Donald Trump to Hungry Seniors: Drop Dead

The budget sent to Congress Tuesday for fiscal year 2018 puts the country's schizophrenia over feeding hungry citizens back on the agenda--this time in the guise of defunding food programs for seniors, millions of whom are homebound, ill, and unable to cook or shop. In March, the Trump administration announced it was slashing federal funds for those programs, meaning that more seniors will go hungry, and waiting lists--already numbering in the thousands in some parts of the country--will get larger. The wait for a meal will get longer, too, leaving thousands of seniors, including those just discharged from a hospital, with few options for nutritious food.

As the number of seniors has increased, so has the number of people, particularly the very old, who need food. Yet, over the years, increases in federal funding--funneled primarily through the Older Americans Act, which accounts for about 35 percent of the budgets of the nation's roughly 5,000 meal programs--have not kept pace with the need, as I reported for The Nation in 1998 and 2013.

This year, the Trump budget calls for real cuts in food programs for seniors, not just smaller increases. Erika Kelly, the government-affairs officer for Meals on Wheels America, an umbrella organization for the Meals on Wheels network, says the network is already serving 23 million fewer meals than in 2005, a decline that has resulted in an increase in hunger. Today some 10 million elders are threatened by hunger, a 65 percent increase over the past decade.

Apparently, numbers like those don't bother Trump budget director Mick Mulvaney. As the budget was unveiled, Mulvaney remarked, "This is the first time, I think, in a long time that an administration has written a budget through the eyes of the people who are actually paying the taxes. We're not going to measure our success by how much money we spend but by how many people we actually help." And at his March news conference, Mulvaney disdainfully told reporters Meals on Wheels didn't help the people it was designed to serve. "Meals on Wheels sounds great," but "to take that federal money and give it to the states, and say, 'Look, we want to give you money for programs that don't work'--I can't defend that anymore."

A 2013 study found that meals delivered to seniors allowed them to avoid nursing facilities, saving on Medicaid costs.

The program, he said, was one of many that is "just not showing any results," a conclusion challenged by several academic studies. A recent randomized controlled study funded by the AARP Foundation showed significant differences among seniors on waiting lists, those receiving home-delivered meals, and those getting frozen-food deliveries. Seniors with home-delivered meals reported the greatest improvement in health and quality of life. A 2013 study by Brown University researchers found that meals delivered to seniors allowed them to stay in their homes rather than go into costly nursing facilities, resulting in net savings to Medicaid, which finances about half of all nursing-home stays.

Mike Williams, an Indiana man whose 88-year-old father receives meals, recently sent an e-mail that speaks to the program's results. His father, he said, is dependent on the program and "very concerned he may lose this service." Williams told me he is his father's only child and still working, and it would be nearly impossible to replace the daily delivery. "Not only does the service provide him with a good, nutritious meal, but the added benefit of having the delivery person touch base with him is a blessing. I find comfort in knowing he is having another real person liven up his day."

But the GOP's repeal and replace bill now on its way to the Senate also aims to slice some $800 billion out of Medicaid over the next 10 years, a cut that experts tell me will undoubtedly affect the amount of money states will have available to pay for nursing-home care. Thirty-eight states also use Medicaid funds under special waivers to provide some home-delivered meals. Those funds could be in jeopardy, too, portending a bleak future for senior services.

At his March press conference, Mulvaney argued that cutting domestic spending programs like Meals on Wheels and increasing military spending was "one of the most compassionate things we can do." After writing about these programs for 20 years, it's hard to see how rationing food to hungry old people is compassionate. It's debilitating and cruel.

"How do you say, 'I know you are hungry. We'll serve you in three months'?" --social worker

One year in Atlanta I met a woman who was number 27 on a waiting list of 120 in mid-April when I visited with her. She was still on the list in November, when it had grown to 198. Another year I interviewed a 79-year-old blind woman in San Francisco who had been on the list for five months. She was vague about what she ate, saying, "It's whatever I can afford." When I asked what she would eat for the week, she replied, "I'll eat, all right, but I don't know exactly what." For supper that night it was an apple and some nuts, though food wasn't far from her mind, I wrote. On a table beside her armchair was a copy of Cooking Light, in braille. "How do you say, 'I know you are hungry. We'll serve you in three months'?" asked the social worker who accompanied me. In Pine Bluff, Arkansas, a hungry woman I met had little in her refrigerator, and little chance of getting off the waiting list any time soon. Others on the list had greater needs. "It's a terrible burden to be the final word on whether they eat or not," an official from the local Meals on Wheels program said as we walked out the door.

