A Dining Dilemma
By Lori Lindner
JOHNSON COUNTY– Increasingly, as state and federal dollars are cut from social assistance programs, local organizations and individuals are attempting to absorb the costs.
When a funding shortfall empties the plates of our nation’s elderly– those who rely on home-delivered meal programs like Meals on Wheels or who regularly attend congregate dining sites– it can become a matter of eating or going hungry.
Beyond getting proper nutrition, studies have shown that regular, meaningful contact with other people is crucial to overall well-being, and senior dining programs throughout Johnson County have successfully helped to provide both.
However, in the past year, the county’s on-site senior dining programs that offered free meals and were funded at least in part by the Older Americans Act (OAA) dwindled to just two: Solon Old Gold Dining, and a daily meal site at the Senior Center in Iowa City.
North Liberty has managed to maintain a congregate meal opportunity every other Friday, but participants must pay. The City of Coralville sponsors a monthly potluck, providing the main entree on the city’s tab and asking seniors to furnish side dishes. Lone Tree voluntarily cut its funding relationship with OAA– relinquishing about $60,000 per year– to purchase its own kitchen equipment and cook its own meals. After a one-time donation from Johnson County, the City of Lone Tree is now that program’s biggest benefactor. Funding to assisted living facilities disappeared, eliminating the free meal program at Emerson Point in Iowa City.
As of Jan. 1, 2014, there will be just one OAA congregate site remaining in Johnson County.
According to Susan Wehr of Elder Services, Inc. (ESI), an average of 50 meals are served at congregate sites and 155 home delivered meals are served in rural Johnson County each day.
But Solon’s dining site, like so many well-intentioned programs that desperately seek to stay afloat on ever-shrinking resources, began taking on water.
In 2012, the Old Gold Dining site council learned from its food and funds provider ESI that attendance numbers at their congregate program no longer warranted a three-hour site manager, but they could accommodate the loss of staff by serving ready-to-eat meals that had been packaged and sealed. Known as “Olivers,” for the company that manufactures the packaging equipment, the same meals would be delivered to Solon’s homebound participants as well. In fact, based on client need, home-delivered meals would become a higher priority than feeding folks at a congregate site.
The changes upset Solon’s site council representatives for several reasons. First, the seals on the meal trays are hard to open, especially for certain clients with arthritic fingers. Second, the portions were reduced and the meals were not filling. Perhaps most importantly, they feared the method of serving pre-packaged meals took away the personal, meaningful interactions most people looked forward to when they gathered at Solon United Methodist Church’s Fellowship Hall each day.
Therefore, a group of program advocates and site council members determined they would not bail out on Solon’s seniors, but fight to keep the program alive and maintain its personal, vibrant character. They sought $7,500 for a site manager’s position, and received $2,500 from the City of Solon and $2,500 from the Johnson County Board of Supervisors. The final third came in the form of OAA dollars by way of long-time supporter ESI.
But that relationship will end as of Dec. 31, and Solon’s Old Gold Dining site council is swimming upstream again.
Historically, senior dining sites have been funded by the federal OAA dollars given to regional agencies, which in turn funnel money to county-level partner entities, which then disperse dollars to local programs.
In Johnson County, the funding mechanism starts with Heritage Agency on Aging, a department of Kirkwood Community College in Cedar Rapids. The Heritage Agency gives funds to ESI as one of its partner agencies. ESI provides direct services and financial resources to community partners that assist older residents, like Old Gold Dining or RSVP.
The Heritage Agency is one of Iowa’s six regional Agencies on Aging, or AAAs, responsible for distributing federal dollars generated by the OAA. The act was introduced in 1965, and has been reauthorized every year since, giving many the impression that it is mandated provision to assist the nation’s elderly, much like Social Security.
But it’s not.
Because it is funded with discretionary federal dollars, OAA is as susceptible to budgetary woes as the national Farm Bill or education spending.
And that’s just part of the squeeze felt by senior nutrition programs, said Ingrid Wensel, director of the Heritage Agency on Aging.
“It’s a little more complicated than saying our federal funding has remained flat or slightly reduced over the last several years,” said Wensel. “That’s true, but on top of that, we’ve seen dramatic food cost increases, transportation costs have been a significant issue, and sequestration impacted us as well.”
Further, Wensel said, in 1965 when the OAA was instituted, life expectancy was shorter, and therefore the incidence of chronic illness that can accompanying aging was less.
“We’ve learned to extend life, but not necessarily the quality of life. Now, as opposed to an elderly population that was served primarily at congregate meal sites– relatively healthy adults gathering for the very real and very important socialization aspect that promotes mental health and community involvement– the (OAA) program has turned into one that really serves the most desperately low-income individuals, often with multiple health care needs in a homebound situation. Because of that, we have not been able to keep pace with the needs,” Wensel said.
And voluntary contributions for meals from participants are also on the decline at a regional level.
“For many years, while we had a relatively healthy constituency, they were able to contribute more to the program. As we see individuals age and become increasingly frail, often these individuals outlive their resources and they are unable to contribute,” Wensel said.
