Critical food programs for older adults, such as Meals on Wheels, avoided major reductions in federal support when Congress finally approved a spending plan last month. But for the third year in a row, lawmakers froze funding for these efforts. And after taking into account rising costs and a growing population of frail older adults, no increase in funding inevitably will result in reduced services and increasing numbers of hungry seniors.

It is a little like someone who had two relatives move in with them but has not gotten a raise in three years. Yes, they still have a job. But it is a lot harder to feed everyone.

Their Benefits

Meals programs provide critical nutrition for older adults. About 1 in 7 who visit hospital emergency departments suffer from malnutrition, often because they cannot shop or cook for themselves.

But meals programs do more than feed people. They also provide an important personal touch for often-isolated seniors. The people who deliver Meals on Wheels, the best known of these initiatives, may be one of the few visitors home-bound older adults see. And congregant meals programs, such as those for people attending senior centers, also help older adults make important human connections.

They also may provide an early warning system that can help identify those losing their ability to care for themselves. These programs keep older adults healthier, reduce ED visits and hospital readmissions, and lower overall health care costs, especially for Medicare.

These programs also are part of a suite of services that are necessary to help people stay at home. They also include adult day, falls prevention, energy assistance, and others—all of which also had their budgets frozen. Yet, they can reduce the need for more costly nursing home care that may save Medicaid money.

The Wrong Pocket

Yet, these programs suffer from what economists call the wrong pocket problem.

In Congress’s fragmented budget system, lawmakers who set spending levels for programs such as Meals on Wheels have no responsibility for Medicare or Medicaid. And congressional scorekeepers won’t credit them for health care or nursing home cost savings.

There are about 5,000 Meals on Wheels programs throughout the US. On average, they get about one-third of their funding from the Older Americans Act home-delivered meals program that Congress froze. But 60 percent of these local programs get at least half of their funding from the federal government.

The rest is supported by state and local governments and private philanthropy.  And some  local money comes from separate federal grants whose funding Congress also froze.

Waiting Lists

Yet, the need for meals among older adults far exceeds the ability of these local organizations to provide them. Meals on Wheels estimates that about 46,000 seniors are on waiting lists for its services. The group says these older adults will have to wait an average of four months but some won’t get deliveries for as long as two years.

Some programs have as many as 5,000 people waiting for help. The most challenged are in rural communities and in red states such as Texas and Florida.

Flat funding will only increase those wait lists. Food costs are expected to increase by 4% this year. And while many of those who deliver food are volunteers, local programs also have paid staff. And labor costs are rising too.

These programs face other challenges as well, due to Trump Administration decisions and policy gridlock.

Last year, the Administration cut staffing by nearly 50% at the office that administers Older Americans Act programs such as the meals initiatives. Because remaining staffers have been working overtime to manage their programs, payments still are going out in a timely way, advocates say.

This is especially important because local community organizations are reimbursed after they purchase and deliver food. These cash-strapped groups cannot manage for long if those federal payments are late.

That’s what happened during last year’s government shutdown. Over those five weeks, local groups scrambled to keep their lights on.

Government staffing cuts also mean providers often can’t get questions answered in a timely way. That creates uncertainty for the organizations and those they support.

Members of Congress broadly support OAA and its individual programs such as Meals on Wheels. It is one of those Capitol Hill oddities: They are wildly popular among voters and, indeed, lawmakers repeatedly refused Trump Administration efforts to slash their budgets.

Yet, while few oppose funding increases, it never quite happens. The battle will be renewed again later this Spring when the Administration proposes its budget framework for next year. Chances are, Congress will freeze the budget for senior services yet again since it will be unwilling to engage in a bitter election-year spending battle.

And, while advocates will again say it could have been worse, even more older adults will lose access to important nutrition programs.