I circled back to the Meals on Wheels programs in San Francisco, Pine Bluff, and Baltimore, three areas I reported on for the 2013 story. Ashley McCumber, who heads Meals on Wheels San Francisco, says the number of meals served has more than tripled since 2007, and the waiting list fluctuates between 120 and 160, with priority given to people in emergency situations, like those coming from the hospital. Even with substantial philanthropic support, he says, if the government doesn't step up, it will soon be like 2008 again, when the waiting list numbered 500 and people waited nine months. (It was 411 when I visited in 1998.)

"Things have gotten terrible. It's worse now than it has ever been for funding." --Betty Bradshaw, Arkansas Meals on Wheels

In Pine Bluff, director Betty Bradshaw, who started the meals program in 1979, says, "Things have gotten terrible. It's worse now than it has ever been for funding." Because of the way money flows from the federal government to the states, her program has been hurt by the state funding formula, which allocates Older Americans Act dollars based on the number of people over age 60. The Pine Bluff area, unlike other parts of the state, has lost population, which means less money. Bradshaw says it's gotten to the point where they may have to close the meal program.

Meals on Wheels of Central Maryland has fared better, but because it is a larger program and gets more federal money (56 percent of its budget), Executive Director Stephanie Archer-Smith told me, the proposed cuts will affect the number of home-delivered meals the program will be able to deliver. In addition to the home-delivered meals, which recipients don't have to pay for (though some do make voluntary contributions), central Maryland also offers a second program, for which 570 recipients do pay, based on their income. Archer-Smith says the typical amount is $2 or $3, which still presents a hardship. "Many of those who pay privately are waiting for a space for federally funded meals, but often they drop off the service before a space opens up. Some die while waiting." Cuts proposed by the Trump administration will make it harder to move people onto the federal program.

Funding for the Older Americans Act falls under the Department of Health and Human Services, and the Trump budget calls for a $3 million cut from FY 2017 levels for the meal program. But it's the elimination of federal block grants to the states that will really blast a hole in their budgets. About a quarter of the programs responding to a recent Meals on Wheels America survey said they relied on money from the Community Development Block Grant program funded under the Department of Housing and Urban Development, while about 10 percent rely on Community Service Block Grant funds, which fall under HHS. Some $30 million from the social-services block grant also funds meals. The budget proposal axes all three grants. Paul Kraintz, who heads the senior-nutrition program at Meals on Wheels in Martinez, California, gets $67,000 from the Community Development Block Grant. "We're already running drum-tight budgets. Any hit is bad and throws the whole program in disarray," Kraintz told me.

Some argue that private fundraising and philanthropic dollars can make up for the federal shortfall. But according to Ellie Hollander, president of Meals on Wheels America, "The gap has grown so much there's no way private philanthropy can fill it." While philanthropy works in places like San Francisco, where celebrity chefs raise money at gala events, or in Dallas, where very rich donors have written checks for (to cite two specific cases) $2.5 million and $1 million to whittle down the current waiting list of 2,000, it doesn't work in low-income areas like Pine Bluff, which are struggling communities and have no celebrity or corporate resources to tap.

"[Cutting] Meals on Wheels, even for some of us...fiscal hawks, may be a bridge too far." --GOP Rep. Mark Meadows

At stake in the budget fight over senior food programs is human decency, but, as Jane Ziegelman and Andrew Coe write in A Square Meal, a history of food programs during the Great Depression, antipathy toward government food programs is not new. The common attitude at that time was that people, especially the able-bodied, should not get a handout at government expense, even if it meant going without. That belief has spilled over to food programs for the not-so-able-bodied--seniors receiving home-delivered meals. Mick Mulvaney's budget blueprint and his comments are a throwback to Depression-era thinking. Yet some members of Congress will have no stomach for snatching food away from the homebound elderly. "It probably is the most conservative budget that we've had under Republican or Democrat administrations in decades," said Mark Meadows, the North Carolina Republican who chairs the conservative House Freedom Caucus. "Meals on Wheels, even for some of us who are considered to be fiscal hawks, may be a bridge too far."

McCumber says that when he and colleagues walk the halls of Congress making their case, "There's almost universal philosophical support for the meals program. But there's an entrenched, emotional connection to the notion that government is just bad. Somehow they believe we just can't afford it, even if the stories are heartbreaking." After the press reported on Mulvaney's plans to cut Meals on Wheels funding, McCumber said his office was deluged with calls from worried recipients. He sent a letter to all clients reassuring them they would still get food. "The news was overwhelming to them. But one story broke my heart." A man who was receiving in-home hospice care two days a week and a Meals on Wheels delivery three days a week called to stop his service. "There are people who need this more than I do," he said.

If only the US government were as generous.