Even programs that receive stable voluntary contributions like Solon’s, are not safe from funding shortages.
“As an area agency, we are charged with providing a regional system of support,” Wensel said. “So when we get voluntary contributions, they are not necessarily put back into that small community. They are pooled at the regional level and then distributed.”
One can rightfully argue that it doesn’t make sense to depend upon the poorest, most frail constituents to support a program in need of money, or that contributions from one program should go to support another, Wensel said. “But at this point in time, (that aspect) drives how many meals we are able to provide.”
The OAA wants agencies to target the poorest populations– those in most desperate need– but it also boosts justification for next year’s funding. Heritage typically receives government reimbursement at about 50 cents per meal, while the meals on average cost about $5 each to serve.
It has required Wensel and Heritage’s volunteer leadership board to stretch every dollar to its maximum efficiency, resulting in what Wensel described as painful prioritizing and difficult decision making.
“Communities are put in the position to demonstrate they can bring additional resources to bear, or I have to work with my board to decide where those dollars go,” Wensel said. “It is sickening, and I hate it. Tim (Getty) has to go and look in the faces of these older adults who are not getting meals.”
Getty is Heritage AAA’s healthy living and nutrition coordinator, and he helps decide how to spread the agency’s increasingly thin resources.
Heritage AAA serves seven counties: Benton, Cedar, Linn, Johnson, Jones, Iowa and Washington. Every two years, the agency receives applications from local-level providers in each county seeking OAA dollars to fund assistance to the elderly– transportation, mental health and nutrition services, for example. Heritage staff and its board weigh the requests against available funds to determine how to get the most bang out of every buck and stay within the federal guidelines for distributing OAA monies.
Those numbers are calculated on such complex and interconnected factors that it’s very difficult to explain Heritage’s spending decisions– why one county or service provider may receive fewer Heritage’s OAA dollars than its neighbor.
“How do we decide what communities get meals? A lot of it has to do with what resources they can bring to bear to support the program,” Wensel said, and offered just one example.
If the cost of a meal averages $3, and one provider asks for the full $3, while another can bring its own resources in the form of donations, city or county funding to make up $1 of the per-meal cost, Heritage can fund more meals at $2 than at the $3 cost.
“Keep in mind, the more meals I can serve, the more money I can bring in next year. It’s not that I don’t want to be equitable between providers, but if that local community brings local dollars to build up that one extra dollar, that’s significant. It can cause resentment and frustration, because some communities are very poor and don’t have the taxed resources of others,” Wensel said.
In fact, other meal programs in surrounding counties aren’t suffering the same demise as those in Johnson County, but an telephone poll conducted with congregate dining managers in Tipton, Anamosa, Lisbon and Belle Plaine– all sites in counties served by Heritage AAA– found that each program have experienced some sort of diminished funding, and had dealt with it in different ways; by trimming personnel hours, holding community fundraisers, and seeking funding from outside agencies or governments.
“On the surface it can look very inequitable, but there are many complicating factors,” Wensel said.
One such factor is that federal dollars from the OAA– 63 percent of the agency’s nutrition budget– aren’t the only resources at play; 37 percent of the money Heritage allocates comes from grant sources, corporate donations, and private donors and confidential voluntary contributions from nutrition program participants.
On Dec. 8, Heritage held a Fill the Plate Telethon to raise additional dollars for nutrition programs. It was the second annual event for Heritage, prompted by an 83,000 reduction in the number of meals Heritage was able to fund in fiscal year 2013. This year’s telethon raised $104,500 to offset the deficiency.
All telethon contributions go directly to feeding the elderly, but even those donations are part of a complex funding process for Heritage, and a function of its partnership with the Kirkwood Community College Foundation.
Some telethon contributions are for designated recipients, while others are unassigned and fall into a general pool for distribution among all partner providers.
The formula is based on a percentage of meals served in each area, Getty added.
“We have to justify to the Kirkwood Community College Foundation our background (for spending decisions). This is not just willy-nilly. There is a whole process we have to go through to even access those funds,” Getty said.
Data required by OAA also helps inform Heritage’s spending decisions. Using a participant intake form, Heritage tracks things like recipients’ ranges of income; whether they live in rural, suburban or urban settings; how many meals they receive; individual levels of nutritional risk; dietary restrictions; and even things like whether or not participants have and can operate a microwave oven or a stove.
Getty and his peers have also negotiated with regional food vendors to maximize purchasing power for a group of meal providers, allowing them to buy more for less.
“I think that’s pretty incredible. It shows the amazing partnership we have with our local providers,” said Wensel. “It would be much easier on us to have a national provider. But we’d have a lot less meals and poorer service.”
Further, the OAA requires agencies like Heritage to educate state and local legislators on issues important to older adults.
Ultimately, none of these actions– telethons, government education, or local advocacy–was enough to save Solon Old Gold Dining in the service model it had built over the course of 33 years.
