The homebound elderly


Material Information

The homebound elderly the need for a national meals-on-wheels program
Physical Description:
iii, 99 p. : ; 24 cm.
United States -- Congress. -- Senate. -- Select Committee on Nutrition and Human Needs
U.S. Govt. Print. Off.
Place of Publication:
Publication Date:


Subjects / Keywords:
Older people -- Nutrition -- United States   ( lcsh )
Meals on wheels programs -- United States   ( lcsh )
Aged -- Nutrition   ( lcsh )
Food Services -- legislation -- United States   ( mesh )
Nutrition -- in old age -- legislation -- United States   ( mesh )
federal government publication   ( marcgt )
bibliography   ( marcgt )
non-fiction   ( marcgt )


Includes bibliographical references (p. 97-99).
Statement of Responsibility:
prepared by the staff of the Select Committee on Nutrition and Human Needs, United States Senate.
General Note:
Includes bibliographical references.
General Note:
At head of title: 94th Congress, 2d session. Committee print.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 028238803
oclc - 02819115
lccn - 76603438 //r91
lcc - HV1457 .C66 1976b
ddc - 362.6/3
nlm - AA2262
System ID:

Full Text
ol a 1. AA VjL/a.

04th Congran co jLM P'glTlllr
2d Somfon





prh9ed for the wo of the Sdect an Nobitba Hume n Nee&


For mL% by the 11 of Domnmb, U.S. GOTWUMBIMS FdaUS9 Offlft
UPC= D.C. 20402 Prks UA comb

-QIKORGE M009VERN, Sotdh Dake HERMAN A.--TA'L'xDdL' sit.
cirA R LE -PE Rcyl-11 is rHILIP A. HART, Miehigan RQBERTDa14E"-K8n
EDWARD M. KENNEDY,,,*psWAus9t$s RICMR&A" R, Pennalvanis
6AYLORD NELSON, XIM6ndu-' RT OT-1-ji./Ohii
ALAN CRANSTON, Califinmia -kiRlt 0. HATFIELD, Oregon
HUBERT H. HVMPHREY, Minnesota Ar"J. SToNm, Staff Diredor MAwwArz. L. MATz, Gmffd Cloumd



Chapter I. The history of meals on 3
II. Characteristics and needs of the homebound elderly------- 5
A. The characteristics of the general elderly population 5 B. The unique characteristics of the homebound- - ___ 12 C. How many need meals on wheels? ---------------- 14
III. Malnutrition and the aging ----------------------------- 19
A. General dietary needs of the elderly --------------- 19
B. Individual nutrition concerns in 22
C. Degree of malnutrition -------------------------- 22
1. Undernutrition -------------------------- 22
2. 43
D. The impact and effect of malnutrition- 44
E. Guidelines for action ---------------------------- 52
IV. Policy options for meeting the needs of the homebound
eldo& -------------------------------------------- 54
A. Food stAmps ----------------------------------- 54
B. Title XX of th&,Social Security 55
C. Title VII of the 01aii- Antericans Act 57
D. Private meals on wheels program ---------------- 58
Factors in meal cost ------------------------ 59
Sliding scale fees compound deficit------------ 59
E. S. 3585--The National Meals on Wheels Act of 1976- 60
V. Meals on wheels as an alternative to institutionalizationthe potential cost savings ----------------------------- 63
The 63
Potential cost savings ------------------------------ 64
Additional considerations --------------------------- 70
Summary ----------------------------------------- 71
VI. Additional program benefits ----------------------------- 72
A. Meals on wheels as a tool for information and referral- 72 B. The special role of the volunteer---- 75
Appendix A. S. 3585--A bill to amend the Older Americans Act of 1965
to provide a national meals-on-wheels program for the
elderly and for other 81
B. Can you starve in Washington? Yes.-reprint from the
Washingtonian, November, 1975 ----------------------- 86
Bibliography ------------------------------------------------------ 97

iDU CiiiiiiiiiiiTiiiiiiiIiiiiiii"iiiiiON ] iiiii

we-, we leased o releasithisisaffistudionithenutriiioalineed
at.i the elderly. iii iIIIiiii Iiiiiii
Mari~~ tha threeii millioniiiiiii Amrcn ove th ageioisixyiarcurentl

