
sources like title III.
In addition to our specific recommendations to USDA and HHS, we
have also noted in prior work that agencies can reduce program
inefficiencies by broadening their efforts to simplify, streamline, or
better align eligibility procedures and criteria across programs to the
extent that it is permitted by law. Consolidating or eliminating
overlapping programs also have the potential to reduce administrative
costs but may not reduce spending on benefits unless fewer individuals
are served as a result. More broadly, essential to all these efforts is
collaboration among many entities. Achieving meaningful results in many
policy and program areas, including food and nutrition services,
requires some combination of coordinated efforts among various actors
across Federal agencies with other governments at State and local
levels and nongovernmental organizations.
conclusion
In conclusion, as I have outlined in my testimony, opportunities
exist to streamline and more efficiently carry out these important
domestic food assistance programs. Specifically, addressing
duplication, overlap, and fragmentation could help to minimize the
administrative burdens faced by those entities--including States and
localities as well as nonprofit organizations--that are delivering
these programs' services. Such administrative burdens range from
eligibility requirements and the application process to costs
associated with carrying out the program and reporting requirements.
Improving consistency among these various requirements and processes as
well as considering how multiple agencies could better coordinate their
delivery of programs could result in benefits both for those providing
and those receiving the services. In addition, collection of adequate
and consistent information about older adults' needs and the extent to
which they are met could help providers make informed decisions about
serving those most in need. It is particularly important to use
resources efficiently given that the need for meals programs among low-
income older adults will likely continue to outpace available services
given the growing older population and continued economic constraints.
Careful, thoughtful actions will be needed to address issues
involving potential duplication, overlap, and fragmentation among
Federal programs and activities. These are difficult issues to address
because they may require agencies and Congress to re-examine within and
across various mission areas the fundamental structure, operation,
funding, and performance of a number of long-standing Federal programs
or activities. Continued oversight will be critical to ensuring that
unnecessary duplication, overlap, and fragmentation are addressed.
Thank you, Mr. Chairman, Ranking Member Paul, and members of the
subcommittee. This concludes my prepared statement. I would be pleased
to answer any questions you may have.
______
Appendix I: Selected Federal Food and Nutrition Assistance Programs,
by Agency
------------------------------------------------------------------------
Item no. Program Name
------------------------------------------------------------------------
USDA
1....................................... Child and Adult Care Food
Program
2....................................... Commodity Supplemental Food
Program
3....................................... Community Food Projects
Competitive Grant Program
\1\
4....................................... Food Distribution Program on
Indian Reservations
5....................................... Fresh Fruit and Vegetable
Program
6....................................... National School Lunch
Program
7....................................... Nutrition Assistance for
Puerto Rico
8....................................... School Breakfast Program
9....................................... Senior Farmers' Market
Nutrition Program
10...................................... Special Milk Program
11...................................... Summer Food Service Program
12...................................... Supplemental Nutrition
Assistance Program (SNAP)
13...................................... The Emergency Food
Assistance Program
14...................................... WIC
15...................................... WIC Farmers' Market
Nutrition Program
DHS Federal Emergency Management Agency
16...................................... Emergency Food and Shelter
National Board Program
HHS Administration on Aging
17...................................... Elderly Nutrition Program:
Home-Delivered and
Congregate Nutrition
Services
18...................................... Grants to American Indian,
Alaska Native, and Native
Hawaiian Organizations for
Nutrition and Supportive
Services
------------------------------------------------------------------------
Source: GAO, Domestic Food Assistance: Complex System Benefits Millions,
but Additional Efforts Could Address Potential Inefficiency and
Overlap among Smaller Programs, GAO-10-346 (Washington, DC: Apr. 15,
2010).
\1\The Community Food Projects Competitive Grants Program is
administered by the National Institute of Food and Agriculture
(formerly the Cooperative State Research, Education, and Extension
Service, CSREES) of USDA. All other USDA programs listed above are
administered by the Food and Nutrition Service. Community Food
Projects Competitive Grants Program participation information is from
CSREES Update: September 17, 2009, Office of the Administrator,
CSREES, USDA.
Senator Sanders. Ms. Brown, thank you very much.
Our final witness is Dr. Mary Jane Koren, vice president
for the Picker/Commonwealth Long-Term Quality Improvement
Program at the Commonwealth Fund, a health policy foundation.
Dr. Koren, an internist and geriatrician, began her career in
geriatrics at Montefiore Medical Center, where she started the
geriatrics fellowship program and was assistant medical
director for the Montefiore Home Health Care Agency.
Dr. Koren, thanks for being with us.
STATEMENT OF MARY JANE KOREN, M.D., M.P.H., VICE PRESIDENT,
PICKER/COMMONWEALTH FUND LONG-TERM QUALITY IMPROVEMENT PROGRAM,
THE COMMONWEALTH FUND, NEW YORK, NY
Dr. Koren. Thank you, Mr. Chairman, for inviting me to
testify today. I'm Dr. Mary Jane Koren and as a geriatrician I
have made many home visits to patients living in the Bronx. In
my experience, these nutritional programs, those supported by
Title III C of the Older Americans Act, are undoubtedly some of
the most cost-effective interventions yet devised to combat
nutrition and hunger in seniors, keeping them healthier,
longer, so they stay out of hospitals, they stay out of nursing
homes, and they remain in their own homes.
Let me tell you why this is the case. Against a backdrop of
physiologic changes associated with aging--such as the anorexia
of aging, poor dentition, difficulty swallowing--there are
multiple medical conditions that compromise an elder's ability
to maintain nutritional status. Older adults have multiple
chronic conditions, such as diabetes, depression, heart
failure, kidney disease, and arthritis. Fifty percent of people
over the age of 65 have two to four chronic conditions.
Likewise, the prevalence of dementia rises with age, affecting
almost half of those 85 years or older.
The interplay of these factors, both physiologic and
pathologic, means that many seniors experience often
insurmountable odds with shopping and meal preparation. They're
at high risk for hunger and consequently high users of health
care services.
Social issues also play a major role in hunger and food
insecurity for elders with limited means and forces them to
choose between buying food and paying the rent. Further, as I
can attest from my own experiences making home visits in the
South Bronx, many elderly patients are reluctant to leave their
own apartments. They've learned the hard way that the denizens
of that urban jungle view them as easy prey. Others of my
patients were just as trapped at home when they could no longer
drive. All too often, my patients were subsisting on a protein-
deficient tea and toast diet.
As a geriatrician, I can tell you that hunger only makes
things worse and drives up health care costs. Yet a low-cost
simple intervention such as home meal delivery or congregate
meals can reduce hospitalization and delay nursing home
placement, thus significantly lowering the costs of what is
otherwise an extremely high-cost population and a major driver
of health expenditures.
Why are these programs effective? When older people don't
eat enough good food, bad things happen. Research findings show
that undernutrition causes any or all of the finding: muscle
wasting, pressure ulcers, apathy, increased susceptibility to
infections, anemia, delirium, increased frailty, functional
decline, and fall. Any one of these negative health outcomes
have enormous implications for service utilization.
Take falls. A third of people over 65 and a third of them
suffer moderate to severe injuries from falls, leaving them
disabled or unable to live independently. In 2000 the health
care costs of falls exceeded $19 billion. Malnourishment
increases the rate of falls and it worsens the outcomes. We
know from research and from experience that providing
nutritional support to vulnerable elders works.
If home-delivered and congregate meal programs could save
even a fraction of what falls cost Medicare and Medicaid,
they'd pay for themselves. Multiply that by the costs of
treating all these other health consequences of hunger and the
value of these programs is off the chart.
Not only that, people really love these programs, because
they not only provide something to eat, they provide a reason
to eat. Make no mistake, social isolation kills people, too.
The socialization provided by these programs is a godsend for
those who've outlived their friends and who because of illness,
frailty, and dysfunction their life has been reduced to a
couple of rooms.
This happened to my father. After a head injury in a car
accident, he couldn't drive, he couldn't shop, and he couldn't
do much in the way of meal preparation for himself. All he knew
is he wanted to stay home. Meals on Wheels played a critical
role in keeping him in his own home for the last years of his
life. The volunteer's visit was the high point of his day.
Meals on Wheels also helped me, too, as his long-distance
caregiver. They became my early warning system. Time and again,
they alerted me to a problem before it was escalated to a
catastrophe.
The bottom line is these programs help seniors stay
healthier, which keeps them out of emergency rooms, decreases
the rate of hospitalization, shortens lengths of stay and re-
admissions, and keeps them out of expensive nursing homes.
In conclusion, I would make several recommendations for
things that might be done at the Federal level. First, I would
urge not only the reauthorization of funding for title III
nutrition programs, I would strongly suggest they be expanded.
They work.
I would also advise there be support for demonstrations,
pilots, and applied research on how the programs could better
serve our diverse population, and test creative strategies for
improving outcomes even further.
Third, I would recommend that the requirements for the
nutrition programs should ensure the caloric adequacy and key
nutrients in meals. For many seniors these meals are their main
source of daily food intake. Target specific highly vulnerable
groups for receipt of enhanced services. Tailor the programs'
services to increase its effectiveness for people with
particularly high burdens of illness. Enhance the nutritional
education and counseling given to caregivers and to their
patients, and give the program the flexibility it needs to
better accommodate regional and ethnic food preferences and
improve palatability and taste.
I thank you for your attention and for providing the
opportunity of addressing the committee.
[The prepared statement of Dr. Koren follows:]
Prepared Statement of Mary Jane Koren, M.D., M.P.H.
Thank you, Mr. Chairman, for inviting me to testify today. I am Dr.
Mary Jane Koren and a geriatrician by training. Most of my career has
been devoted to serving the elderly, particularly those with serious
chronic conditions. I have taken care of residents living in nursing
homes, made home visits as the assistant medical director of the
Montefiore Home Health Agency to patients living throughout the Bronx
and later was appointed to be the director of New York State's Bureau
of Long Term Care Services. Currently, I am vice-president at the
Commonwealth Fund, an independent private foundation working toward a
high performing health system which is located in New York City. The
grant-making program I manage is aimed at improving long term services
and supports particularly for people covered by both Medicare and
Medicaid, also called the ``dual eligibles'', and for those
transitioning from one level of care to another.
No matter which hat I'm wearing--geriatrician, policymaker or
grantmaker--my goal has been, and is, to help frail older adults
maintain their independence and well-being. The program I would speak
to today, Title III-C of The Older Americans Act, Nutrition Services,
is probably one of the simplest, yet most effective programs yet
devised to help low-income seniors stay in their homes and stay out of
hospitals and nursing homes. You have heard today from both Federal and
State policymakers and from those who administer these programs. I will
therefore try to give you a somewhat different perspective. Based on my
professional background and front-line experience caring for elderly
patients I'll briefly cover four areas: First, I'll say a bit on
exactly why hunger, or under-nutrition, is so common in this
population; second, talk about the consequences of under-nutrition both
for patients and for rising health care expenditures; third, describe
how home delivered and congregate meals can help low-income seniors,
their families, health care providers and policymakers, especially in a
time of constrained resources; and lastly, make several recommendations
to strengthen these programs.
First, some information about aging: because of the way our bodies
age, older people have a heightened risk of ``hunger''. The aging
process itself predisposes a person to under-nutrition--
physiologically, it's a stacked deck. These physiologic changes make it
extremely difficult for even healthy older adults to stay well
nourished. Here are some examples. There is what's termed the
``anorexia of aging'', a natural phenomenon in which the desire for
even adequate quantities of food declines commensurate with the decline
in physical activity seen in the very old. This means that seniors
don't feel as hungry as you or I do at meal times and so there is the
tendency to only eat a little bit or even to skip a meal. Compounding
that, stomachs ``shrink'', or become less compliant, as people age so
they feel ``full'' faster. This sensation of satiation is further
mediated by the release of such hormones as cholecystokinin, leptin and
dynorphin which act both on the brain and on the gut. The senses of
smell and taste likewise diminish with age--food loses its savor making
meals less interesting and enjoyable so people tend to eat less. Oral
problems, such as poor dentition, ill-fitting dentures, or decreased
saliva production are common in old age which can make eating a misery.
It has been estimated that dental problems alone may decrease food
intake by up to 100 kcal/day--not a lot, perhaps, for 1 day but
cumulatively, over weeks and months, enough to cause an insidious and
inexorable loss of weight.\1\ Swallowing problems, or dysphagia, can
make mealtimes a source of stress, not enjoyment. People who've
experienced difficulty swallowing may be reluctant to eat very much or
be very selective about what they try to eat because of their fear of
choking. In addition, older adults don't get as thirsty as young
people, which, especially in hot weather or for people with congestive
heart failure on diuretics, can cause dehydration with its serious
complications including dizziness, delirium and falls.\2\ In a word,
the aging process itself sets the stage for inanition or energy-protein
malnourishment.
---------------------------------------------------------------------------
\1\ ``Nutrition'' ch2, p9. Merck Manual of Geriatrics, Second
Edition, (Whitehouse Station, NJ: Merck & Co., Inc. 1995).
\2\ Up to 2 percent of falls in elderly patients result in hip
fractures and up to another 5 percent result in other fractures. These
types of injuries account for about 5 percent of hospitalizations for
patients over 65 years old. About 5 percent of elderly hip fracture
patients die while hospitalized, while overall 12-month mortality
ranges from 12 to 67 percent. See N. Alexander, ``Falls'' in Merck
Manual of Geriatrics, Third Edition. (Whitehouse Station, NJ: Merck &
Co., Inc. 2000).
---------------------------------------------------------------------------
On top of this, there are a whole host of medical problems and
social issues common to low-income older adults that further compromise
an elder's ability to maintain optimum nutrition. Far and away the most
common cause of under-nutrition is depression. Research has shown that
depressive symptoms are associated with insufficient food intake and
nutritional deficiencies, especially in poor elderly people living at
home \3\ because of loss of appetite, diminished enjoyment of food,
difficulty with food preparation and consumption of a less varied
diet.\4\ A vicious circle gets started where depression leads to poor
intake, which worsens depressive feelings, and so on. It can be a hard
circle to break especially in the homebound elderly who tend to become
lonely, withdrawn and apathetic. One study, for example, found that
depressive symptoms, which were more common among women in the study,
were linked with diminished mobility and social interaction.\5\ I would
also note that social isolation is one of the major risk factors for
elder abuse, most commonly perpetrated by family members.\6\
Encouraging those delivering meals to look for signs of elder abuse
would help enormously in the detection of what's often a hidden problem
and in getting help for an elder, who may have no other contact with
people outside the home.
---------------------------------------------------------------------------
\3\ German L, Kahana C, Rosenfeld V, Zabrowsky I, et al.
``Depressive symptoms are associated with food insufficiency and
nutritional deficiencies in poor community-dwelling elderly people.'' J
Nutr Health Aging. 2011; 15(1):3-8, cited in Morley JE.
``Undernutrition: a major problem in nursing homes.'' J Am Med Dir
Assoc. 2011 May; 12(4):243-6. Epub 2011 Mar 23.
\4\ Sharkey JR, Branch LG, Zohoori N, Giuliani C, et al.
