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The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
March 30, 2020
The Health of Aging Populations Population Health COVID-19
Emma Tucher Read Bio
Kali S. Thomas
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We know that older adults are at increased risk of becoming seriously ill from COVID-19, but we cannot forget the epidemic’s effects on their basic needs. COVID-19 has led to the restricted access and closing of senior centers and churches, many of which offer group meals through a large federal–state nutrition program for older adults. The closure of these meal sites will likely have harmful effects on the health and well-being of their participants.
In 2018, the senior congregate nutrition meal program—funded through the Older Americans Act (OAA) and bolstered by a state match and charitable contributions—provided over 71.5 million healthy meals to more than 1.5 million, or about 2% of, people over age 60. The majority of recipients are over 75 years of age and live alone.
The meals offered at congregate sites are designed to reduce hunger and food insecurity, as well as promote socialization, health and well-being, and delay the onset of adverse health conditions. Our internal analyses of the 2018 National Survey of Older Americans Act Participants (NSOAAP) suggest that for individuals who receive congregate meals at least once per month, 57% receive at least half of their total daily food intake from the program. While congregate meals reduce food insecurity among older adults and improve their diet quality, about 18% of those who receive them still have unmet food-related needs. This rate of food insecurity is nearly double the national average for older adults (7%). Overall, participants lack sufficient money or food stamps to buy food and make trade-offs between food and medications, paying utilities, or rent, and skip meals at least once per month due to insufficient money for food. These needs increase the importance of congregate meal programs in the lives of this vulnerable population.
In addition to offering a nutritious lunch, congregate meal programs positively affect the health and well-being of older adults. Our analyses suggests that 82% of participants report that their congregate meal program improves their health, 86% report that the meals make them feel better, and 69% report that the meal program helps them remain in their homes. These benefits lead to reduced use of health care services: a recent national evaluation of the congregate meals program suggests participants were less likely to experience a hospitalization (8.5% vs. 13.7%) or emergency department visit (5.4% vs. 10.4%) than similar individuals who did not participate in the program. These findings were more pronounced among lower-income participants.
Congregate meal programs also provide much-needed socialization to older adults living alone. Among congregate meal participants, more than 87% report seeing their friends more because of the lunch program. Social isolation has been estimated to be on par with smoking, obesity, and other adverse health behaviors in its link to morbidity and mortality.
On Friday, Congress passed a COVID-19 relief package that included $955 million in funding for the Administration for Community Living (ACL) to support nutrition programs, home- and community- based services, family caregiver support, and expand protections for people with disabilities. It also included $15.5 billion in additional funding for the Supplemental Nutrition Assistance Program (SNAP) to ensure all Americans receive needed food. While this funding is an incredible first step in addressing the current crisis and responding to the needs of vulnerable older adults, states must decide how best to utilize these resources.
There are a number of ways states can address the distinct challenges that face older adults in meeting their nutrition and socialization needs. For example, a portion of the funding could be directed to congregate meal programs to enable grab-and-go lunches. However, this approach could be challenging for the large portion of participants who rely on assistance to get to the meal site. With the enhanced funding, states could also consider temporarily turning to the robust network of home-delivered meals providers, such as Meals on Wheels. This would only be possible with additional resources as these organizations are over-stretched as they serve the additional older adults needing their services during these times.
Approximately 4.8 million older adults receive SNAP, including 8% of OAA service recipients. Given the risks posed to older adults from congregating and shopping for groceries, states could consider expanding SNAP’s pilot free online grocery shopping and delivery benefit to more older adults.
Finally, we should all realize the importance of checking-in on our older neighbors. With the majority living alone, many older adults are limited in their social networks and social support and would benefit from individuals able to drop off groceries, prepare meals, and pick up prescriptions. Another way states can foster connectivity could be through technology, such as participation in a virtual senior center program. Evaluations of virtual senior centers suggest they reduce participants’ feelings of social isolation and help them feel more connected.
Although some states and individual congregate meal programs have made strides to ensure access to nutrition and social support during program closures, it will require a coordinated national effort with more federal resources and flexibility for states to develop short- and long-term plans that will minimize the risks for vulnerable older adults who are reliant on these programs for nutrition and socialization. This is not only the right thing to do to maintain older adults’ health, but it should be cost-effective as well; preventing hospitalizations and emergency department visits will reduce the impact on state and federal budgets and already overburdened hospital systems as many of the participants are enrolled in Medicare and/or Medicaid.
Given the links among food insecurity, social isolation, and health care utilization, we cannot overstate the benefits congregate meal programs offer to older adults’ ability to remain healthy and situated in their communities.
Emma Tucher is a doctoral student of health services, policy, and practice in the Brown University School of Public Health.
Kali S. Thomas, PhD, is an associate professor of health services, policy, and practice in the Brown University School of Public Health and an investigator in the Center of Innovation for Long-Term Services and Supports at the Providence VA Medical Center.
Nov 16, 2020
Jul 16, 2020
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