Defending the Indefensible: Meals on Wheels

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In early 2017, the White House budget chief Mick Mulvaney defended cuts to welfare programs such as Meals on Wheels stating that “Meals on Wheels sounds great — again, that’s a state decision to fund that particular portion to. But to take the federal money and give it to the states and say, look, we want to give you money for programs that work — I can’t defend that anymore. We cannot defend that anymore.” This statement comes despite clear evidence of significant, positive health, social and economic effects of at-home food delivery programs like Meals on Wheels and has been widely criticized on both sides of the aisle.

Meals on Wheels America is a non-profit, national organization that supports local nutrition organizations, most of whom serve seniors as their principal population. Meals on Wheels America (and its local chapters) provides nutritious meals and social visits to homebound seniors as well as safety checks in case its clients need medical attention. In some locations, Meals on Wheels has even expanded to provide pet food delivery, home repair services and transportation to doctor appointments. These services are free to seniors in the program as Meals on Wheels is financially supported by donations, grants and federal/state funding.

The budget cuts proposed by the Trump administration would do nothing but reduce the number of meals and other services provided by Meals on Wheels to the detriment of all American citizens. The proposed cuts would reduce Meals on Wheels funding nationwide by 35%. This would reduce the number of meals provided by Meals on Wheels yearly from approximately 2.2 million to 1.4 million, not to mention the other services that may be reduced. This reduction is further complicated by the fact that the fastest growing demographic in the United States is the population 85 and older, the same population that is most likely to need Meals on Wheels services. This would mean that the budget cuts would result in fewer meals and services, while the number of people in need continues to grow.

Some, such as budget chief Mulvaney, still question the effectiveness of programs like Meals on Wheels despite evidence to the contrary. For example, Wright et al. conducted a study on seniors pre- and post-Meals on Wheels enrollment and found that, after enrollment in the program, the seniors increased their average calorie intake from approximately 1200/day to 1600/day and their average protein intake from approximately 54 grams/day to 73 grams/day. Enrollment in this Meals on Wheels program resulted in 41.2% of seniors having significant increases in food security (as measured by the USDA Food Security Scale). Additionally, the seniors in the program saw significant, positive changes in their sense of well-being and loneliness (as measured by the WHO emotional well-being questionnaire and the UCLA 3-item loneliness scale). Feelings of loneliness were approximately halved and sense of well-being increased by approximately 28%. The links between nutritional deficiencies and morbidity in elderly populations are well-documented and malnourished seniors have significantly reduced wound healing and surgical recovery time as well as increased hospital readmission rates and mortality. Moreover, psychosocial issues among seniors, such as depression or isolation, contribute to nutritional deficiencies, further highlighting the need for programs like Meals on Wheels.

Research has found that not only is Meals on Wheels and other senior meal delivery programs effective at improving the health of seniors, it provides net positive savings with regards to senior healthcare costs. For example, one study analyzed the projected healthcare savings if all states were to expand senior meal deliveries to an additional 1% of eligible people. They found that this would result in approximately 400,000 more seniors served every year and nationwide Medicaid savings of $109 million. They found that the median savings of each state would be $462,120, however, some states, such as Florida, would likely incur net losses under the program. The authors suggest allowing states to opt-in to such a program would likely result in significant enrollment as most states could expect substantial savings. Further analysis by Thomas indicated that, between 2005-2009, for every 1% of the population over the age of 65 that receives personal care services (such as Meals on Wheels) there is a proportional 0.8% decrease in the number of low-care resident in nursing homes. This analysis indicates that, if current trends continue, increased spending on personal care services for elderly individuals can reduce the number of nursing home residents, resulting in a significant cost-savings as personal care services are generally less expensive than nursing homes.

A recent, novel idea for expansion of senior meal delivery programs is the use of drones to deliver meals in areas where there are too few volunteers, too large a population at need, or when delivering meals with a vehicle is inefficient (such as in densely populated or very rural areas). The use of a drone may not provide the same social support as having a person come and hand-deliver a meal, but it would still provide meals to seniors who may otherwise be nutrient deficient and the drone operator could still check in on the recipient to ensure they do not need medical attention. Start-up companies like Starship Technologies are already delivering take-out food in cities across the United States and Amazon is beta-testing drone delivery of packages. If these programs are successful a drone-based meal delivery system for seniors could be built on similar architecture. Drone delivery is unlikely to entirely replace hand-delivery anytime soon, but could still provide notable benefits and allow volunteers to visit and deliver meals to more people.

Meals on Wheels and other senior meal delivery programs have proven themselves to not only be effective at improving the health and mental well-being of seniors but also reducing the fiscal burden of healthcare costs posed by an ever-growing population of seniors. Those who claim programs like Meals on Wheels are not effective have either not read the research or have a vested interest in shifting the costs of senior care to insurance markets and the American taxpayers. Cutting the budget of Meals on Wheels will result in more depression, more malnourishment and more healthcare costs among American seniors while increasing the number living in isolation and starvation. If budget chief Mulvaney doesn’t want to stand up for programs like Meals on Wheels, then American citizens must.

Tej Mahta

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