``Inadequate nutrient intakes among homebound elderly and their
correlation with individual characteristics and health-related
factors.'' Am J Clin Nutr. 2002 Dec; 76(6):1435-45.
\5\ Penninx BW, Leveille S, Ferrucci L, van Eijk JT, et al.
``Exploring the effect of depression on physical disability:
longitudinal evidence from the established populations for
epidemiologic studies of the elderly.'' Am J Public Health. 1999 Sept;
89(9):1346-52, cited in Sharkey JR, Branch LG, Zohoori N, Giuliani C,
et al. ``Inadequate nutrient intakes among homebound elderly and their
correlation with individual characteristics and health-related
factors.'' Am J Clin Nutr. 2002 Dec; 76(6):1435-45.
\6\ ``Who Are the Abusers?'' National Center for Elder Abuse,
Administration on Aging. Accessed June 17, 2011 http://
www.ncea.aoa.gov/NCEAroot/Main_Site/FAQ/Basics/Abusers.aspx.
---------------------------------------------------------------------------
In addition to the impact of depression on food intake, older
people have multiple chronic conditions, such as diabetes, heart
failure, kidney disease, stroke and arthritis. The prevalence for those
over age 65 of two to four chronic illnesses is about 50 percent. For
those over age 75 almost 20 percent have five or more chronic illnesses
\7\ which take a huge toll on normal function, including even basic
actions like being able to stand or lift things which compromises the
ability to shop, prepare a meal and sometimes even the ability to eat.
The presence and perceived effect of individual diseases and conditions
on daily activities is termed the ``the burden of disease'' \8\--and
the more illnesses a person has, the higher that ``burden'' becomes.
When people don't feel well, appetite is often the first thing to go
which leads to insufficient energy-protein intake and weight loss.
---------------------------------------------------------------------------
\7\ ``Chronic Care: A Call to Action for Health Reform.'' AARP
Public Policy Institute. Accessed June 17, 2011 http://assets.aarp.org/
rgcenter/health/beyond_50_hcr.pdf.
\8\ Ibid. 4
---------------------------------------------------------------------------
But treating people's illnesses may actually worsen the situation
as far as nutrition is concerned. National surveys show that more than
9 of 10 older adults are taking prescription medications. According to
the National Health and Nutrition Examination Survey, 64 percent of
adults ages 60 and older are taking three or more prescription drugs
per month. Almost 40 percent are taking five or more prescription
medications per month \9\--and that's the average! In a population with
such a high burden of illness, the likelihood that people will be on
multiple medications is all but certain. Some drugs, like digitalis, a
common medication for those with heart problems, directly suppress
appetite. Others, like medications for arthritis or antibiotics, can
cause stomach upset.
---------------------------------------------------------------------------
\9\ Gu Q, Dillon CF, Burt VL. ``Prescription Drug Use Continues to
Increase: U.S. Prescription Drug Data for 2007-8.'' NCHS Data Brief.
2010 Sept; (42):1-8. Accessed June 17, 2011. http://www.cdc.gov/nchs/
data/databriefs/db42.pdf.
---------------------------------------------------------------------------
Then, there is another group of medications that can cause
malabsorption, i.e. the medicines inhibit the uptake of nutrients from
the intestinal track.
Another disease that is a major factor in under-nutrition in the
elderly is dementia, a slowly progressive disease found in almost 50
percent of people over the age of 85. It is the fifth leading cause of
death for those over 65.\10\ Data shows that it strikes women with far
greater frequency than men, with \2/3\ of the cases being women, who
according to census data are far more likely than men to be poor and
live alone. So here we have people who may not feel hungry, who may
quite literally forget to eat and, even if they do remember, may be
unable to figure out how to prepare even the most rudimentary of meals.
In this all too common scenario the probability of admission to a
nursing home rises exponentially. Yet a low cost, simple intervention
such as home meal delivery or congregate meals can reduce
hospitalization and delay nursing home admissions thus significantly
lowering the costs of what is otherwise an extremely high cost
population and a major driver of health care expenditures.
---------------------------------------------------------------------------
\10\ ``2011 Alzheimer's Disease Facts and Figures, Fact Sheet.''
March 2011, p1-2. Accessed June 17, 2011 http://www.alz.org/
documents_custom/2011_Facts_Figures_Fact_Sheet.pdf.
---------------------------------------------------------------------------
Aside from these common medical problems however there are many
social factors that play a vital role in the health and well-being of
the elderly. Compared to the under 65 population, almost 9 percent of
the elderly live at or below poverty.\11\ Data from numerous studies
shows that poverty and hunger go hand in hand in the elderly. This is a
problem that will only get worse. A recent survey by AARP's Public
Policy Institute \12\ reported that one quarter of those surveyed who
were ages 50 and over, said they had already exhausted all their
savings during the recession and over a third who were having
difficulty making ends meet had to stop or cut back on saving for
retirement. Food insecurity is a problem that will grow as more and
more old people are faced with having to choose between food, rent or
medicine. Addressing hunger through title III's nutrition programs will
help seniors stay independent in their own homes.
---------------------------------------------------------------------------
\11\ ``A Profile of Older Americans: 2010'', p. 1. Administration
on Aging (AOA), U.S. Department of Health and Human Services. Accessed
June 17, 2011 http://www.aoa.gov/aoaroot/aging_statistics/Profile/2010/
docs/2010profile.pdf.
\12\ ``Recovering from the Great Recession: Long Struggle Ahead for
Older Americans.'' May 2011, p. 3. Sara E. Rix, AARP Public Policy
Institute. Accessed June 17, 2011. http://assets.aarp.org/rgcenter/ppi/
econ-sec/insight50_recovering.pdf.
---------------------------------------------------------------------------
Physical disability, frailty and dementia separately and in
combination mean that many seniors experience difficulty with shopping
and meal preparation. For example, people who've ``aged in place''
either in rural or suburban areas may find themselves living miles from
a grocery store and, unable any longer to drive, dependent on the good
will of neighbors, friends or relatives to get out to shop for food.
Even in areas with reasonably good public transportation, buses and
subways may be difficult for the frail and disabled especially if
trying to lug groceries or maneuver a small shopping cart. Furthermore,
as I can attest from my own experiences making home visits in the South
Bronx, many patients are afraid to venture beyond their apartments.
They learned the hard way that denizens of the urban jungle saw them as
``easy prey''. I cannot tell you how many of my patients ended up
defaulting to a ``tea and toast'' diet, essentially devoid of
nutritional benefit because they were trapped in their own apartments
and couldn't or wouldn't risk a trip to the store for food. For them,
meals on wheels was central to their survival.
But does ``under-nutrition'' or ``hunger'' really matter?
Absolutely--and here's why. Under-nutrition leads to any one of several
types of nutritional deficiencies. Whether it's not enough calories to
maintain weight, insufficient protein to maintain muscles and other
vital organs or deficiencies of vitamin and micronutrients, such as
zinc, unless older people eat enough ``good food'' bad things happen.
These include:
Weight loss--and at least two longitudinal studies suggest
that weight loss in later life predicts mortality \13\;
---------------------------------------------------------------------------
\13\ ``The Role of Nutrition in Maintaining Health in the Nation's
Elderly: Evaluating Coverage of Nutrition Services for the Medicare
Population.'' 2000, p. 67. Institute of Medicine. National Academy
Press. Washington, DC.
---------------------------------------------------------------------------
Skin problems, such as the development of pressure ulcers
and decreased wound healing, especially of the skin tears that are such
a common occurrence with the papery skin seen in the oldest old.
Unhealing wounds leave people vulnerable to infections of the
surrounding skin, soft tissues and underlying bone;
Loss of muscle mass, or sarcopenia, causes loss of
strength and function which predisposes to increased falls leading to
hospitalization, nursing home placement and death \14\;
---------------------------------------------------------------------------
\14\ Fielding RA, Vellas B, Evans WJ, Bhasin S, et al.
``Sarcopenia: an undiagnosed condition in older adults. Current
consensus definition: prevalence, etiology, and consequences.
International working group on sarcopenia.'' J Am Med Dir Assoc. 2011
May; 12(4):249-56. Epub 2011 Mar 4.
---------------------------------------------------------------------------
Suppressed immune function, which makes people more
susceptible to infections and less able to mount a defense against
otherwise minor infections;
Fatigue which exacerbates depressive symptoms and saps any
energy an individual might have to stay engaged with their communities
and wider social network;
Increased frailty, which has been described as loss of
physiologic reserve that increases the risk of disability, which is a
sort of precursor state to being dependent on another individual to
compensate for functional deficits \15\;
---------------------------------------------------------------------------
\15\ Buchner DM, Wagner EH. ``Preventing frail health.'' Clin
Geriatr Med. 1992 Feb; 8(1):1-17, cited in Rockwood K, Fox RA, Stolee
P, Robertson D, et al. ``Frailty in elderly people: an evolving
concept.'' CMAJ. 1994 Feb 15; 150(4):489-95.
---------------------------------------------------------------------------
Functional decline and impairment, which means people have
trouble with their own personal care, e.g. bathing, as well as things
like ambulation, thus increasing the risk of falls and gradual loss of
the capacity to independently manage routine household tasks such as
grocery shopping and meal preparation;
Higher complication rates and more severe complications
from underlying chronic conditions or acute inter-current illnesses,
such as pneumonia, and longer lengths of stay when hospitalized;
Depression, loneliness and sometimes a condition known as
pseudodementia;
Falls which may arise from altered function brought about
by any number of vitamin deficiencies such as Hypovitaminosis D,
Vitamin B12 deficiency or from unrecognized dehydration;
Delirium, which even when transient, has been shown to
have long-term sequellae;
Anemia from deficiencies of B6 (sideroblastic anemia) or
B12 (megaloblastic anemia) which leaves people feeling exhausted and
can even worsen heart failure.
Any of these negative health outcomes have enormous implications
for service utilization. For example, as was mentioned above, many of
the consequences of malnutrition increase the risk of a fall. Already,
according to the CDC \16\:
---------------------------------------------------------------------------
\16\ ``Costs of Falls Among Older Adults.'' Centers for Disease
Control and Prevention. Accessed June 17, 2011, http://www.cdc.gov/
HomeandRecreationalSafety/Falls/fallcost.html.
One in three adults 65 and older falls each year.\17\ \18\
---------------------------------------------------------------------------
\17\ Hausdorff JM, Rios DA, Edelberg HK. ``Gait variability and
fall risk in community-living older adults: a 1-year prospective
study.'' Arch Phys Med Rehabil. 2001 Aug; 82(8):1050-6.
\18\ Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, et al.
``Preventing falls among community-dwelling older persons: results from
a randomized trial.'' Gerontologist. 1994 Feb; 34(1):16-23.
---------------------------------------------------------------------------
Of those who fall, 20 percent to 30 percent suffer
moderate to severe injuries that make it hard for them to get around or
live independently and increase their chances of early death.\19\
---------------------------------------------------------------------------
\19\ Alexander BH, Rivara FP, Wolf ME. ``The cost and frequency of
hospitalization for fall-related injuries in older adults.'' Am J
Public Health. 1992 Jul; 82(7):1020-3.
---------------------------------------------------------------------------
Older adults are hospitalized for fall-related injuries
five times more often than they are for injuries from other causes.\20\
---------------------------------------------------------------------------
\20\ Ibid. 19.
---------------------------------------------------------------------------
These statistics translate into real money:
In 2000, the total direct cost of all fall injuries for
people 65 and older exceeded $19 billion: $0.2 billion for fatal falls,
and $19 billion for nonfatal falls.\21\
---------------------------------------------------------------------------
\21\ Stevens JA, Corso PS, Finkelstein EA, Miller TR. ``The costs
of fatal and nonfatal falls among older adults.'' Inj Prev. 2006 Oct;
12(5):290-5.
---------------------------------------------------------------------------
By 2020, the annual direct and indirect cost of fall
injuries is expected to reach $54.9 billion (in 2007 dollars).\22\
---------------------------------------------------------------------------
\22\ Englander F, Hodson TJ, Terregrossa RA. ``Economic dimensions
of slip and fall injuries.'' J Forensic Sci. 1996 Sept; 41(5):733-46.
---------------------------------------------------------------------------
In a study of people age 72 and older, the average health
care cost of a fall injury totaled $19,440, which included hospital,
nursing home, emergency room, and home health care.\23\
---------------------------------------------------------------------------
\23\ Rizzo JA, Friedkin R, Williams CS, Nabors J, et al. ``Health
care utilization and costs in a Medicare population by fall status.''
Med Care. 1998 Aug; 36(8):1174-88.
If home delivered services and congregate meal programs could
reduce by even a fraction of what just this one preventable event costs
the health care system, the program would pay for itself. Multiply that
by the number of items in the list above and the value of these title
III-C Nutritional programs is manifest. Especially since we know, from
research studies and from experience, that providing nutritional
support to vulnerable elders works. For example, in one study
nutritional support of malnourished elderly individuals after a
hospitalization actually improved their function.\24\ Translation? It
reduced the likelihood of nursing home placement.
---------------------------------------------------------------------------
\24\ Neelemaat F, Bosmans JE, Thijs A, Seidell JC, et al. ``Post-
discharge nutritional support in malnourished elderly individuals
improves functional limitations.'' J Am Med Dir Assoc. 2011 May;
12(4):295-301. Epub 2011 Feb 11.
---------------------------------------------------------------------------
This discussion would not be complete however without asking what
the impact of these programs is for the elderly themselves. Ensuring
that old people have a balanced, nutritionally complete diet, can
reverse many of the consequences of malnutrition or outright prevent
them. People feel better, stronger, and more able to care for
themselves. Which is good. However the other real ``take away'' is that
the importance of these programs transcends food--they not only give
people something to eat, they give people a reason to eat. They are a
life-line out to the community for low-income older people whose world
has often been reduced to a couple of rooms due to frailty, illness and
dysfunction. The nutrition programs are a source of socialization which
is so often missing for the old. Knowing that someone's coming by is
often the only reason for them to get out of bed. Forming a
relationship with the person delivering the meal so they have someone
to talk to or getting out to a lunch program where they'll see friends
a couple of times a week is as important as the food itself.
I saw this with my father. He received home delivered meals after
an automobile accident at age 82 left him with a traumatic brain
injury. He could no longer drive, his higher executive functions were
impaired and gradually his short-term memory eroded but his desire to
live in his own home stayed strong. I live 75 miles away from where he
lived and don't own a car. I can assure you that had he not had Meals
on Wheels, which came by 5 days a week, he would have been in a nursing
home for the last 14 years of his life. I also know how much he valued
the volunteer's visit, which was the high point of his day. That
volunteer was his audience for an all too brief but important few
minutes a day, relieving some of the tedium and loneliness of his life
out there in his house in the country.
Meals on Wheels did something for me too in my role of long
distance caregiver: it was my early warning system if something was
going wrong. Over the course of several years I'd get a call that
either he appeared bruised from having fallen, or ``wasn't himself ''
or the heat didn't seem to be working. Meals on Wheels were my eyes:
they got to know my father and alerted me about ``a problem'' before it
became ``a catastrophe''.