6mbound~~~~ an aeualto iefrteowms...................

th ilo oeon ldri'etznls -hn6,0 rsnl
recive boe-dfivredmeas. omeoun seioitizensiiiiiiiiii

OW tof lvig i rra aea, o ote bcoe..laed.ln.y. n

..,.W d lirfnsm o hirbsc ua nessuha

to ntriionand ompnioshi hav goe umet


The Federal Government has also made a strong commitment to
-the elderly through such programs as the Social Security Act, the Older Americans Act, and the Food Stamps program. However, this study points out the homebound elderly suffer from wide variety of unique problems. As a result, the existing programs have been unable to successfully reach this forlorn group. if we are to solve the situation of these elderly, we must make a direct allocation of support t6 a program whalt acpyT,&or, tei~rseilnes This staff study demobikths th4d^'tIA e* is a need for a National Meals-on-Wheels program, th A*$,Jdil a service, and that it is worth our investment. We firmly beievethat the Nationa Meals-on;Wheels Actis a model.,program, cdeerving Ih.spoto pi ji
Congress. By combining 'local initiative and concerntis assistane,it-demonstraqtes .the. effective pottil of social,
Lt' nt gnpre, our .,most, dependant: citizens-,---theh
Le' ..... i Rrteh

,elderly---et's *A nW. ..*!... ; a qi

.Rankng.r ineit .. s

I* *t I

iiiiiiii'till-i 6MiM

11 701
of Vk A17.

J !..........) 4= = ii ~ i iiiiHi i = ========= :::::::: ::: :::::=====H==== :::::::::::::::::::

iiii~iHiiiiiYMiRi IHiiii~i ii i

M ealson-W heelsiiiiiiiiiielliiiiiiiiiilii

of ........ com m u niiiiiliiiiiiiifin u .................................................r...............
p erson s,.q iiiiiiiiiiiiiii .......
,4is~bW -nnated in, Great Bitanin10. h rorm
,V..... 1)cm nona he"naiKitcheniiiiiofiiLondon,"iiiiiiremainedi~
................................... iu iiiiiii i h r l b e o eiii: a t t i
time,~ theWo ens........evie...a.t. dlierthus.. o

volunteer. They dom notinlude nutrition efforts: funded MkA" Federal Goverment through Tile VII of the OlderAmr Establihed in 1972 (.h. 9828), the Tiit VII Elel NUti Program is designed to serve most of its meals at..ngeat sites. In 1975, there were 750 project servn el t510M However, 85 percent (638) of these prjects: asorvidea levels of home-delivered meals.,
Overall, the conept of defiVetin mel ote ddon1edr has been embraced and tested a bglarg numbers of virtually every State in the Nation. In spite of ti 0ouaiy howeveraclA tonsftensu has de=eloPed4 on nutrition. antd theA _tha the: current l1"e of mtlent the homiebound is wi eqss Thymos IM f
t6 examine th sdita f &heclieadodtrie are needed at the ederal leeloeo r
... .. .. .. uix

