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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 

Printed for the use of the Committee on Health, Education, Labor, and Pensions 

( 

Available via the World Wide Web: http://www.gpo.gov/fdsys/ 
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 

JEFF BINGAMAN, New Mexico 

ROBERT P. CASEY, JR., Pennsylvania 

KAY R. HAGAN, North Carolina 

JEFF MERKLEY, Oregon 

SHELDON WHITEHOUSE, Rhode Island 

TOM HARKIN, Iowa (ex officio) 

RAND PAUL, Kentucky 

RICHARD BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

ORRIN G. HATCH, Utah 

LISA MURKOWSKI, Alaska 

MICHAEL B. ENZI, Wyoming (ex 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) 

(1) 

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 
2 

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. 
3 

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. 
4 

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, WalMart 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 
5 

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? 
6 

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 LongTerm 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 
7 

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 major-
8 

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. 

ity 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. 

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. 
9 

2Serving Elders at Risk—National Evaluation of the Elderly Nutrition Program, 1993–95, pp. 

117–18. 

• 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

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 admis-
10 

3 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select 

AGID. 

sion, 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

For the majority of program participants, the program provides more than onehalf 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 multiyear, 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. 
11 

• 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 capacitybuilding 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 longterm 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: 
12 

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 longterm 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 inde-
13 

pendent. 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. 
14 

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 
15 

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. 
16 

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. 
17 

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 ex-
18 

pensive 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 
19 

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 
20 

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. Homedelivered 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 MedicareMedicaid 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 
21 

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 homedelivered 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, 
22 

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 wellbeing 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. 
23 

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 costeffective food and nutrition services in home and community-based social and longterm 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. 
24 

• 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 communitybased 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 
25 

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 commu-
26 

nities, 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 communitybased 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 
27 

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 Nutri-
28 

tion 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. 
29 

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 ex-
30 

pected 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:] 
31 

1Pub. L. No. 89–73, 79 Stat. 218 (codified as amended at 42 U.S.C. §§3001–58ff ). 2GAO, 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). 3GAO, Older Americans Act: More Should Be Done to Measure the Extent of Unmet Need for 

Services, GAO–11–237, (Washington, DC: February 28, 2011). 4We 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. 5GAO, Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue, GAO–11–318SP, (Washington, DC: March 1, 2011). 6Statutory 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). 

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. 

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. 

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 selfreported 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. 

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 bil-
32 

7Our 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. 

lions 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. 

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: 
33 

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. 9The CPS asked seniors whether they received home-delivered or congregate meals, but did 

not specify the source of the meals. 10We 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. 

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

Table 1: Percentages of Low-Income Older Adults With Each Characteristic of Likely Need and 

Percentages Who Did and Did Not Receive Meals Services 

Characteristics of likely need 

Have 

each 

characteristic 

Received 

homedelivered 

meals 

Did not 

receive 

homedelivered 

meals 

Received 

congregate 

meals 

Did not 

receive 

congregate 

meals 

Received 

either 

type of 

meal 

Received 

neither 

type of 

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. 2We 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. 
34 

11OAA title III authorizes a supportive services and senior centers program that covers, for 

example, health, transportation, ombudsman, nutrition, and education services, as well as homedelivered 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). 

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). 
35 

12 Allison Barrett and Jody Schimmel, Mathematica Policy Research, ‘‘Multiple Service Use 

Among OAA Title III Program Participants,’’ September 2010 (Research Brief). 13GAO, 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). 

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. 

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. 

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 out-
36 

14The 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. 15 42 U.S.C. §3012(a)(26). 

comes 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. 

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. 

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 
37 

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 Program1

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). 1The 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 fellow-
38 

ship 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 highcost 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 un-
39 

able 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 
40 

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). 3German 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. 

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. 

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 
41 

4Sharkey 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. 5Penninx 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/MainlSite/FAQ/Basics/Abusers.aspx. 7 ‘‘Chronic Care: A Call to Action for Health Reform.’’ AARP Public Policy Institute. Accessed 

June 17, 2011 http://assets.aarp.org/rgcenter/health/beyondl50lhcr.pdf. 8 Ibid. 4 

9Gu 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. 10 ‘‘2011 Alzheimer’s Disease Facts and Figures, Fact Sheet.’’ March 2011, p1-2. Accessed June 

17, 2011 http://www.alz.org/documentslcustom/2011lFactslFigureslFactlSheet.pdf. 

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. 

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. 

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. 

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. 

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 
42 

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/ 

aginglstatistics/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/insight50lrecovering.pdf. 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. 14Fielding 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. 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. 

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. 

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; 

• 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; 

• 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; 

• 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; 
43 

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. 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. 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. 20 Ibid. 19. 21Stevens 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. 22 Englander F, Hodson TJ, Terregrossa RA. ‘‘Economic dimensions of slip and fall injuries.’’ 

J Forensic Sci. 1996 Sept; 41(5):733–46. 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. 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. 

• 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: 

• One in three adults 65 and older falls each year.17 18

• 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

• Older adults are hospitalized for fall-related injuries five times more often than 

they are for injuries from other causes.20

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

• By 2020, the annual direct and indirect cost of fall injuries is expected to reach 

$54.9 billion (in 2007 dollars).22

• 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

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. 

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 
44 

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. 

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. 

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 
45 

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 wellbeing. 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. 
46 

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. 
47 

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? 
48 

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 
49 

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. 
50 

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. 
51 

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 homedelivered 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 
52 

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.] 
53 

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 mid2000s, 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 communitybased 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., Stateonly 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; 
54 

• 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 longterm 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 Hun-
55 

ger 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) re-
56 

leased 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. 
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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 
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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, 
59 

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 lowincome 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, 
60 

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 
61 

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 costof-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 
62 

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 
63 

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, nonFederal 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 
64 

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 stateby-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 
65 

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 preconferenced 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. 
66 

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. 
67 

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. 
68 

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. 
69 
70 

1Funding 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. 

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 lifespan 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

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. 
71 

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. 
72 

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 textto-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 
73 

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.] 

Æ