The bottom line is title III-C funds are amazingly effective at
helping seniors help themselves by feeding not only the body but the
person. Having social connections and having enough to eat fulfills
several basic human needs and keeps people healthier, longer. Healthy
people, even when they are very old, don't need and don't use as many
health care services as sick people do. Without a strong program of
home delivered meals and congregate dining the really big ticket items
go up: more trips to the emergency rooms, more frequent
hospitalizations with longer stays, more re-admissions, and more years
in a nursing home.\25\ As a nation, it behooves us to start spending
smart. Providing funding for these programs is the way to do just that.
Nutritional programs are low cost solutions for high cost problems.
---------------------------------------------------------------------------
\25\ Yang Y, Brown CJ, Burgio KL, Kilgore ML, et al.
``Undernutrition at baseline and health services utilization and
mortality over a 1-year period in older adults receiving Medicare home
health services.'' J Am Med Dir Assoc. 2011 May; 12(4):287-94. Epub
2010 Oct 27.
---------------------------------------------------------------------------
In conclusion I would make several recommendations for things that
can be done at the Federal level. First, I would urge not only the
reauthorization of funding for the nutritional programs covered under
Title III-C of the Older American's Act, I would suggest they be
expanded. The elderly use more health care services than any other age
cohort and the low-income elderly, or dual eligibles, even more so.
Therefore, while there is no single ``silver bullet'' to rein in costs
for Medicare these title III programs come about as close as you will
ever get to a simple, low-cost, low-tech intervention that's very
popular with patients and their families with an incredible pay back.
Second, I would advise that there be support for demonstrations, pilot
programs, evaluations and applied research aimed at better
understanding the needs of the populations served and testing creative
strategies for improving outcomes. Third, I would recommend that
certain elements of the program be strengthened to make it even more
cost-effective. Specifically, the requirements for the Nutrition
Programs under the Older American's Act should:
Ensure the nutritional completeness and adequacy of key
nutrients in delivered or served meals. For many seniors these meals
are their main source of daily food intake. Therefore, they need to
have sufficient calories, high quality protein from meat, fish or
poultry, green, leafy vegetables and fresh fruit. Research has shown
that nutritional supplements are unnecessary if people are eating a
well-balanced diet.
Target specific highly vulnerable groups, such as women,
African-Americans and the homebound for receipt of enhanced services.
Tailor the program's services to increase effectiveness
for people with particularly high burdens of illness or high energy
(caloric) requirements, such as those with Parkinson's Disease, who
burn through calories because of tremors.
Include nutritional education and counseling to patients
and caregivers.
Give the program flexibility to accommodate regional,
ethnic and racial food preferences and improve palatability and taste.
I thank you for your attention and providing the opportunity of
addressing the committee.
Senator Sanders. Dr. Koren, thanks very much for your
testimony.
Let me begin the questioning with Ken Gordon. Ken, you live
and I used to live years ago in one of the most rural parts of
a rural State. We got a lot of snow in the wintertime. People
are isolated. Talk for a moment about the impact of Meals on
Wheels among elderly, frail people in a very rural part of
America?
Mr. Gordon. They are incredibly important to people's well-
being. Social isolation is in fact a huge problem, particularly
so in rural environments, where there's little social
interaction, and apartment buildings or other settings. So not
only do they provide essential nutrition for individuals who
may have difficulty being able to travel to a senior center or
to a grocery store to pick up food, but they help on the social
end as well.
Senator Sanders. Thanks.
Dr. Koren, let me ask you a question. I read your testimony
with great interest, and I think the thrust of what you are
saying, which I would like you to elaborate on, is that if
seniors are not getting the nutrition that they need, in a
dozen different ways it ends up costing us as a society and
costing the government substantially more money to address
needs that result from lack of nutrition.
Do you want to elaborate on that point, please?
Dr. Koren. Yes. As I mentioned, there are a lot of
physiologic problems with aging and also medical conditions.
But undernutrition, malnutrition, causes in and of itself even
further conditions. As I mentioned, you have muscle wasting,
which causes people to be weak. They fall more. You have--
Senator Sanders. So you're saying--I'm sorry to interrupt
you--is that people who do not have adequate nutrition are more
likely to sustain injuries falling?
Dr. Koren. Yes.
Senator Sanders. And what is the cost of taking care of
people who fall?
Dr. Koren. The 2000 costs were $19 billion.
Senator Sanders. Let me just mention. That's falls.
Dr. Koren. That's falls; it's a single condition.
Senator Sanders. The cost of this entire bill that we're
talking about nutrition and nonnutrition, is $2 billion,
compared to $19 billion addressing just the issues relating to
falls.
Please continue.
Dr. Koren. The $19 billion was in 2000. The estimated costs
for falls in 2020 is $54 billion. The costs for this are going
up. So even that one condition alone, which is worsened by the
other problems that come with malnutrition--anemias,
depression, and wasting of muscles--all of these things are
things that can be prevented, and they also make the underlying
medical conditions far worse for people. So it worsens things.
For example, anemia can worsen heart failure. That's one of
the major drivers of health costs in this country today, is
caring for people with congestive heart failure. So the
interplay of the problems that occur from undernutrition make
underlying medical conditions far worse.
Senator Sanders. Mr. Blancato, say a few words, if you
will, about the unmet need in this country? What we've heard
from Dr. Koren is that in fact as a nation we are unnecessarily
spending many, many billions of dollars because seniors are
incurring a number of illnesses and problems because of poor
nutrition.
Could you tell us what you perceive to be the unmet needs
in terms of nutrition and seniors?
Mr. Blancato. I think a lot of it is reflected in the
numbers that we provided in the statements about the number of
food-insecure people, that could range between 3 and 6 million,
the 87 percent of older people who have those common three
chronic diseases. The one on diabetes in particular stood out
as one that indicates that for them they have a three times
higher rate of being placed in nursing homes.
Again, the idea with the Older Americans Act was to catch
the problem early, to find when the person was assessed as
being at risk and potential institutionalization it was because
of many reasons, and because of nutritional needs. So the idea
of the intervention early was intended to save the dollars that
are down the road.
I think that this program has proven itself over and over
again through the work that's been done and, as pointed out by
the GAO, by the evaluation that is done of this program on a
regular basis to ensure it's meeting its goals.
Senator Sanders. Thanks very much.
Senator Paul.
Senator Paul. Thank you, Senator Sanders.
I still can't get over how we're going to spend more money
and we're going to save money by spending more money. This idea
that for some--people are going to get less injuries from their
falls. Dr. Koren just said people are still falling and their
costs are rising. The rising nutritional costs, all the
statistics seem to show that we're getting worse, not better.
We're spending more, not less.
If we're going to make this argument that somehow providing
nutrition is going to make the injuries less from falling,
shouldn't we have some data? It sounds like the data argues the
opposite. The data argues we're spending more on injuries from
falls as a percentage, we're spending more on nutrition as a
percentage, we have more problems, not less problems.
You have to have data that proves your points. You have to
argue somehow that we are making progress, that we're saving
money. You can't just say that we're going to spend $2 billion,
why not spend $4 billion or why not spend $10 billion to save
more money? You have to prove what we're actually asserting.
Now, one of the things I was curious about--I don't have
arguments against Meals on Wheels. I like Meals on Wheels. I do
have an argument against a multimillionaire getting Meals on
Wheels. I do have a question in my mind when Dr. Koren says her
father benefited from it. I have no question her father
benefited from it, but my question is should a guy or a fellow
working at McDonald's be paying taxes to provide Meals on
Wheels for the father of a physician? Is there not anybody else
who has that question, whether or not we should target people,
those who are in need or whether everybody--does Warren Buffett
need Meals on Wheels? If Warren Buffett's father or his
daughter lives nearby, do they need Meals on Wheels? Should we
not ask these questions, whether or not there is someone else
to provide or what the means of the people are before we give
these programs? We don't have unlimited programs.
I really think there are questions about this. I guess my
question to Dr. Koren would then be, if the health care costs
related to falls, are going up, how is that an argument that
nutrition is somehow helping the health care costs related to
falls?
Dr. Koren. One of the reasons that costs are going up are
there are more old people. But another reason is that what
nutrition can do is slow the trend. What we want to do is not
eliminate every fall--that will never happen--but what you want
to do is slow the rate of falls and decrease the incidence of
falls, which can happen from better nutrition.
I also want to improve the odds of a better outcome if
people fall. And if malnourished older people fall, they're
going to stay in the hospital longer and they're going to end
up in a nursing home.
Senator Paul. But basically you'd have to look at some
statistics. And we aren't talking about numbers here; we're
talking about percentages. So you'd have to look at percentage
of old folks getting hip fractures and tell me you're getting
less hip fractures because you're feeding them better through
these poverty programs. I think you'll find those statistics
don't exist.
Most every group that comes up here wants to tell us how
much worse the problems are because they can get more money
because the problems are worse. I don't see anybody coming
forward to any of these committees saying, ``oh, the problems
are getting better, the war on poverty is really working, we
have less poverty now.''
We're not looking at numbers, raw numbers. Everybody
understands the population's growing. But if you look at
percentages, what everybody who comes before the committee
says: ``Things are worse, things are worse; give us more
money.'' Well, things are worse; what happened to the money we
already gave you?
We have 70 programs doing the same thing. I think we need
to ask the question, how do we get rid of duplicate programs?
My question to Ms. Brown would be: Do you have any suggestions
for how we would get rid of duplicate programs in nutritional
assistance? Thank you.
Ms. Brown. Just for the record, we're not recommending
there be a change in any single program. We are, in view of the
dire fiscal condition of the country, suggesting that we need
to step back and look across the number of different programs
that we're offering right now and see if we can find ways to
increase the efficiencies, especially as we expect the demand
to grow.
It's not a simple issue, and all of these programs were
created because there was some kind of need. If we were to step
back and look across the programs, the things that we would
have to keep in mind are what any effects of any change would
be on the recipients and those who need the services and also
what the cost-effectiveness would be.
The actual decisions about how programs would be changed,
combined, many different options, would be policy decisions.
Senator Sanders. Thank you.
Senator Franken.
Senator Franken. Ms. Brown, Senator Paul asked for actual
research. It sounds like you have done research on the Older
Americans Act, the nutritional programs in that. Is that true?
Ms. Brown. With the 18 programs that we identified that
existed ought to provide nutrition, we looked at each of those
programs to see what kind of research was available to tell us
whether the programs achieved their goals, the specific goal of
the program. For 11 of the programs, there wasn't enough
research; and for the remaining, there was research and, yes,
this program, the senior nutrition program, is one of the ones
that is achieving its goals.
Senator Franken. So by achieving its goals, do you mean
that it saves money and that by providing these nutritional
programs, it allows people to stay in their homes and therefore
cuts the costs to the taxpayer in what we would pay and to
everyone in terms of what they pay in terms of going into
nursing homes?
Ms. Brown. When I say that they met their goals, we looked
at the explicit goals of the program as they're laid out in the
law and in the regulations. The two most clear are related to
food insecurity, and there is some evidence that these programs
help address food insecurity, and the other is to address
isolation of older adults, and there's some evidence that the
programs have an effect on that, too.
Senator Franken. Mr. Gordon, the clear inference of those
results would be the ability to stay out of nursing homes,
wouldn't it, and be able to stay at home, if you reduce
isolation and increase nutrition?
Mr. Gordon. Yes, Senator, we see evidence of that every
day.
Senator Franken. Now let me ask you this. Senator Paul had
questioned how only people in Washington could see the
relationship between spending money in that way and that
actually spending money could save money. Do people in Vermont
see that relationship, because people in Minnesota do and we've
learned that people in Kansas do. So it's not only in
Washington, is that correct?
Mr. Gordon. That's correct. The Vermont legislature and
several Vermont governors have also recognized that
relationship.
Senator Franken. Let me ask you this, too. Senator Paul
brought up the idea of Warren Buffett being a recipient of
Meals on Wheels. I think that's very unlikely. But he makes the
point that there are probably some people who in some way or
another could either contribute to the Meals on Wheels. And
some people do, right, or the congregate dining? Some seniors
do, right?
Mr. Gordon. Correct.
Senator Franken. OK. But I think what he's suggesting is
that if we do this program at all, and since Ms. Brown seems to
say that it achieves its goals, if we do this program at all,
what he is I think suggesting is that the Older Americans Act
set up a large bureaucracy to determine whether any recipient
of either congregate dining or Meals on Wheels has a little bit
too much money to qualify.
He also talked about absurdity. Do you think that it would
be absurd to set up that kind, really in a cost-benefit
analysis, to set up a vast bureaucracy to make sure that Warren
Buffett doesn't take too much advantage of the Meals on Wheels
program?
Mr. Gordon. Well, the intent----
Senator Franken. Is that absurd?
Mr. Gordon. In my mind, yes. As I understand it, the intent
of Congress was that this program not be means-tested. I can
also tell you that we worked carefully with individuals to talk
about family supports and how family can help them remain
independent in the community, and that's a part of our work
with every senior that we engage.
Senator Franken. Ms. Brown, I was a little confused,
because you talked about 18 different programs and Senator Paul
talked about 70 programs. Do you have any idea--I know the
Senator has left, but do you have any idea where that
discrepancy comes from?
Ms. Brown. Yes, Senator. When we started our work to review
all the domestic nutrition assistance programs, we went through
the catalogue of many, many Federal programs. First we
identified any programs that could provide food assistance or
provided funding that would support food assistance. After we
identified those 70, then we narrowed it down to those 18
programs that existed solely to provide nutrition assistance.
And looking at the available research and the administration of
those 18 programs was plenty for us to do.
Senator Franken. Thank you.
Thank you, Mr. Chairman.
Senator Sanders. Thank you, Senator Franken.
Senator Hagan.
Statement of Senator Hagan
Senator Hagan. Thank you, Mr. Chairman. I really appreciate
you holding this hearing today. In my State of North Carolina,
we have an aging population. In fact, the 65-year-old
population is expected to double in the next 20 years to 2.1
million people. Currently close to 30 percent of the seniors 65
and older are living alone and 25 percent of those have an
income between 100 to 200 percent of the poverty level.
I know that the congregate and the home-delivered meals
provided to our seniors, particularly our low-income seniors,
really provide the vital nutrition to keep them alive. It's a
very important program to millions of elderly people across the
country, so I appreciate you holding this hearing.
Mr. Blancato, you spoke of cutbacks in services and
volunteers because of rising gas prices and food prices. Can
you explain in more detail how the nutrition programs that rely
on volunteers and provide also more information on the impact
that such cutbacks in services have on seniors trying to access
these programs.
Mr. Blancato. Yes, Senator. Thank you. I point out, I have
a brother who's aging in Winston-Salem, so he's in one of your
populations there.
The volunteers are impacted by the rising cost of gasoline
in their ability to provide their volunteer service when the
prices go up and end up having them being unable to continue to
do volunteer work. So they are cutting back on their volunteer
hours in these programs.
We did a survey, and I'd be happy to share it for the
record, but some of the things we learned were that programs
ought to be cut back, the number of meals would have to be
scaled back, waiting lists would start for people who applied.