* it


-Aw Cuslu'llewwrM eirw GzN353RAL ELD=LY PbSTMATION

.1o 0 or "Ant-W' elderly Ave, mcis if pot a of the
as the al elderly, m ulation. m addition to
OM40 herZore. xt t 6em& lieginour
t?: Qf Ahe, homebound with a brief deso tioix Of
aCMg e elderly, in Venaal..
iA 1974. ip tp a lorip and Mcreamug, number of 1411M slivu -2 1, milUml. -- M wi"
-W77- over e=%FAW
A"T ef hi J*. 1074 the num or, was, expectedto lum
zmased a LMeantly-se Mc.,ifien. 1ndeed'tSis age group 'is prbjected
to -"&,6;Vef the next 25 Te a fact that has
JwVdrvmvb3dp&&&# for- policy deolsioto in this aft (taWs I)i. The Cebst* Sum0w r A eA th6 SbMal- and Emnamic Charaztwisties
;of th#Ud* r"WqRv&p 1974, notos thate 64 anit over copWtuted about 4, Perm t, of t
1, W
9149W'but now, tute 1,0 penent Of Aie. total
o t f tile OP
-vqr se qR o d"Ou
s expected to:: by the year 0 .tQ Aoikt 0
of orient over the re"n
per onp, an incre e about 49 M t
11:70)7ktifibev it.vonid thon o ..94 nalt the revei oft
rm tettth' _W on
&o fkMitPY, 0 of: tha total pop
i spos oF Tar ToirAL*PbEA IT"t

*vaft lxjf.t' 190
77 7
'70 213; 641 Vk 7iS 241,274 2S7,1a M 585 WON
Mob -------------------------------------- 10 9, 2" 10 9 979 h7,560 125 605_ JRjj:, jail
Female -------------------------- -------- 1 397 1 72,6 123, 714 13 058

------------------ 213; 32T 220,359' 22t: 3" IA
male --------- -------------------- 14, V 107,238 1 0 40 X14,
14, 1 210 2P 1 3M 491
-,4 1;4,'Vl
Ift a* 4&; 4W COML M gk5&' *459 '2k= 14 MI A CM
a We$: yr ------------------------------------ 9" ow 9,023
70 IF T* 056
75 BAII kit 1 521
------- A
Mob 6 Rgst:: 1 ,14141
9%PJMff_:& "
----------------------ft M"Ji r id df I
m a 10 P
0. ILI 10.7

I Anum V WrOw pat womm
So=v: UX Departmed of Commens, B v of do Cmm% (5)

There are two additional which an of
V relevamo-in
undeirsta444 "0 the p* Id 4T
64fe group musUbe Zfto un er the authority of thiA M *0W derl I I y Nutrition, Pr m.
1974 statistics provided by the National Clearinghouse on place the number of individuals mt age bracket at slightly:mm
.than 10-million, bAnffing the toW for-the 60SAdOvergroulp-tb spo*Amately, 30 million. 1 .1
E Qcon Iie ap gr i IiN.. &A 4I d 66ve ig Q 2 ar
since the-infirnAies.4LI caus'6 m6bW1y1in*w 4-m ar related. Theyifi' f Y'ineieaw in 'd in
'fig ires re oft 8;449,000'iia thiilracket i h6_-to crease to-13.521.,000 by the q
UTZ gi 4rk
,In i6sponse to'a Siirvey _) *.ek t6ra
Qommiiie6 siaff in 197 666 dii c 164'
A pr jO ... ,. ., -**
of e6ns'idommg th6 ihlcr o ft,- ages am an 45,
-Our program is, sompw at, upr i!rA.W, 40 *U Oj
bound meals. The proffam-fai1s.,W,,,t*q
that -our.p,"CiPAM",,,S Im POWAM....: 14
,were 17" X"" 10
ago. Many of our pvticipAnM Lb 4_ Ag
Webegan with-about 10 percent omeboiM AS our
PaAi6ip in e, con 'm re
greg te, 'ge
moFe,- Q. t66n vMbe' out zvida
e ': r I 0. = ,
ta 6 of home ound as
percent b 154 46ded to
g I me
in th4 jir. hoini&
Of these *n J -Apmorp ok
appro= MAy 3 t mi.ffi 0 var -the
million have, beeii, idanftW aw, sW1e4ng,, A-9m, %yaxpous md degrees of malnutrition (for a complete review Of mainutriOWWO]w theagedisee,.q ptier, M. entitled,,"' +60DOntheElderk")
; 4W
There 'is' "a common'. a d h =qwR at e mall
nourishment which plagues,, the, aluon s senior citizens is wholly income-related,. as it more otten is among y? inger agre groupL.Iu fkat lo*'Micome among theAdeft and the rising 6osi of food have combined to make this an ortant and continue a
adequate or iM ;. Imp g ci Uge- lbriw
pr per diet mong the aged. Unfortuiliely, it is Ut one reason among- many. Cd -i&4 ce
-w h-66qdtrib&es to the hijh utrifimm.
Perhaps the most succinct summary of the'vArious 6iijws of malnutrition is found _iu,-t q en ng, section of Title'vft of 0 rupw
-Americans Act:
sA4 h6t e'
many older, PO at adequatelk-beciii9i
(1) they eannot-afford,,-to do, so*'(2). they lack tha sWH tw4,0,w
s6lect aad prepare nouidshipg -balanced meall;
thV hav6 limited, mobility which may Uinpffir ieir aLpa it
to shop and cook for iheiiiseIves; and (4) t ey hiL*6 feenngs
of 'rejection, and,' -j0nej* obliterate the int*
op W o er:,
necessary to prepare and eat a al 3'q
physiological, psycho al son21111 94' ec
W1 W-111gl. -of li whi*
that-occvi" t WTes;lt in a pattern ving
vAwses malnutrition.- and further phys __iiia m-'enitfil


