Starving seniors: How California’s aging are falling through the cracks

by Laura Ungar and Trudy Lieberman

SAN JOSE, Calif. — In the neighborhoods around San Jose, more than 1 in 9 seniors struggle to get enough to eat.

They are among the millions of seniors across the country who quietly go hungry as the safety net designed to catch them frays. Nearly 8% of Americans 60 and older were “food insecure” in 2017, according to a recent study released by the anti-hunger group Feeding America.

That’s 5.5 million seniors who don’t have consistent access to enough food for a healthy life, a number that has more than doubled since 2001 and is only expected to grow as America grays.

Overall, California’s rate hovers at 8.4%, worse than the national average. In the San Jose metro area it is 11.5%, and in Riverside it is not far below that.

While the plight of hungry children elicits support and can be tackled in schools, the plight of hungry older Americans is shrouded by isolation and a generation’s pride.

One of the main federal programs helping seniors is starved for money. The Older Americans Act — passed more than half a century ago as part of President Lyndon Johnson’s Great Society reforms — was amended in 1972 to provide for home-delivered and group meals for people 60 and older. But its funding has lagged far behind senior population growth and U.S. inflation.

Home-delivered and group meals have decreased by nearly 21 million since 2005, according to a Kaiser Health News analysis of federal data. Only a fraction of those facing food insecurity get any meal services under the act; a U.S. Government Accountability Office report examining 2013 data found 83% got none.

With the act set to expire Sept. 30, Congress is now considering its reauthorization and how much to spend going forward.

Meanwhile, according to the U.S. Department of Agriculture, only 45% of eligible adults 60 and older have signed up for another source of federal aid: SNAP, the food stamp program for America’s poorest.

For now, millions of seniors — especially low-income ones — go without enough to eat nationwide. Across the nation, waits are common to receive home-delivered meals from Meals on Wheels, a network of 5,000 community-based programs and a crucial provider of food for seniors.

“It’s really sad because a meal is not an expensive thing,” said Sally Jones Heinz, president and CEO of the Metropolitan Inter-Faith Association, which provides home-delivered meals in the Memphis area. ”This shouldn’t be the way things are in 2019.”

In Santa Clara County, Calif., where San Jose is located, the number of seniors getting free or low-cost meals dropped 7.4% from fiscal 2015-16 to fiscal 2017-18, according to a report by the county on its $9.1 million senior nutrition program.

James Ramoni, who directs the county’s aging and adult services, said he is now concerned that some seniors may be forgoing meals over the fear that availing themselves of publicly funded assistance could jeopardize their immigration status.

A recently finalized Trump administration rule, which has weighed on immigrant communities since it was first proposed last autumn, allows federal officials to deny green cards and visas to people who receive food aid, housing vouchers or Medicaid benefits for more than 12 months in any three-year period.

Senior nutrition programs are excluded from this “public charge” rule, but the fears are hard to counter.

Seniors without steady, nutritious food may wind up in hospitals because malnutrition exacerbates diseases and prevents healing. That drives up Medicare and Medicaid costs, hitting taxpayers with an even bigger bill. A recent analysis by the Bipartisan Policy Center found that Medicare could save $1.57 in medical costs for every dollar spent on home-delivered meals for chronically ill seniors after a hospitalization.

Most hospitals don’t refer senior outpatients to Meals on Wheels, and advocates say too few insurance companies get involved in making sure seniors have sufficient food to keep them healthy.

Edwin Walker, a deputy assistant secretary for the federal Administration on Aging, acknowledged waits are a long-standing problem but said 2.4 million seniors a year benefit from the Older Americans Act’s group or home-delivered meals, allowing them to stay independent and healthy.

Still, some slip through the cracks. Widower Robert Mukes, 71, starved to death on a cold December day in 2016, alone in his Cincinnati apartment.

The coroner listed the primary cause of death as “starvation of unknown etiology;” death records show the 5-foot-7 man weighed just 100.5 lbs.

A Slow Killer

James Ziliak, a University of Kentucky poverty researcher who led the Feeding America study, said food insecurity shot up with the Great Recession in the late 2000s, peaked in 2014 and shows no signs of dropping to pre-recession levels.

While older adults of all income levels can go hungry, rates are highest among seniors in poverty. And more than 17% of black seniors and 16% of Hispanic seniors are food insecure, compared with fewer than 7% of white seniors.

A host of issues combine to set those seniors on a downward spiral, said registered dietitian Lauri Wright, who chairs the Department of Nutrition and Dietetics at the University of North Florida. Grocery store visits get harder if they can’t drive. Expensive medications leave less money for food. Chronic physical and mental health problems sap stamina and make it tough to cook. Inch by inch, hungry seniors decline.

And, even if it rarely kills directly, hunger can complicate illness and kill slowly.

Malnutrition blunts immunity, which already tends to weaken as people age. Once they start losing weight, they’re more likely to grow frail and to die within a year, said Dr. John Morley, director of geriatric medicine at Saint Louis University.

In June, the U.S. House passed a $93 million increase to the Older Americans Act‘s nutrition programs, raising total funding by about 10% to $1 billion in the next fiscal year. In inflation-adjusted dollars, that’s less than in 2009. And it still has to pass in the Republican-controlled Senate, where the proposed increase faces long odds.

U.S. Rep. Suzanne Bonamici, an Oregon Democrat who chairs the Civil Rights and Human Services Subcommittee, expects the panel to tackle reauthorization of the act soon after members return from the summer recess.

“I’m confident the House will soon pass a robust bill,” she said, “and I am hopeful that the Senate will also move quickly so we can better meet the needs of our seniors.”

In the meantime, the need for home-delivered meals keeps increasing every year, said Lorena Fernandez, who runs a meal delivery program in Yakima, Wash.

A devastating phone call brought that home for Kim Daugherty, executive director of the Aging Commission of the Mid-South, which connects seniors to service providers in the region. The woman on the line told Daugherty she’d been on the waiting list for more than a year.

“Ma’am, there are several hundred people ahead of you,” Daugherty reluctantly explained.

“I just need you all to remember,” came the caller’s haunting reply, “I’m hungry and I need food.”

California Healthline senior correspondent Barbara Feder Ostrov contributed to this report.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. 

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