This is all because of rises in gas prices, food prices,
particularly the food that's most important that's provided
daily in these programs--beef and meat and bread and things of
that nature.
We're finding that the responses we're getting from our
members run the gamut of what these cutbacks are really doing
for their day-to-day services.
Senator Hagan. I've been hearing that a lot, too, with
rising gas prices, that the volunteers can't afford it.
Mr. Gordon, in your testimony--and I know it was brought up
already, too--we talked upon the issue about seniors who live
in rural areas. North Carolina has a large population in the
rural areas and many of them, according to your testimony, are
at the greatest risk of hunger. Can you discuss some of the
solutions that would target this vulnerable population?
Mr. Gordon. It's a challenging area because of the
logistics and the miles that need to be traveled. One of the
promising areas of practice that we've begun to see around the
country is merging our senior meal programs with the local food
movement. We're seeing more and more attention being paid to
growing food locally, to rely on local agricultural economies
and distribution systems that are a part of that. I think
particularly in rural communities, that is a solution to look
for as we move forward.
Senator Hagan. Thank you.
Dr. Koren, in your testimony you make some recommendations
for strengthening the nutrition programs. In particular, you
recommend that we ensure the nutritional completeness and
adequacy of key nutrients in delivered or served meals. Can you
speak to the current nutritional components of the meals? I'm
just curious, who determines the caloric, the macro and the
micronutrient content of the meals, and does it vary State by
State?
Dr. Koren. I can't give you the exact statistics. I do have
them in some of the materials I used to prepare my testimony.
You also might be able to find that from Ms. Greenlee. Usually
it is my understanding that the delivered meals provide about
one-third of the recommended daily allowances for proteins,
calories, and nutrition. But as I said, these meals are very
often the primary food intake for people during the day.
Also, with some of the cutbacks it's been harder to have
high quality protein, such as meat, fish, poultry, and so
forth, and also to have green, leafy vegetables and fresh
fruits, which are really key for delivering the kinds of
nutrients that elderly people need.
Senator Hagan. So what is your recommendation on how to
address that?
Dr. Koren. I think some of the ideas that we've heard from
Mr. Gordon, and also to really look carefully at these programs
and see, are there ways of enhancing these. There have been
questions about the provision of nutrient supplements, vitamin
pills, things like that, with people. But also, if we can sort
of think about these programs and enhance them so that the food
itself is nutritious and can really deliver the kind of
nutrient content that people require.
Mr. Blancato. Senator Hagan, if I may, there's another
point, too, and that is if we more closely enforce the
provision of the law now that allows for consultation with
dieticians with the nutrition programs, I think that would also
address that issue, and we should look at that.
Senator Hagan. Thank you.
Ms. Brown, in your testimony you discuss how some seniors
might receive assistance through the alternative means other
than the elderly nutrition program. You mentioned that some
seniors might choose to participate instead in the Supplemental
Nutrition Assistance Program, or SNAP. Did you look at why some
seniors might choose SNAP over the elderly nutrition program
and, if so, what were the reasons?
Ms. Brown. I think the specific thing with SNAP is that
because it's an electronic benefit transfer, you can swipe a
card in a supermarket, and you have the option to buy the food
that you prefer and what you'd like to have. I think that's the
main thing. There are people who also participate in the
congregate meals or home-delivered meals and SNAP.
Senator Hagan. Are there restrictions on what they can
purchase with the SNAP card, the SNAP benefit?
Ms. Brown. Yes, there are, and it's just primarily nonfood
items, no alcohol, tobacco, that kind of thing.
Senator Hagan. You also discuss that the GAO found overlap
in these 18 nutritional programs for seniors run by the USDA,
HHS, and DHS. However, when I look at the list of these 18
programs, some of the programs don't appear to be geared toward
the elderly. For example, the school breakfast program and the
national school lunch program. Do all 18 of these programs that
you've cited have an elderly component, and if not which of the
18 could realistically be coordinated to ensure that services
are provided for seniors needing nutritional assistance?
Ms. Brown. I can explain the 18. That work was done at a
request to look at the total domestic nutrition assistance
programs in the United States.
Senator Hagan. Not just for the elderly?
Ms. Brown. Correct. Then for this testimony we stepped back
and highlighted the ones that we know are available to the
elderly. I can tell you, there's the commodity supplemental
food program, the child and adult care food program. There's an
emergency food program that provides commodities, and several
others which I'd have to find.
Senator Hagan. Thank you, Mr. Chairman.
Senator Sanders. Thank you, Senator Hagan.
Let me conclude the hearing by, first, thanking all of the
panelists for excellent presentations without exception; and
second of all, saying that I think that this discussion that
we've had this morning raises a very fundamental issue about
this country. Today in America we have the most unequal
distribution of wealth and income of any major country on
Earth. Some people are doing phenomenally well, a lot of people
are doing very, very badly economically, and those numbers are
growing.
We've got to address that issue from a moral perspective,
what do we do when millions of senior citizens do not get the
nutrition that they require. Are we happy with that as a
nation?
The second issue--and I think Dr. Koren went into that at
some length--is whether or not that is good economics, whether
it makes sense that at a time when health care costs are
escalating and we spend much, much more per person on health
care than any other industrialized Nation on Earth, and that
maybe one of the reasons is that we do a pretty bad job in
terms of prevention in general, and maybe it does not make a
whole lot of sense to see increased costs, health care costs,
because of excessive emergency care utilization, nursing home
utilization, hospital utilization, because people are not
getting the nutrition they need.
Is that good economics? I think not. So that's where we
are, and I want to thank you all for commenting on this issue
and for your excellent presentations. Thank you very much.
The hearing is now adjourned.
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of AARP
AARP is a nonprofit, nonpartisan organization with a membership
that helps people 50+ have independence, choice and control in ways
that are beneficial and affordable to them and society as a whole. We
appreciate this opportunity to offer some preliminary ideas on the
reauthorization of the programs and services of the Older Americans Act
(OAA), pending formal legislative language. Our interest is to ensure
that the act maintains critical service and information roles, and
promote greater responsiveness to the needs of mature and older
Americans, including those facing nutritional risk aggravated by
advancing age.
Today nearly 6 million older Americans experience hunger and this
number will only increase as the aging population grows. Between 2006
and 2008, the percentage of poor and near-poor elderly struggling with
hunger or lacking sufficient nutrition and food resources more than
doubled--from 4.7 percent to 10.1 percent. It is projected that by
2025, this number will reach 12.6 million Americans 50+, or 14.9
percent of this population. Based on recent studies, more than 5
million seniors, or 11.4 percent of all seniors, experienced some form
of food insecurity in the mid-2000s, and the number is increasing.
Further, a recent study by NASAUD and the AARP Public Policy Institute
reported that although demand for meals has increased substantially
since the beginning of the recent recession, State funding for these
programs has not kept pace and in several areas has decreased. The
dimensions of the senior hunger problem are clearly growing as
solutions appear to evade the grasp of our policy reality.
In this period of economic downturn, AARP is most concerned that
programs, authorities and partnerships that have already proven
effective in meeting the needs of vulnerable older Americans be
maintained and strengthened. We believe that older persons would be
best served if Congress works expeditiously to reauthorize the program,
with only minor changes in existing programs to improve efficiency. As
related to combating senior food insecurity and nutritional risk, AARP
believes that better coordination of existing OAA nutrition programs
with other Federal, State and local programs holds great promise and
merits the support of the Administration and Congress.
i. reinforcing capacity for delivery of home and community-based
nutrition services
Helping people to grow older in their communities with independence
and dignity is a bedrock goal of the Older Americans Act. All too
often, advancing age and increasing frailty threaten the ability of
older persons to remain healthy, nutritionally secure and independent
in their own homes. The fear of having to enter a nursing home due to
vulnerabilities aggravated by nutritional risks and other aging-related
circumstances weigh heavily on the minds of many older persons and
their families.
AARP is open to potential new initiatives that complement existing
caregiver and service programs with innovative and effective approaches
to expanding nutrition program access through the existing and evolving
network of home and community-based nutrition services. Newly adopted
nutrition initiatives, however, often require additional funds be
provided through the annual OAA appropriations process. AARP urges that
no OAA nutrition or other OAA services activities be sacrificed to pay
for new programs. This would require real commitment and creativity
given Federal budget constraints. In the past, OAA has not
traditionally received significant new increases in funding.
Over the past two decades, States have made great strides in
improving the nutrition options for nutritionally at-risk older
persons, especially for those who want to remain in their own homes and
communities for as long as possible. However, the weak economy has
reduced funding availability and has forced reductions or elimination
of nutrition services in many instances for our members and other older
Americans. Advocates in States across the country are working to
preserve access to vital nutrition services for older adults in these
tough economic times and to prevent or minimize the potential harmful
impacts that cuts in services or benefits could have on these
individuals. Successful State delivery strategies that AARP could
support may include:
better coordination of Federal and State nutrition program
funding (e.g., State-only funded programs, USDA nutrition programs, and
public-private nutrition initiatives) with the existing network of OAA
nutrition programs and other OAA home and community-based services;
streamlining administrative operations that will permit a
designation of central points of coordination for nutrition services
for seniors; and
adopting nutrition assessment and eligibility management
practices that allow targeting of resources to the persons most in
need, especially those traditionally underserved. Aging and Disability
Resource Centers (ADRCs) might be a source of help in providing
individuals and their families with one-stop nutrition information and
other assistance to enhance coordination of the range of home and
community services.
AARP also believes, however, that it is preferable to retain the
current separation between the assessment of eligibility and the actual
provision of nutrition services, so that the agency that conducts
eligibility assessments does not have a financial interest in the type
and amount of services authorized. Any potential and actual conflicts
of interest by agencies authorizing or providing services should be
avoided to ensure that older adults receive the services they need.
The use of existing authorities under the OAA could also be
explored to enhance nutrition and other community-based services under
the Older Americans Act. Some examples could be the use of volunteers,
support for innovative and proven intergenerational programs, and
partnerships with National and State Title V Grantees to increase
opportunities for Senior Community Service Employment Program enrollees
to participate in the delivery of nutrition services.
The aging network should consider where it can add real value and
provide assistance to older adults at nutritional risk or experiencing
food insecurity by leveraging partnerships and exploring new
opportunities and coordination with Federal, State, local or public-
private programs and initiatives, especially if there is evidence-based
data to support such efforts.
ii. targeting of oaa nutrition services
Administration of the programs and services provided under the OAA
is more critical in these days of austere budgets than ever before. It
is important to direct resources to areas that achieve the most impact
while aiming to meet the goals of the act. Toward this end, the AARP
supports uniform data collection procedures and definitions that permit
evaluation of program effectiveness, especially regarding gaps in
service to rural, frail, low-income and minority older persons. This is
critical for addressing those elders who are food insecure and
nutritionally at risk.
Years of studies show pockets of under-service to certain older
populations by the programs of the act. The Administration on Aging
(AOA) has improved its ability to collect participant data in recent
years. However, there are not adequate measures of the unmet need for
services. Broadening the rigor and scope of data collection for title
III nutrition programs could help demonstrate their impact on special
populations and should be pursued. Toward that end, AARP continues to
be concerned about the potentially harmful effect of mandatory cost
sharing because of its undetermined impact on food insecure and
nutritionally at-risk elders in target communities.
For many years, AARP has advocated targeting OAA services to
persons with the greatest social and economic need and, in particular,
to low-income, older minorities. AARP continues to strongly support
retention of the targeting provisions of the act. The flexible nature
of the OAA programs is one of its strengths because it helps to garner
broad public and political support. However, historically there have
been problems in achieving adequate service delivery to older minority
individuals. It is critical that new participation data collected by
AOA be disseminated, so that the adequacy of current nutrition service
delivery to older minorities can be evaluated. By tracking results, it
is possible to ensure that more funding goes to those programs that
achieve the best results with the targeted populations. Better tracking
would also enhance ability to assess delivery of nutrition services to
other underserved target populations, such as rural elders, and enable
more effective allocation of OAA nutrition dollars.
iii. aarp and aarp foundation anti-hunger efforts
As such, AARP and its affiliated charity, AARP Foundation, are
making a long-term commitment to help older Americans get nutritious
food on the table so they will no longer have to make the devastating
choice between basic needs like food and prescription drugs or food and
housing. Drive to End Hunger is a national multi-year initiative
designed to provide solutions to feed people today and prevent hunger
among older Americans tomorrow.
Drive to End Hunger aims to build national awareness about the
issue of hunger among 50+ individuals. One platform for this is AARP's
sponsorship of four-time NASCAR Sprint Cup Series Champion Jeff
Gordon's No. 24 Drive to End Hunger Chevrolet. As part of this
collaboration, Gordon and Hendrick Motorsports are engaging the NASCAR
fan base, corporations, and charitable organizations through track
engagement events across the country. AARP and AARP Foundation have
also created a new online resource--www.drivetoendhunger.org--where
anyone interested in learning more about the issue of hunger among
older Americans can obtain information on the causes and consequences
of hunger, as well as access resources to help eligible persons receive
assistance.
Drive to End Hunger aims to provide short-term support to people in
need and to organizations serving the 50+ low-income segment, such as
food banks, food pantries, and home meal service providers. AARP
Foundation support comes in the form of both food and monetary
donations. In only 6 short months since AARP and AARP Foundation
launched Drive to End Hunger, we have provided the equivalent of 2.18
million meals to local service providers in Alabama, Arizona,
California, Colorado, Florida, Kansas, Michigan, North Carolina,
Pennsylvania, South Carolina, Tennessee, and Virginia.
Drive to End Hunger aims to increase participation in the
Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps)
by utilizing AARP State Offices, volunteers, partners and existing AARP
Foundation program infrastructure to educate and enroll eligible older
Americans. While over 7 million 50+ individuals are eligible to receive
benefits, only one-third are currently enrolled in the program.
Participation in SNAP is low for many reasons including, but not
limited to, misinformation about eligibility criteria, complexity of
the application for benefits, and stigma associated with receiving
public assistance. Not only will SNAP enrollment help nourish older
Americans, increased participation will also help boost local economies
as every $5 in SNAP benefits expended, generates $9.00 in local
economic activity.
Drive to End Hunger aims to develop sustainable solutions to
hunger. Next month, AARP Foundation will launch a grant program and
offer $1 million to fund projects that address the food needs of older
adults experiencing hunger and focus on improving food access,
adequacy, affordability, and appropriateness for 50+ Americans. State
and local governments as well as national and community-based
organizations will be eligible to apply.
Drive to End Hunger aims to further thought leadership and research
on hunger, paying particular attention to key research gaps that could
lead to systemic solutions for 50+ older Americans.
conclusion
Again, AARP appreciates the opportunity to address the critical
issue of senior hunger, especially in the context of the OAA
reauthorization as the Nation experiences a rapidly expanding older
population. AARP believes that the economic climate demands a very
targeted and reasonable approach to addressing the nutrition needs of
older persons under the act while laying a foundation on which to build
and direct future nutrition investments when the opportunity permits.
We look forward to working with the groups in the aging network,
Congress and the Administration to advance the interests, independence,
and well-being of older Americans during this reauthorization process.