Wensel said the change to the service model is an unfortunate reality.
“Under the OAA, those that receive priority are the homebound. It’s not that we don’t value congregate meals, but we increasingly have to figure out how we can serve the most frail individuals. It’s not pretty. These are human beings, and this is food,” she said. But with statewide research indicating that the average nursing home resident depletes his or her resources and begins accessing Medicaid within 5.5 months of initial placement, it’s a compelling reason to sustain independent living as long as possible, Wensel believes. “The cost-effectiveness of keeping someone in their home through supportive nutrition services is a huge bang for the buck.”
While home-delivered meals are more expensive to serve– by far, Getty said– resources have to follow the people. In many counties, rural residents are moving closer to medical facilities and urban areas where other options like food pantries or church meals are available.
For Solon Old Gold Dining participant Sandy Hanson, it’s nearly apples to apples, regardless of the funding intricacies.
“Our congregate meal attendance also focuses on the frail– people with oxygen, wheelchairs and walkers,” Hanson said. “Attending congregate meals promotes mobility, sociability, plus nutrition, which seems to focus on the same group of challenged seniors.”
Hanson said attending senior dining and its accompanying programs has changed some people’s lives for the better; people who might otherwise sit at home, eat a packaged meal alone, and lose important social contact all together.
Bob Welsh of Iowa City has served as a pastor and an advocate for aging citizens for many years. A member of the Johnson County Task Force on Aging, the Johnson County Livable Community for Successful Aging policy board, and the Heritage Agency’s on Aging Advisory Council, Welsh learned the lesson early in his career as a minister.
“A lady in my congregation passed away, and I later found out that her death was due to malnutrition,” Welsh said. “And she was not poor. I learned that when you are old and single, there is not much incentive to fix yourself a balanced meal.”
As for mental stimulation and sociability, Welsh added, “everybody benefits from both of those.”
Welsh served on Heritage’s budget and planning committee as well, and has seen the OAA program’s trending nationwide to serve more home-delivered meals.
“I’ve been a strong believer that with congregate meals, nutrition is one very important part, but sociability is an equally important part,” Welsh said. “From my experience through the years, there are people who, if it wasn’t for them coming to the congregate meal site, would probably spend the entire day in their pajamas. So just getting up, getting out and being with other people is tremendously important. And I think we often lose sight of that. It’s not just, a nutrition program.”
It’s the same philosophy now buoying the Old Gold Dining advocates in Solon.
Since severing ties with ESI, Solon’s Old Gold Dining will see internal changes beginning Jan. 1. Food will be purchased from the Solon Retirement Village, to allow for continued family-style service of home-style cooking, and meals will still be served at the Solon United Methodist Church. However, participants will be required to pay, instead of relying on free-will donations. In an informal poll, Hanson said, most seniors said they could pay the $3.25 per meal, but there are at least two recipients of homebound meals who cannot afford the price of the meal.
Assisting them, and finding a way to secure future funding for meal delivery drivers and the congregate site manager– currently Duane McAtee, who takes reservations, picks up the food, packages it for home delivery and sets up and cleans the kitchen for the on-site meal, among many other duties– will be the next funding hurdles to overcome.
Last Tuesday, the Johnson County Board of Supervisors agreed to sustain the remainder of their financial commitment through the end of the fiscal year, but made it clear that as of July 1, 2014, the county was unlikely to give anything in the future.
Supervisor Janelle Rettig said she viewed the site manager as an employee of the Retirement Village, even though he would be under the direction of Old Gold Dining site council.
“The (Solon) care center, while wonderful, is a for-profit business, and the site manager is there at the care center’s behest. If you use county money to advertise their business, trying to recruit people to live there, I see that as a conflict,” Rettig said. “I don’t know how county money can be involved in a for-profit business. Therein lies my problem with this.”
Further, supervisor Rod Sullivan feared setting the proverbial precedent.
“Right now we are making a small investment in this program and are willing to do that. What we can’t do is substitute what the federal government has been doing all these years. What I fear is, all over the county, seniors will (ask us to fund other nutrition programs) and financially we can’t.”
By OAA rules, Wensel and the Heritage Agency on Aging can also be of no further assistance in operating Solon’s congregate site as it has been.
“When I talk with people in communities like Solon or Belle Plaine who are very frustrated and angry with us, I understand why,” Wensel said. “But unless there is a minimum threshold of participation, it is not viable. Not because we don’t care about those people– and I can see why they would think that in some cases– it is just not viable for us to continue to do so. It used to be; we could make it work 20 years ago, but not anymore.”
Like the tables at former congregate meal sites across the county, it’s got Hanson and Old Gold Dining council members feeling empty.
“We’re going to need long-term, consistent funding to keep this site open and I am at a bit of a loss how to do it,” Hanson said. “We understand everybody is crunching dollars, so we know we might lose our program, but we are trying to do the best for our seniors, the population of which has increased quite a lot over the last few years.
“This is our senior center. Solon has nothing else.”