Prepared Statement of Feeding America
introduction
Chairman Sanders, Ranking Member Senator Paul, and members of the
U.S. Senate Committee on Health, Education, Labor, and Pensions,
Subcommittee on Primary Health and Aging, thank you for the opportunity
to submit this statement for the record on behalf of Feeding America
and for holding this hearing. We look forward to hearing testimony from
the witnesses and from committee members on the issue of senior hunger
as well as the upcoming reauthorization of the Older Americans Act,
particularly its impact on nutrition policies that impact the health
and welfare of our Nation's increasing numbers of seniors.
Feeding America is the Nation's leading domestic hunger-relief
charity with a network of more than 200 food banks serving all 50
States through over 61,000 local food assistance agencies. Feeding
America food banks, as well as the food assistance agencies they serve,
rely on a variety of public and private funding streams to feed 37
million Americans, one out of eight, every year.
During the worst economic downturn since the Great Depression, the
number of American families struggling to make ends meet has increased
significantly. Data being reported by the Federal Government mirrors
what food banks across the country are seeing. In November 2010, the
U.S. Department of Agriculture (USDA) released a report showing that
more than 50 million Americans were at risk of hunger during the 2009
calendar year. This number was an increase of nearly 14 million people
since the economic recession began in 2007. With unemployment still
hovering near 9 percent, the need for food assistance continues to grow
and food banks continue to be pressed to meet the need in their
communities. Last year, 37 million people, including 14 million
children and nearly 3 million seniors, received emergency food
assistance through the Feeding America network. This represents an
increase of 46 percent since 2006.
Many Feeding America food banks offer programs designed to meet the
special nutritional needs of certain segments of the population,
including children and seniors. Currently, 116 Feeding America food
banks offer senior programs. The Federal Commodity Supplemental Food
Program (CSFP) and the private Brown Bag (Food Box) delivery program
are the most common program models. Combined, these programs account
for 61 percent of the senior programs operated in the network and 87.6
percent of the food distributed by senior programs. The other program
models that food banks operate include senior home delivered meals and
targeted mobile pantries. In total, more than 86.5 million meals are
provided to seniors through these programs.
the great recession, senior poverty, and hunger
According to the U.S. Census Bureau, there are currently 38 million
individuals in this country aged 65 and older. As the Baby Boom
generation continues to age, this number is projected by the U.S.
Department of Health and Human Services' Administration on Aging to
increase by one-third by 2020, reaching nearly 55 million individuals.
And, by 2030, the number of Americans aged 65 and older is projected to
grow to 70 million people. At that time, seniors will comprise nearly
one out of every five Americans.
While the challenge that the aging of the Baby Boom generation--
those born between 1946 and 1964--would place on nutrition assistance
programs has long been anticipated, the prolonged recession and its
adverse impact on older American's financial security has made the
challenge of meeting increased need more urgent. In addition to
significant declines in retirement nest eggs, according to a 2009
report by the Urban Institute, about 2 million adults age 55 or older
were unemployed in August 2009, double the number in that age group who
were unemployed just prior to the recession. Additionally, according to
AARP, the average duration of unemployment rose for older job seekers
from 20.2 weeks at the beginning of the recession to 29.9 weeks at the
end. Moreover, the percentage of adults age 55 or older who were among
the long-term unemployed (27 or more weeks out of work) rose from 23
percent at the beginning of the recession to 38 percent at the end.
Health and housing costs are a strain on the budgets of low-income
older Americans, making it extremely difficult to afford other basic
necessities such as food. According to a 2010 Feeding America study, 30
percent of client households with seniors indicated that they have had
to choose between food and medical care and 35 percent had to choose
between food and paying for heat/utilities. Providing low-income
seniors with nutrition assistance allows them to stretch their food
budget and eases the burden of having to choose between buying food or
other necessities, such as medicine and rent.
Currently, one in six persons aged 65 and older lives in poverty,
and another nearly one in three lives in near poverty. This is
extremely troublesome given that seniors living below or near the
poverty line are more likely to be at risk of food insecurity, and
therefore at risk from the serious health consequences of not having
proper nutrition. The prevalence of food insecurity among older
Americans is a serious and growing problem in America. Given that the
number of food insecure seniors is projected to increase by 50 percent
in 2025, the demand for nutrition services among older Americans will
continue to increase in the coming decades.
It is particularly important that we address the nutritional needs
of food insecure seniors. According to analysis of data from the 1999-
2002 National Health and Nutrition Examination Survey, seniors over the
age of 60 who are experiencing some form of food insecurity are
significantly more likely to have lower intakes of major vitamins,
significantly more likely to be in poor or fair health, and more likely
to have limitations in activities of daily living. Additionally,
adequate nutrition is essential for preventing and managing chronic
medical conditions. Without the proper nutrients seniors are at risk of
the following: deterioration of existing health conditions, increased
disability, decreased resistance to infections, lengthening of hospital
stays, deteriorating mental health, increased risk of underweight, and
at risk for diabetes.
As the number of older Americans living in poverty and facing food
insecurity continue to increase as a result of the fallout from the
prolonged and severe recession, it is critical that we ensure that
these seniors have access to the food they need to maintain a healthy
lifestyle. While there are many effective programs working to address
senior hunger in local communities across this country, there is still
an unmet need that must be addressed. A report issued in February 2011
by the General Accountability Office (GAO) estimates that only 10
percent of low-income seniors that were food insecure in 2008 received
meals through congregate or home delivered meal programs. As this
report shows, it is critical that we not only fill these current gaps,
but also proactively prepare to meet the future increased demand for
nutrition services among the senior population.
federal nutrition/food assistance programs and feeding america
recommendations
Feeding America's emergency food assistance and other targeted
efforts to fill the gaps in nutrition services for low-income, older
Americans cannot do the job alone. Instead, these charitable efforts
are complimented by several key Federal food assistance programs,
including: the Elderly Nutrition Program, the Supplemental Nutrition
Assistance Program (SNAP, formerly known as food stamps), the Commodity
Supplemental Food Program (CSFP), and The Emergency Food Assistance
Program (TEFAP). These Federal programs are each a critical component
in helping to ensure that food assistance reaches all seniors across
the continuum of need--from seniors who are not homebound and can cook
or access meals to seniors who are homebound and can cook to seniors
who are homebound and can't cook. Different interventions are required
to reach seniors throughout this continuum of need, and the
continuation of each of these valuable programs helps to ensure that
low-income seniors in need of food assistance continue to have access
to healthy foods no matter where they are located on this continuum.
And, while each of these programs is effective at helping to combat
senior hunger, each could be expanded and improved to better meet the
needs of an increasing number of food insecure seniors and fill the
gaps in food assistance.
Elderly Nutrition Program: The Elderly Nutrition Program,
administered by the Department of Health and Human Services Agency on
Aging (AOA), is a compliment to the broader nutritional safety net
programs for low-income seniors administered by the USDA. The Elderly
Nutrition Program is designed to: reduce hunger and food insecurity,
promote socialization of older individuals including meaningful
volunteer roles, and promote the health and well-being of older
individuals and delay adverse health conditions through access to
nutrition and other disease prevention and health promotion services.
The nutrition program for seniors operated by the Agency of Aging
is delivered in two ways, through congregate feeding sites and through
home-delivery. According to the AOA, in fiscal year 2008, Congregate
Nutrition Services provided more than 94.8 million meals to more than
1.6 million seniors in a variety of community settings while Home-
Delivered Nutrition Services provided 146 million meals to more than
909,000 individuals. These nutrition services help millions of older
adults receive the meals they need to stay healthy and be food secure.
Recommendations for the Older Americans Act: As the boomers retire
and more Americans are living longer, it will be critical to ensure
that seniors have access to the food and nutrition they need to
maintain a healthy lifestyle. According to a report published by the
American Dietetic Association, nutrition is one of the major
determinants of successful aging. Food is not only critical to a
senior's physiological well-being but also contributes to their social,
cultural, and psychological quality of life. In addition, research from
the Centers for Disease Control and Prevention (CDC) has shown that
behaviors such as eating a healthy diet, taking part in physical
activity, and not using tobacco are more influential than genetic
factors in helping individuals avoid the deterioration associated with
aging.
Unfortunately, current levels of funding provided to AOA through
the Older Americans Act are not sufficient to meet the increasing
demand for senior nutrition. In order for the AOA to continue serving
seniors in need of food and nutrition assistance, Feeding America
recommend that Congress increase funding for these critical Nutrition
Services programs. Additionally, to ensure that food insecure seniors
participating in the Nutrition Services programs are better able to
access other Federal food assistance programs available to them,
Congress should consider requiring the dissemination of materials about
other Federal food assistance programs.
Supplemental Nutrition Assistance Program (SNAP): While Feeding
America food banks and the 61,000 local agencies we support--including
food pantries, soup kitchens, and emergency shelters--are often the
first place older Americans turn to for emergency food assistance when
they fall on hard times, the Supplemental Nutrition Assistance Program
(SNAP) administered by the USDA is the cornerstone of the nutrition
safety net. SNAP helps ensure struggling Americans have adequate
resources for food until their household economic conditions stabilize
and improve. In addition to providing emergency food assistance, many
of our food banks conduct outreach to inform clients about their
potential eligibility for SNAP and connect them with the long-term
benefits they need. Incorporating SNAP application assistance and/or
outreach into other senior food programs provides food banks with a
venue to discuss the benefits of SNAP, dispel myths about the program,
and assist seniors with the SNAP application process.
SNAP is the Nation's largest Federal nutrition program, providing
over 44 million participants with monthly benefits in the form of an
electronic benefit (EBT) card that they can use like cash at most
grocery stores to ensure access to an adequate diet. Nearly 80 percent
of SNAP households include a child or an elderly or disabled person.
SNAP benefits can be redeemed at any of the more than 200,000
retail stores nationwide that are authorized to participate in the
program. Almost 80 percent of SNAP benefits are redeemed within 2 weeks
of receipt, and 97 percent are spent within a month. Because the
benefits can be quickly and efficiently delivered to recipients via EBT
cards, and recipients are likely to spend the benefits quickly, many
economists view SNAP as one of the most effective forms of economic
stimulus during an economic downturn. The USDA estimates that every
$1.00 spent on SNAP benefits generates $1.79 in local economic
activity.
SNAP is an important resource that helps low-income seniors buy the
food they need to maintain a healthy lifestyle. However, the SNAP
participation rate among eligible seniors is much lower than the
general population. According to the USDA, in 2008 a little over one-
third of eligible seniors participated in SNAP, compared to about two-
thirds of the eligible general population.
Many seniors, especially those that are in need of assistance for
the first time, are not aware of SNAP and the application process can
be confusing for older Americans. According to a survey conducted by
USDA's Economic Research Service, misinformation and confusion about
the program's eligibility rules and benefit levels was cited as a major
reason eligible seniors chose not to apply for SNAP benefits.
Other seniors may choose not to apply for SNAP due to the perceived
stigma associated with the program. According to the same Economic
Research Service survey, many seniors felt that participation in SNAP
might be degrading or embarrassing if others in their families or
communities found out they were receiving SNAP benefits. Additionally,
some seniors who had worked most of their lives and had never needed
government assistance felt that asking for help from the FSP was a sign
of failure or weakness.
Recommendation to Improve Access and Participation: Congress should
continue to strengthen SNAP's ability to meet need by breaking down
access and participation barriers. Not all seniors who are eligible for
SNAP participate in the program, because of stigma, misinformation
about eligibility and potential benefits, or cumbersome enrollment
procedures. While SNAP has made steady improvement in senior
participation rates over the last several years, still only about one-
third of those eligible are served. Continued outreach is needed to
make sure all who are eligible and in need of assistance are informed
of and enrolled in the program.
Congress should take steps to improve program education and
outreach targeted to seniors, streamline the application and
eligibility-determination process, and increase coordination with SNAP
across other programs serving seniors. For example, categorical
eligibility has been shown to both improve program access while at the
same time allowing States to reduce administrative costs and simplify
administration. Congress should strengthen categorical eligibility and
encourage States to take advantage of the expanded option.
Commodity Supplemental Food Program (CSFP): Administered by USDA,
the Commodity Supplemental Food Program leverages government buying
power to provide nutritionally balanced food packages to more than
604,000 people, most of whom are low-income seniors 60 years or older
in 39 States, 2 tribal organizations, and the District of Columbia. For
many of these seniors, CSFP may be the only nutrition assistance
program readily accessible to them.
CSFP is an efficient and effective program. While the cost to USDA
to purchase commodities for this package of food averages $20 per
month, the average retail value of the foods in the package is $50. For
the seniors participating in this program, CSFP provides more than just
food and nourishment, it also helps to combat the poor health
conditions often found in seniors who are experiencing food insecurity
and at risk of hunger. CSFP food packages are specifically designed to
supplement needed sources of nutrients typically lacking in
participants' diets like protein, iron, zinc, and vitamins B-6 and B-
12. CSFP plays an important role in addressing the nutrition needs of
low-income seniors.
Despite the clear benefits of CSFP to low-income seniors and the
long waiting lists that many States have of seniors who need this
program, H.R. 2112, the fiscal year 2012 Agriculture Appropriations
bill, has targeted CSFP for deep cuts. While this program will require
a funding level of $176.8 million in fiscal year 2012 in order to
sustain the current caseload, H.R. 2112 proposed cutting funding for
this program by $38 million. As a result, if a cut of this magnitude
were to be enacted, an estimated 150,000 low-income seniors would
immediately be dropped from this vital program. Although the $20
monthly CSFP food package may not seem like much, to a low-income
senior it can mean the difference between putting food on the table and
not having enough to eat.
Recommendations for CSFP: Recognizing the role that this program
plays in the lives of vulnerable, low-income seniors, Feeding America
recommends that this program be reauthorized in the 2012 Farm bill and
expanded to all 50 States. Additionally, Feeding America recommends
that the income threshold for seniors wishing to participate in CSFP be
raised to 185 percent of the Federal Poverty Line, bringing it in line
with the threshold already applied to women and children participating
in this program. Further, Feeding America recommends that the Senate
provide $181.8 million for CSFP in fiscal year 2012 to maintain current
caseloads and allow CSFP to expand into six additional States with
USDA-approved State plans (Connecticut, Hawaii, Idaho, Maryland,
Massachusetts and Rhode Island).
The Emergency Food Assistance Program (TEFAP) Commodities: TEFAP is
a means-tested Federal program that provides food commodities at no
cost to low-income Americans in need of short-term hunger relief
through organizations like food banks, pantries, soup kitchens, and
emergency shelters. Healthy and nutritious food commodities provided
through TEFAP are essential resources that enable Feeding America food
banks to meet the need in their communities.
TEFAP commodities currently account for approximately 25 percent of
the food moving through Feeding America food banks nationwide. In most
instances, local food banks supplement TEFAP commodities with privately
donated foods to extend TEFAP program benefits beyond the budgeted
amount for the program. As the unprecedented demand for food continues
at food banks across the country, TEFAP commodities are essential for
the provision of a steady emergency food supply. However, the level of
commodities USDA provides is projected to drop off in fiscal year 2011
and fiscal year 2012.
In fiscal year 2010, TEFAP provided approximately $655 million
worth of nutritious foods to low-income Americans. This figure includes
commodity purchases mandated by the 2008 Farm bill as well as bonus
commodity purchases that were appropriated for in fiscal year 2010
Agriculture Appropriations and those bonus purchases made by USDA when
necessitated by market conditions.
In fiscal year 2011, even as the need for food assistance remains
at unprecedented levels, the agricultural markets remain very strong.
As a result, there is little need for USDA to intervene in the markets
to make additional bonus commodity purchases. Without additional bonus
purchases in fiscal year 2011, TEFAP spending levels will fall by about
45 percent to approximately $360 million. This $295 million decrease in
TEFAP commodity spending for fiscal year 2011 will significantly impact
efforts to address the growing need for emergency food assistance
throughout the country. Without additional funding for commodities, too
many seniors who rely on the commodities they receive from emergency
food distributions may go without adequate access to the nutritious
foods they need.
Recommendation for Increasing the Supply of Emergency Food: With
agriculture commodity markets projected to remain strong in the coming
years thereby driving a marked decline in the availability of bonus
TEFAP commodities, Feeding America recommends that the amount of annual
funding for mandatory TEFAP purchases be increased in the 2012 Farm
bill. In addition, with respect to TEFAP commodities available in
fiscal year 2011, Feeding America recommends that members of the
committee make a request to the Secretary of Agriculture that he use
his administrative authority to direct funds for the purchase of
additional TEFAP commodities this fiscal year.
conclusion
As the committee begins to engage in debate on the reauthorization
of the Older Americans Act, we greatly appreciate the opportunity to
submit testimony today on behalf of Feeding America, our over 200
member food banks, and the 37 million Americans our food banks fed last
year. For a growing number of Americans--including more than 3 million
seniors--food banks are truly the first line of defense, and many times
the only resource standing between them being able to put food on the
family dinner table or going to bed with an empty stomach. However, our
food banks and the charitable food assistance network cannot meet the
needs of these families alone. It is only through our partnership with
the public sector and the sustained support the Federal Government
provides through programs like SNAP, CSFP, TEFAP, and congregate and
home delivered meals that we can make real strides in the fight against
hunger.
Prepared Statement of The Gerontological Society of America
The Gerontological Society of America (GSA) is the Nation's oldest
and largest interdisciplinary organization devoted to research,
education, and practice in the field of aging. The primary purpose of
the Society--and its 5,400+ members--is to advance the study of aging
and disseminate information among scientists, decisionmakers, and the
general public. GSA would like to thank the HELP subcommittee on
Primary Health and Aging for hosting a hearing on the important topic
of nutrition for older adults, and the fundamental role of nutrition
programs in the Older Americans Act.
The Older Americans Act oversees congregate and home-delivered
meals that bolster nutrition in older adults, allowing them to live
healthily and age in place within their communities. According to the
2005 White House Conference on Aging final report, physical changes
that take place during aging can result in different nutritional needs,
contributing to decreased food intake, unintentional weight loss,
malnutrition, and/or obesity. These changes can lead to chronic
diseases, such as diabetes and heart disease that ultimately cause
individuals to seek costly hospital stays and placements in nursing
homes. The cost of 1 day of hospitalization would more than cover the
cost for an older person to receive 365 days of home-delivered meals.
With this preventative approach, Older Americans Act nutrition programs
not only provide crucial services to older Americans, but represent an
important investment in keeping older adults healthy and costs down.
Although organizations like the Meals on Wheels Association of
America (MOWAA) collect data on the services they provide and self-
reported outcome measures, more research needs to be done on the need,
current services, and outcomes. GSA supported the Leadership Council of
Aging Organizations (LCAO) 2011 OAA Consensus Document, including the
following recommendations for evidenced-based research:
1. Improve data collection in the title III C nutrition programs,
particularly unmet need, such as waiting lists. Currently, according to
a report by the National Health Policy Forum, data on the unmet need
for nutrition services are elusive and national data on waiting lists
does not exist.
2. Look for and provide support for best practices in nutrition
programs that have succeeded in recruiting and retaining first wave
boomers who are at risk for malnutrition in addition to existing
clientele.
In addition to improving the research on older adult nutrition, GSA
supports strengthening the volunteering component of Older Americans
Act nutrition programs. Roles for volunteers of all ages can include
delivering meals, providing nutrition counseling, and organizing
education activities or congregate meals. Benefits of engagement for
older adults include self-reported quality of life, lower rates of
dementia, reduced risk of depression, improved recovery from illness,
and reduced mortality. Continuing to develop the connection between
volunteering and older adult nutrition helps both groups, and reduces
the cost burden on agencies.
The Gerontological Society of America recognizes the importance of
nutrition for older adults, and the great work accomplished by Older
Americans Act programs to keep older adults healthy and in their
communities. Every year, GSA hosts an Annual Scientific Meeting that
brings together more than 3,500 top researchers in the field of aging
for over 400 scientific sessions. The theme of GSA's 2011 meeting is
``Lifestyle Leads to Lifespan.'' Indeed, this year's program includes a
public policy symposium, developed in partnership with the Tufts
University USDA Human Nutrition Research Center on Aging, focused on
the critical role nutrition plays in healthy aging. Once again, thank
you for making this topic a priority.
Prepared Statement of Hunger Free Vermont
Hunger Free Vermont, formerly the Vermont Campaign to End Childhood
Hunger, is an education and advocacy organization with the mission to
end the injustice of hunger and malnutrition for all Vermonters.
Incorporated in 1993, we are a statewide nonprofit organization
dedicated to hunger prevention through expanding access to nutrition
programs that nourish Vermont's children and families. Hunger Free
Vermont committed to expanding advocacy efforts to the senior community
in 2010 in response to low participation among seniors in Federal
nutrition programs, and the increase in senior hunger and malnutrition
in Vermont.
Vermont is considered the ninth hungriest State in the Nation,
because we have seen a sharp rise in the more severe form of hunger
known officially as ``very low food security.'' When asked about the
causes of such an increase, Hunger Free Vermont points to Vermont's
particular challenges as a State: relatively low incomes coupled with
high housing and heating costs, plus the added burden of transportation
costs as the most rural State in the country.
At the same time, Vermont's older population is growing at a rapid
pace; the fastest growing segment of the population is now 85 years and
older with projections for 2030 showing a 149 percent increase over
2000 census numbers. While the cost-of-living, particularly housing,
food and fuel in Vermont, continue to rise, seniors on fixed incomes
struggle to afford the necessities. Food tends to be the most flexible
item in the household budget and is often cut first when funds are
limited, particularly as seniors' appetites and desires to cook are
waning. From our experiences working with front lines service
providers, Hunger Free Vermont has come to understand that senior
hunger is a very real problem in our State.
Seniors are more likely to be at risk of hunger if they are living
near or below the poverty line, between the ages of 60 and 64,
divorced, separated, or living with a grandchild, or are a renter. Good
nutrition is critical to maintain health and independent living when
aging. Food insecurity and hunger have serious consequences on the
health and well-being of elders. Seniors experiencing food insecurity
are significantly more likely to have lower intakes of calories and
major nutrients, significantly more likely to be in poor or fair
health, and more likely to have limitations in activities of daily
living. All these direct results lead to a sicker, less independent and
less economically stable aging population.
The 2010 USDA Food Security Report revealed that 14 percent of all
Vermont households are food insecure. Food insecurity is defined as the
lack of access to enough food to fully meet basic needs at all times
due to lack of financial resources. Multiple national organizations,
such as the Meals on Wheels Association, the AARP Foundation and
Feeding America have documented an increase in senior food insecurity
across the country. We see the effects of this increase in Vermont
every day as usage of Federal nutrition programs rises and agencies
report of more clients' in need of food.
11,115 seniors ate meals at congregate meal sites in 2010,
a 2 percent increase in meals and 8 percent increase in participants
from 2009.
736,514 meals were delivered to 4,357 seniors' homes in
2010, a 5 percent increase in meals served from 2009.
In 2010 there were over 5,000 calls to the statewide
Vermont Senior Helpline regarding help with food and nutrition.
Agencies on Aging report that they are seeing more people
eating alone, and more young seniors (age 60-64) signing up for home
delivered meals.
While many home delivered meal programs request a
suggested donation, programs often average a much smaller donation
amount (for example, the suggested donation in the Lamoille Valley is
$3 per meal; the average donation received is $.90 per meal).
Agencies on Aging and Vermont Kin as Parents report that
there are more grandchildren living with grandparents, and because
financial support for kin is limited, delivered meals are sometimes
being given to the children rather than the elders.
Given the challenge of rising senior hunger in Vermont, the
nutrition programs within the Older Americans Act are increasingly
important as part of the social safety net to help seniors remain
healthy and independent. In working with our partners across Vermont,
Hunger Free Vermont sees the following challenges in reaching seniors
in need via congregate and home delivered meal programs:
Funding: Funding is limited and meal programs must do
significant fundraising to be able to continue serving seniors at their
current capacity. Nutritional meals cost much more to make than the
Federal reimbursement provides. Agencies report that as seniors live
longer, they are now serving multiple generations in their meal
programs, from 60 years to 100-plus, presenting new challenges for
serving meals, especially as more seniors have special diets and
changing health needs. Transporting meals throughout rural Vermont is
expensive, especially as gas prices continue to rise. Some programs
risk losing their drivers unless they offer a mileage reimbursement or
stipend.
Access: Due to limited funding and capacity, congregate
meal programs in Vermont are dispersed geographically and rarely serve
meals more than a couple days a week. Seniors need access to good
nutrition every day no matter where they live. Even in locations where
meals are served daily, without low-cost public transportation options,
seniors have difficulty accessing these meals.
Structure: A one-size-fits-all prepared meal may not be
the most cost-effective or flexible source of nutrition for every
senior in need. In order to qualify for home delivered meals, a senior
must be homebound, unable to cook, and/or nutritionally at risk. For
some seniors, the problem is not inability to cook, but rather they are
homebound due to loss of ability to drive or access public
transportation. For others the issue is limited income; they need food
but not necessarily a hot prepared meal.
It is critical that the nutrition programs that serve food to
insecure older Vermonters are able to do so both efficiently and
effectively. These nutrition programs play a pivotal role in ensuring
that seniors are able to live and age successfully and independently in
their own homes and communities. By investing in proven, cost-effective
programs now, Congress can ensure that seniors' nutritional needs are
met, health care costs are reduced, and tax payer dollars are used
wisely well into the future.
Given the on-the-ground realities in Vermont, Hunger Free Vermont
recommends the following improvements to congregate meal and home
delivered meal programs:
Increase Funding for Good Nutrition: Increased funding for
both congregate meal programs and home delivered meal programs will
allow programs to serve high quality meals to more food insecure
seniors. As food and fuel prices continue to rise, additional funding
will allow meal programs to meet the bottom line and meet the need.
More Flexibility to Serve More: A more flexible home
delivered meal program will allow funds to be used more efficiently and
effectively while serving more seniors. Programs will have options for
kinds of foods to be delivered and in what form (for example, as
groceries or as prepared meals) to stretch funds and maintain
independence as much as possible while still meeting the needs of
seniors.
In conclusion, to emphasize the importance of these programs, we
will share a quote from one local advocate who visited a senior in
rural Vermont. She said that,
``This senior had only one squash in her house and no money
in her bank account with 2 weeks to go before receiving her
next Social Security payment. Without access to the available
services and programs, such as 3SquaresVT, home delivered
meals, congregate meals and commodity boxes, she and many other
seniors in Vermont would go hungry.''
Thank you for the opportunity to submit this statement for the
record. Hunger Free Vermont looks forward to the successful
reauthorization of the Older Americans Act as we work towards the day
when Vermont is hunger free.
Prepared Statement of Meals On Wheels Association of America
Chairman Sanders, Ranking Member Paul and members of the
subcommittee. The Meals On Wheels Association of America (MOWAA)
commends you on beginning your hearings related to the reauthorization
of the Older Americans Act by focusing on senior hunger in America and
on the role of Older Americans Act (OAA) Senior Nutrition Programs
(SNPs) in addressing it. We thank you for the opportunity to present
testimony for your consideration as you work to improve the OAA's
effectiveness in delivering needed nutrition services to those seniors
who otherwise would not have access to nutritious food.
The Meals On Wheels Association of America (MOWAA) is the oldest
and largest national organization representing local, community-based
Senior Nutrition Programs--both congregate and home-delivered (commonly
referred to as Meals On Wheels)--and the only national organization and
network dedicated solely to ending senior hunger in America. While we
have traditionally used and continue to use the term ``community-
based'' to describe these programs, it is important to understand that
the community has a much greater role in them than simply being the
location in which these SNPs operate. It is more accurate to call these
individual programs not only community-based but also community-
focused, -reliant, -reflective, -informed, -supported, -dependent and -
directed. So when MOWAA employs the term ``community-based'' we intend
for it to carry all those meanings, and we believe the concept is an
important one. Each SNP is unique, and while they all comply with
certain uniform OAA-prescribed standards as related to things like the
nutritional content of meals, for example, there is tremendous
diversity among programs from community to community and State to
State. This is the strength of our network, and it is one of the
characteristics that distinguishes Senior Nutrition Programs from the
majority of so-called Federal or federally funded food or feeding
programs with which SNPs are often associated. In fact, there are more
differences between SNPs and those programs than there are
similarities. As the name SNP implies, these programs--which are also
often referred to as senior meal programs--are nutrition programs that
provide complete, well-balanced meals; and many of those meals are
delivered to the homes of individuals who need them. Food programs are
not necessarily either nutrition programs or meal programs. Again, the
distinction is significant.
Another hallmark of SNPs, which separates them from other Federal
food programs, is that they are strong public-private partnerships.
SNPs could not exist and operate without the majority of their funding
coming from other, diverse sources, such as States and localities,
foundations, corporations, individual donors and clients themselves or
their families. The Administration on Aging (AOA) often notes that
every $1 of Federal support made available through OAA leverages
another $3.35 from other sources. As impressive, and distinctive from
other food programs, as that figure is, we believe it significantly
underestimates the leveraging power of these Federal funds. It fails to
take into account the monetary value of the free labor contributed by
the vast volunteer army--numbering between 800,000 and 1.7 million
nationwide--as well as the donation of the use of personal vehicles to
deliver meals. In an effort to calculate this additional value, we
interviewed MOWAA Members representing rural, suburban and urban and
small, medium-sized and large SNPs to derive the average per meal value
of volunteer labor. We used $10 an hour, about half of the generally
accepted value as calculated by the Independent Sector ($21.36 for
2010). We also assumed that volunteers drove an average of 2 miles per
meal delivery on average, again deliberately under estimating the
distance. Using these numbers we found that volunteer labor and vehicle
usage (calculated at $0.50 per mile) contributed about $2.75 for each
home delivered meal. In fiscal year 2009, when 149 million meals were
provided, that equates to additional leveraged, non-Federal funds of
almost $410 million. Again, we stress that this grossly underestimates
the actual value of the volunteer labor contribution and does not even
take into account such labor associated with meals served at congregate
sites.
Not all MOWAA Member programs throughout the United States receive
OAA (Title III) funds. There are numerous programs nationwide that are
entirely privately funded. These programs work in many, if not most,
communities side-by-side with their peers partially title III-funded
programs; and the relationship is a symbiotic one. Both types of
programs acknowledge the value and necessity of the other and both are
necessary to the community's goal of providing meals to all the seniors
who need them. Some of the private programs are also ``private pay,''
which means simply that clients who can afford them must pay for their
meals; other private programs operate in the same way that title III
programs do, often utilizing a sliding scale based on self-declared
income and suggesting a voluntary contribution from clients. Where both
types of programs exist, they clearly complement each other and expand
the community's ability to provide nutrition services to seniors in
need. But the reality is that not all communities have such private
programs, for a variety of reasons, including the location and size of
the community and the lack of human and financial resources to sustain
any regular, appropriate and reliable nutrition services.
Another critical distinction between OAA SNPs and Federal food
programs is that OAA programs are not means-tested. The criteria is
need, and that is, as it should be, much broader than income alone.
Need can include disability or frailty or immobility or inability to
carry out the Activities of Daily Living or social isolation. More and
more we are witnessing the emergence of food deserts--that is,
communities where there is not one single food source other than the
SNP--even in those rural areas that once were the Nation's food basket.
Lack of access to food and lack of ability to obtain it certainly
constitute need. And if the need gaps, regardless of their cause, are
not addressed, then seniors are hungry.
MOWAA's mission, which is shared by our MOWAA Member programs, is
clear and straightforward--``to end senior hunger by 2020.'' Our
singular vision is driven by conviction. It is also compelled by the
tragic fact that the number of seniors facing the threat of hunger in
this great land is not only unacceptably high, but also--and this is
despite the heroic efforts of some 3,500 senior nutrition programs
funded through the Older Americans Act and their private peers--it is
growing. Yes, growing. MOWAA believes that several factors account for
this increase in senior hunger and hunger risk. Some of them are
frequently discussed . . . like the significant growth in the number of
individuals age 60 or older, fueled by the Baby Boom; or ever-
increasing costs of food and gasoline; or the state of the economy in
general. Like SNPs themselves, this subcommittee has no control over
these. But there are other factors that you can mitigate. Some of these
``controllable'' are factors that, MOWAA believes, may be unintended
consequences of the Older Americans Act in its current state. Let me
reiterate what I just said, because it may be both a new concept and a
provocative one: the current structure of the Older Americans Act may
be contributing unintentionally to the rise of hunger risk among
seniors in America.
We can back up that bold statement not with emotion and anecdote,
but with data. Then we will propose changes to the Older Americans Act
that MOWAA is convinced will enable Senior Nutrition Programs across
the United States to serve more meals to more seniors. Doing so will
begin to shift the trend, even if only incrementally, toward fewer, not
more, hungry seniors. The two major recommendations that we will put
forth are simple, and are simply designed to reduce hunger risk among
our Nation's vulnerable elderly.
Before we describe them, we want to articulate some assumptions,
which we trust can be universally accepted:
1. Food is a basic necessity;
2. There is a direct, and scientifically demonstrable, relationship
between nutrition and health;
3. Good nutrition contributes to the prevention, treatment and/or
delay of onset of many of the most common chronic medical conditions in
the elderly, such as hypertension, diabetes, and obesity, for example;
and
4. Hunger is a disease, and we have the cure for it today.
If we agree on those four fundamental points, then we hope that we
can agree that the Older Americans Act should be one of the primary
vehicles through which we deliver the cure to the deleterious disease
called hunger--and prevent so many other diseases as well. We hope the
subcommittee will agree that specific changes need to be made to the
act during reauthorization in order to enable America to move more
effectively and deliberately toward the eradication of senior hunger.
Let us provide brief background about the basis for MOWAA
recommendations for change, as well as the data sources that support
those recommendations. We have based our recommendations on data,
because data are impartial and in this case tend to be extraordinarily
straightforward. In 2007 the MOWAA Foundation commissioned outstanding
researchers from the University of Kentucky's Center for Poverty
Research and Iowa State University to conduct a study entitled ``The
Causes, Consequences and Future of Senior Hunger in America.'' That
groundbreaking study was released at a hearing of the U.S. Senate
Special Committee on Aging in March 2008. The findings were helpful to
our understanding of the extent of senior hunger in the United States.
They were also discouraging. The researchers found that in 2001, 1 in 9
seniors, or 5 million older individuals, faced the threat of hunger.
The next year we engaged the same researchers again and asked them
to update the national study with 6 additional years of data, as well
as to give us a state-by-state look at the incidence of senior hunger
in America. The second study was released in November 2009 at a
briefing of the House Hunger Caucus. To say that those findings were
dispiriting is an understatement. They were, and are, morally
unacceptable. By 2007, there had been a 20 percent increase in the
number of seniors facing the threat of hunger, with the number growing
from 5 to 6 million seniors.
What is the relevance of this to the reauthorization of the Older
Americans Act? Taken in isolation, probably nothing. Put in a context,
quite a lot. MOWAA took the state-by-state data from the study and then
overlaid specific program information and results taken from the
National Aging Program Information System (NAPIS). This NAPIS data is
available on the AOA Web site.
Here is what we found. In fiscal year 2007, the year that
corresponds with the study's hunger numbers, 21 of the top 25 Senior
Hunger States--that is, those States with the highest rates of senior
hunger--transferred funds from title III C, senior nutrition, to title
III B. By contrast, only 12 of the bottom 25 Senior Hunger States made
such transfers. In fiscal year 2008, 17 of the top 25 senior hunger
States increased the amount of funds transferred from title III C
nutrition to unspecified title III B services; and in fiscal year 2009,
16 of the top 25 senior hunger States again increased the transfer from
nutrition [see Appendix I].
MOWAA believes the evidence is compelling and clear. Allowing
transfer of funds from title III C to title III B is having a serious
adverse impact on the health and well-being of vulnerable seniors
across this great land. It must be stopped. MOWAA's first
recommendation for reauthorization is to eliminate the authority to
transfer funds from title III C to title III B. This is not a new
position for MOWAA, but it is one for which we are advocating with
renewed vigor--because what was once a surmise is now a fact, clearly
supported by the data.
In the past those groups that opposed this anti-transfer
recommendation primarily raised two arguments against it. The first was
that the amount of transfer nationally had remained relatively constant
over time. We did not understand the relevance of that statement; even
if it were relevant, it is no longer true. Over the course of the most
recent 4 years for which we have data, net transfers into title III B
from III C have grown significantly from approximately 9.6 percent, or
just over $33 million, to about 13.4 percent or nearly $48 million [see
Appendix II]. That is real growth and that lost nutrition funding could
have furnished hundreds of thousands of additional meals at a time when
hunger risk is growing.
This trend of increasing transfer should be alarming to Congress,
because both the House and the Senate are on record in report language
as strongly warning States, particularly those with high incidences of
senior hunger, not to transfer funds from nutrition to other services
as long as needed for nutrition services existed. Below is an excerpt
of House Report 109-493. That document is the only source by which to
determine legislative intent, as the Senate bill was pre-conferenced
with the House, so that there were no Senate or Conference Reports. The
House Report reads in part:
``The committee cautions States from transferring funds from
nutrition services to non-nutrition supportive services unless
such transfers support, facilitate, or foster participation in
senior nutrition programs. In particular, States with a high
prevalence of food insecurity are strongly discouraged from
diverting funding provided for food services to non-food
expenditures and should do so only as a last resort. Further,
the committee strongly encourages States to use general and
administrative dollars provided in the specific line item or
category for which the funds were intended. The committee
believes strongly that . . . title III C dollars should not be
used by States to pay the administrative cost associated with
managing title III B services.''
Clearly the committee's ``caution'' was not taken seriously by the
States and in fact, many States' actions were in diametric opposition
to the House's intent. The following year, the Senate expressed its
agreement with the House authorizing committee's warning by adopting
report language to accompany the Senate's Departments of Labor, Health
and Human Services, Education and Related Agencies appropriation bill
(Senate Report 110-107). That language read:
``The committee is aware that proper nutrition is essential
to the health and wellness of older Americans. A healthy diet
can prevent weakness and frailty, improve resistance to illness
and disease, and lead to better management of chronic health
problems. All of these in turn lead to greater independence and
quality of life for older persons. The recent reauthorization
of the Older Americans Act recognized the important role that
nutrition plays in promoting the health and well-being of
seniors. In addition to reducing hunger and promoting
socialization, the nutrition services program was reauthorized
with the purpose of assisting older Americans in accessing
nutrition and other disease promotion services that can delay
the onset of adverse health conditions. The act also added
greater emphasis on nutrition education, nutrition counseling
and other nutrition services. Despite increased recognition of
nutrition's importance to the health and well-being of our
seniors, the funding level for the nutrition services program
has stagnated in recent years, while at the same time the
population of older Americans continues to increase. The
committee notes that the number of meals provided under the
nutrition services program has declined by more than 8 percent
from fiscal years 2000 to 2005. The committee is aware that
flat funding, along with higher food and transportation costs,
has forced many programs to implement waiting lists and
consolidate meal sites in order to cut costs. The committee
hopes that the funding increase provided will help alleviate
the fiscal strain affecting these programs and will allow them
to continue to provide meals services that are essential to our
seniors. The committee recognizes that the recent
reauthorization of the Older Americans Act (Public Law 109-365)
continues to allow States to transfer funds between title III
B, which funds supportive services, and title III C, which
provides funding for nutrition services. While such transfers
have remained relatively stable over time, amounting to
approximately $35,000,000 per year transferred from nutrition
programs to supportive services, the committee is concerned by
the decrease of funds available for nutrition services. The
committee believes that the specific funding increase provided
for nutrition services in this bill should be used to directly
support, facilitate, or foster nutrition programs, and should
not be transferred for non-nutrition-related supportive
services.''--[emphasis added]
Opponents to our proposal will likely attempt to argue that the
transfer of funds have, in fact, been used to ``support, facilitate,
foster nutrition programs.'' But that argument is in no way supported
by the facts. There is not a shred of evidence to corroborate the fact
that in fiscal year 2009 $48 million was spent on such activities. In
fact, the data clearly show that was not the case. The single largest
expenditure within the title III B spending is for a category entitled
``Other Services.'' Other services do not include transportation,
assisted transportation, nutrition education, nutrition counseling or
case management.
These activities all have their own discrete line items. AOA data
gathered through the National Aging Program Information Services
(NAPIS) system shows that the Federal portion title III B expenditures
for ``Other Services'' in fiscal year 2008 was greater than $105
million. Federal spending on title III B transportation and assisted
transportation combined was less than $72 million. By fiscal year 2009
Federal spending had risen to more than $110 million for other
services, while spending for the two transportation lines remained
relatively stable at just over $72 million. The most disturbing element
of this transfer and spending activity is that the AOA data show
absolutely no service units and no persons served attached to this
``Other Services'' spending. That data, either persons or units or both
(as is the case with meals), is recorded for every other category of
title III spending. We should not have to imagine where and how that
money is being spent, but we can be certain that it is not ``to
directly support, facilitate, or foster nutrition programs'' [see
Appendix III].
The voluntary compliance regarding the use of nutrition funds to
furnish nutrition services that the Congress has sought in the years
since the last OAA reauthorization simply has not materialized. To the
contrary, the opposite has occurred. The result has been increasing
numbers of vulnerable older persons going without the meals and
nutrition support they need to age healthily, prevent or improve
chronic illness, recover from acute illness, avoid
institutionalization. More have suffered hunger or faced its threat. It
is time to stop the funding hemorrhage from title III C nutrition
funds. We appeal to you, on behalf of the thousands of SNPs across
America and the more than 6 million seniors needing services, to amend
the Older Americans Act to prohibit the transfer of funds from title
III C to title III B. It is a simple change that could have a
monumental impact of the health and well-being of our seniors as well
as a positive impact on the bottom line of the Federal budget. We will
address that point in more detail below, after we offer MOWAA's second
major reauthorization recommendation.
MOWAA's second recommendation for changes in the OAA is also
related to the issue of transfer. We propose the consolidation of
titles III C 1 and III C 2 into a single title III C. This would
eliminate the administrative burdens of intra-section transfers.
States, Area Agencies on Aging and Senior Nutrition Programs could more
easily direct nutrition dollars to areas of greatest need. There would
be no change in what entities are eligible for funding, who could
receive services, how clients are served, etc. Both congregate and
home-delivered meal programs would continue to have access to these
dollars, and the process of directing them where they need to go would
be simplified. The administrative burden would be significantly reduced
and time and energy could be directed to the provision of services.
The adoption of these two recommendations would entirely eliminate
transfer within the act by removing the only two provisions that allow
it. MOWAA believes this change would benefit not only nutrition
programs but also every other program and service funded under title
III. It dispels long-held myths associated with transfers that have
held us all captive--namely, that the resources provided to programs
under the act have been sufficient, and that transfer authority allows
States and localities to direct surplus funds from one service to
another. There are no surpluses.
Our first assumption, among the four principles we articulated
earlier, was that food is a basic necessity. We believe that it is our
moral imperative as a nation to make this basic necessity accessible
and available to every citizen who needs it, particularly those who are
vulnerable. We hope that this subcommittee agrees with that principle
and trust that you do, judging from your decision to hold the first of
your reauthorization hearings on the issue of senior hunger. As the
architects of the legislation that governs SNPs you have the ability to
profoundly improve the lives of those individuals who depend on us, and
their communities, for the vital life supports. We know that Congress
faces extraordinarily difficult decisions relating to spending and that
the deficit must be addressed. We also know that this subcommittee has
the power to direct millions of ``additional'' dollars to providing
nourishing meals to seniors in need without spending 1 additional cent.
That, we believe, should be an easy choice in this time of fiscal
austerity. Had transfer from title III C to title III B been
statutorily prohibited in fiscal year 2009, those $48 million of
nutrition funds that were siphoned off for other services would have
been available to provide a basic necessity to those in need.
Ethically, it is the right thing to do. Practically, it makes eminently
good sense.
Our second and third assumptions focused on the connection between
nutrition and health. They are indisputably linked. Good nutrition
promotes and supports good health. Poor nutrition on the other hand
leads to poor health, and poor health is extremely costly not only in
personal terms for the individuals who suffer from it but also for the
Nation and our economy. If we leave frail seniors languishing in their
homes without proper nutrition, their health will inevitably fail. If
they survive, they will end up hospitalized or institutionalized at a
cost to the government that far exceeds the cost of providing adequate
funds to Senior Nutrition Programs to enable them to furnish seniors
meals in the homes and other settings. Senior Nutrition Programs can
provide meals for nearly a year for roughly the cost of one Medicare
day in the hospital. MOWAA can quantify, using actual health spending
data, the savings that can accrue when seniors receive nutritious meals
immediately following a hospital stay for an acute condition.
Our evidence in this regard is based on 2006 data (in 2006 dollars)
from a special project that MOWAA carried out in partnership with a
major national insurance company. The findings were presented in
December 2006 in Washington at a Leadership Summit sponsored by AOA.
Through the special partnership, the private insurer's Medicare
Advantage patients in select markets across the United States were
offered without additional cost to the enrollees 10 nutritionally
balanced meals, delivered by local Meals On Wheels programs,
immediately following discharge from the hospital for an acute
condition. Participation in the program was purely voluntary, and those
individuals who chose to receive the service were typically sicker than
those who declined it. Despite this fact, the insurance data show that
those seniors who received just 10 meals had first month post-discharge
health care costs on an average of $1,061 lower than those seniors who
did not. The beneficial affects were also lasting. The third month
after receiving those meals, the average per person savings to the
insurer were $316.
Individuals who did not receive meals had both more inpatient
hospital days and more inpatient admissions per 1,000 than those who
did receive meals. According to PricewaterhouseCoopers, preventable
hospital re-admissions cost the Nation approximately $25 billion each
year. One out of every five Medicare patients discharged from a
hospital is re-admitted within 30 days at an annual cost to Medicare of
$17 billion. Given these facts, providing adequate funds for Senior
Nutrition Programs can only be regarded as a strong and demonstrable
value proposition.
Let us suppose that slightly less than 5 percent of traditional
Medicare enrollees, or about 1.8 million seniors, received those 10
meals after an acute illness. And let us suppose that providing meals
for those seniors achieved only half the savings, that is, $688, that
the Medicare Advantage insurer realized. That still would amount to
savings to Medicare of approximately $1,238,400,000. The cost to the
Federal Government of furnishing those meals would be less than
$500,000. Simple subtraction makes clear the savings: $1,237,900,000.
Is our scenario here hypothetical? Yes. Is it based on real world data
and real life experience. Yes. Does furnishing vulnerable seniors meals
make good fiscal sense and actually save Federal dollars? Absolutely
Beyond that, from a human and humane perspective, and from the
perspective of the value of individuals and their liberty--principals
on which this Nation was founded and for which it still stands--it is
the acceptable and right thing to do.
All this leads to our principle No. 4, namely that hunger is a
disease and one for which we have a cure today. Meals On Wheels and
other SNPs throughout the United States deliver that cure to hundreds
of thousands of seniors everyday. But, with additional resources, they
could reach more. In closing, we ask you to give careful and serious
consideration to the two primary recommendations that we presented to
you today. We have others, but we believe that making these two
relatively simple changes to the Older American Act are the place to
begin our collective effort of reducing senior hunger and improving
America's elders physical and emotional health at the same time that we
improve our Nation's financial health.
We thank you for your attention to this most critical issue and
express our appreciation once again for the opportunity to present
testimony to the subcommittee.
In fiscal year 2007, of the top 25 senior hunger States, 21
transfer funds from nutrition (title III C) to title III B. Of the
bottom 25 senior hunger States, only 12 transfer funds from nutrition
(title III C) to title III B. In fiscal year 2008, 17 of the top 25 top
senior hunger States increased the amount of funds transferred from
nutrition (title III C) to title III B. In fiscal year 2009, 16 of the
top 25 senior hunger States increased again the amount of funds
transferred from nutrition (title III C) to title III B.
An Overview of Senior Hunger in the United States--June 13, 2011
(By James P. Ziliak--University of Kentucky; and Craig Gundersen--
University of Illinois)
Food insecurity is one of the leading public health challenges
facing the United States today. In 2009 alone, over 50 million
Americans lived in food insecure households, i.e., households that were
uncertain of having, or unable to acquire, enough food for all
household members because they had insufficient money and other
resources for food. The experience of food insecurity manifests itself
across the life-span in the United States. In recent years, increased
attention has been paid to the experience of senior Americans and, in
this overview, we consider the extent and determinants of food
insecurity among senior Americans, the health consequences associated
with food insecurity, and the influence of the recent economic
downturn. This overview is based on our research reported in Ziliak,
Gundersen, and Haist (2008), Ziliak and Gundersen (2009), and Gundersen
and Ziliak (2011).\1\
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\1\ Funding for the research in Ziliak, et al. (2008) and Ziliak
and Gundersen (2009) was made possible by a grant from the Meals On
Wheels Association of America Foundation and, in Gundersen and Ziliak
(2011), by a grant from the Merck Foundation.
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The extent and determinants of food insecurity among seniors. Based
on data from the Current Population Survey (CPS), a nationally
representative survey of over 50,000 households per year, we have
characterized the extent of food insecurity among seniors over the past
decade. The CPS contains the Core Food Security Module (CFSM), which is
the data used to characterize food insecurity in the annual report from
the USDA (Nord, et al, 2010). On average, between 2001 and 2009 about 3
million seniors were food insecure in any year. Along with those
experiencing food insecurity, another 2.9 million seniors are
marginally food secure, i.e., they are experiencing some level of food
hardship, albeit not enough to be fully food insecure.
Insofar as food insecurity is closely tied to economic constraints,
it is not surprising that certain groups of seniors are at greater risk
of food insecurity. In particular, seniors with limited incomes,
African-Americans, Hispanics, never-married individuals, renters, and
younger seniors are all more likely to be food insecure. One other
group that is at especially high risk of food insecurity are seniors
raising grandchildren. We find that households with a grandchild
present are on average about two and a half times as likely to be food
insecure as households without a grandchild present.
Along with income and demographic characteristics, there is a great
deal of geographic diversity across the United States in food
insecurity rates. This diversity is evident in Figure 1 which displays
food insecurity rates for all 50 States plus the District of Columbia.
The range of food insecurity rates is enormous from 1.6 percent in
North Dakota to a rate over 7 times higher in Mississippi (12.5
percent).
While certain groups of seniors are at greater-risk of food
insecurity and there are States with especially high rates of food
insecurity, food insecurity cuts across the income spectrum. For
example, over 50 percent of all seniors who are at-risk of hunger have
incomes above the poverty line. Likewise, it is present in all
demographic groups. For example, over two-thirds of seniors at-risk of
hunger are white.
The consequences of food insecurity among seniors. The mere
existence of food insecurity among seniors is of concern to
policymakers and program administrators in the United States. What
makes food insecurity among seniors an even more pressing concern is
that it may lead to numerous negative health outcomes. We examined
whether or not food insecurity does lead to worse health outcomes among
seniors through the use of data from the 1999-2006 waves of the
National Health and Nutrition Examination Survey (NHANES), a nationally
representative data set with numerous questions on health and nutrition
outcomes.
Controlling for other factors, we found that, as in the general
population, food insecure seniors have worse health outcomes than food
secure seniors. With respect to nutrient intakes, food insecure seniors
are significantly more likely to have lower intakes of energy and major
vitamins. The effects are very strong; for example, across all the
measures, the effect of being marginally food insecure is over twice as
large (and generally much larger) than a move in income from one-to-two
times the poverty line. With respect to broader measures of well-being
food insecure seniors are significantly more likely to report being in
poor or fair health and report limitations in activities of daily
living (ADL). For the latter, the effects are especially strong--for
example, being marginally food insecure is roughly equivalent to being
14 years older.
Recent changes in food insecurity among seniors. The recent
economic downturn has been associated with unprecedented increases in
the extent of food insecurity among seniors in the United States. As
seen in Figure 2, derived from Ziliak and Gundersen (2011), across all
three measures there was an increase of over 30 percent in food
insecurity from 2007 to 2008. While food insecurity rates did decline
somewhat from 2008 to 2009 for seniors, in comparison to earlier in the
decade, the proportions of food insecure seniors are markedly higher.
And for the more vulnerable group of seniors raising grandchildren,
food insecurity continued to rise through 2009. Overall, then, by 2009,
23 percent more seniors were marginally food insecure, 37 percent more
were food insecure, and an astonishing 88 percent more were very low
food secure. Translating into estimates of the numbers of seniors
involved, by 2009 7.5 million seniors were marginally food insecure,
and of those 4 million were food insecure and 1.4 million were very low
food secure. Despite another decade of efforts to address food
insecurity among seniors, the scale of food insecurity remains
stubbornly high.
References
Nord, M., A. Coleman-Jensen, M. Andrews, and S. Carlson. Household Food
Security in the United States, 2009. U.S. Department of
Agriculture, Economic Research Report 108. 2010.
Ziliak, J. and C. Gundersen. A Portrait of Food Insecurity in
Multigenerational Households: Part 1. Technical Report submitted to
the Merck Foundation. 2011.
Ziliak, J. and C. Gundersen. Senior Hunger in the United States:
Differences across States and Rural and Urban Areas. Technical
Report submitted to the Meals on Wheels Association of America.
2009.
Ziliak, J., C. Gundersen, and M. Haist. The Causes, Consequences, and
Future of Senior Hunger in America. Technical Report submitted to
the Meals on Wheels Association of America Foundation. 2008.
______
Jeff Gordon Inc.,
June 20, 2011.
Hon. Bernard Sanders, Chairman,
Subcommittee on Primary Health and Aging,
428 Dirksen Senate Office Bldg.,
Washington, DC 20520.
Dear Chairman Sanders: It's an honor to be invited to speak before
the committee--what a great opportunity to share all the work we are
doing in NASCAR. Unfortunately, I am not able to travel to Washington,
DC on the requested date due to other obligations previously scheduled.
Below, please see information detailing the 2011-13 program. In
addition to our objectives, we have partnered with International
Speedway Corporation (ISC), the owners of Daytona International
Speedway, and other tracks we race at to donate left over event food to
local food banks.
Concord, NC (Oct. 27, 2010)--Hendrick Motorsports and four-time
NASCAR Sprint Cup Series champion Jeff Gordon have teamed with AARP and
AARP Foundation on the Drive to End Hunger (www.DriveToEndHunger.org),
an unprecedented 3-year initiative to address the growing problem of
hunger among older Americans, including 6 million over the age of 60.
Drive to End Hunger will be the majority sponsor of Gordon's No. 24
Hendrick Motorsports team in 2011, 2012 and 2013, with primary paint
schemes in 22 Sprint Cup races annually. The No. 24 Drive to End Hunger
Chevrolet, which will be unveiled at a later date, will race in the
next three Daytona 500 events.
``This is a truly unique opportunity to help people, and it's a
completely new, cause-driven approach to sponsorship,'' said Gordon,
39, winner of 82 career Sprint Cup races.
``Every single day, millions of older Americans arc forced to
make a choice between food, medicine and utilities. It's going
to be a team effort, and it's not going to be easy, but we can
solve this problem.''
With Gordon as its spokesperson, Drive to End Hunger will help the
millions of older Americans who are facing hunger across the United
States. The effort will engage the NASCAR fan base, corporations and
charitable organizations via a text-to-donate program; activation at
racetracks across the country; further research on the causes and
consequences of hunger in older Americans; and an innovative national
grant program that will provide resources to address the problem at a
local level.
Donations from Drive to End Hunger will benefit the hunger programs
of AARP Foundation.
``Hunger is a hidden problem that millions of older Americans are
battling silently. In fact, between 2006 and 2008, the percentage of
seniors struggling with hunger more than doubled,'' said Jo Ann
Jenkins, AARP Foundation president.
``NASCAR fans are among the most charitable, community-minded
sports fans in the country, and they have a track record of
commitment. With the help of Jeff and the Hendrick team, we
will make the most of this unprecedented opportunity to end the
struggle that so many older Americans have with hunger.''
Drive to End Hunger will build on the hunger initiative launched
earlier this year by AARP Foundation, including volunteer-led food
drives, individual and corporate fundraising campaigns, and online
hunger resources at www.aarp.org/hunger.
``It's exciting to see a new organization engage with our
sport and our fans through such an innovative approach,'' said
Rick Hendrick, owner of Hendrick Motorsports. ``Having seen
firsthand what the NASCAR community is capable of
accomplishing, I know the program will help a lot of people in
our country who desperately need it. Success ultimately will be
measured by how many lives we can impact, and that's a truly
unique and special opportunity for everyone involved.''
Darlington, SC--Four-time NASCAR Sprint Cup Series Champion Jeff
Gordon, International Speedway Corporation's (``ISC'') Chief Executive
Officer Lesa France Kennedy and Darlington Raceway President Chris
Browning today announced that, on behalf of Drive to End Hunger,
Americrown, ISC's food and beverage concessions operator, will donate
all extra food items from the NASCAR Sprint Cup Series races it
services to the local food bank that serves the race track area.
Drive to End Hunger is AARP and AARP Foundation's national effort
to end hunger for older Americans. Donations are expected to include
breads, produce and other food items and will be prepared for delivery
by Americrown on Mondays following ISC's NASCAR Sprint Cup Series
races.
``This commitment is a huge opportunity to help people who are
struggling with hunger in the communities around the ISC tracks,''
Gordon said.
``Fifty-one million Americans struggle with hunger and six
million of them are over 60. This is a problem that if we all
work together, we can solve. We're really thrilled that ISC has
joined us in this important fight.''
``Providing food to those who need help is a cause that positively
impacts each community in which we operate,'' said France Kennedy.
``We are privileged to collaborate with Jeff Gordon and
AARP's Drive to End Hunger effort. Through our collective
efforts, we can make a difference in the lives of many in
need.''
Today's announcement follows ISC's donations at Daytona
International Speedway of more than 7,000 pounds of excess food to the
Second Harvest Food Bank of Central Florida following the 2011 Daytona
500; Talladega Superspeedway, which donated the extra food from its
Aaron's Dream Weekend to the Community Food Bank of Central Alabama;
and Richmond International Raceway Central which donated to the Central
Virginia Food Bank.
``We are pleased that Darlington Raceway, through AARP's Drive to
End Hunger, can make a significant difference for people in our
community,'' Chris Browning said.
``In South Carolina alone, more than 22 percent of people
reported not having enough money to buy food in the last year.
Almost 10 percent of seniors in South Carolina are at risk of
hunger. Particularly in these economic times, we want to do
everything we can to support the folks in communities around
ISC tracks. They are important to us, they are important to the
sport, and solving this problem should be important to everyone
in America.''
Donations will be made at these ISC tracks for the remainder of the
2011 NASCAR Sprint Cup season, including:
Daytona International Speedway (Daytona Beach, FL)--July 2d--Coke
Zero 400; Homestead-Miami Speedway (Homestead, FL)--November 20th--Ford
400; Kansas Speedway (Kansas City, KS)--June 5th--STP 400; and October
9th--Hollywood Casino 400; Martinsville Speedway (Ridgeway, VA)--
October 30th--TUMS Fast Relief 500; Michigan International Speedway
(Brooklyn, MI)--June 19th--Heluva Good! Sour Cream Dips 400 and June
19th--Michigan 400; Phoenix International Raceway (Avondale, AZ)--
November 13th--Kobalt Tools 500; Richmond International Raceway
(Richmond, VA)--September 10th--Last Race to Make the Chase; and
Watkins Glen International (Watkins Glen, NY)--August 14th--Heluva
Good! Sour Cream Dips at The Glen.
Once again, I would like to thank you for this opportunity.
Sincerely,
Jeff Gordon.
[Whereupon, at 11:36 a.m., the hearing was adjourned.]