(1) They esa" aford to it so
Acicordn to 1970 Census Bureau statistics, half of the 7.2 million famiies headed by persons as or o(er bad ineones af less than $5,058 ot only 48 percent of the median iome 10,541) ofy i es.
Ahnost a quarter of the older families had 1970 incomes of less than 08,000.
In 1974 53.1 percent of families from 65 to 72 years old had incomes below $6,99, with a median income of $6,691, while 70.4 percent of those families age 73 and over were below this level, havin a median income of 5,084 (table 2). w .
OTougMh there appas to have been sat siht increase in income levels between 1970 and 1974, the rising cos of lving during .that time more than offset the gains.
Perhaps a better perspective can be gained by using the poerty level as a measure of the income status of senior citizens. I 970 about 4.7 an1Hofin persons over 65 or almost one-quarter, lived in household where the total income fell below the poverty level for-that specific household type.
Even easing~ the more generous low-income level measure (25 percent above the pbirtty level), approximately one in every si s65
VO=ol dand over, 16 percent -or about 3,360,000, was -ow the
For blacks the figures were even higher, With three out of every eight perons4 O5 and over (37 percent) below the low-income level. In rurst wean the percentage for blacks exceeds 50 percent.

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314 R.d !s i t
D- I:gdsat ae m

.f these economib facts, it is to be expected that low-income
useldsuffe the amediulties in purchm adequate fqod
X~bRW *&OMS ver~nin this countr.-Dr. DosdWatkin, then O10int thie Too1k~ Comittee on Nutrition and Chairman of fPan ~el on Nutrition, Poeteonference Board, 1971 White him@ on Aging, testilled before the Select: Committee r 3 ISO19p that:
Abundantl statistics indicate that about one-third of the Wdlive at or beow. the current poverty line. Many more
.ase medical iniet rem out of poverty only when Woeosd by god health. Theseelel persons living in or on the brm.k of poverty find nutrition temost compressibl itan in heir budget. Houig utilities, transportation,
bealth, clothint and even whit some may re gardaslxr items receive rank order of priority ahead ot nutrition.
The questant escalation of food price since 1970 has increased the
0*a and impact of this pnioritisation. When food is a lowiteds a use in food costs cnant be overcome merey by a
to lem kexpnive, lower uahty food stuff. Indeed prior to any enet iniflton, ihap foods are, byecessity the mainstay of loweiddey. Instead, when bftalon hits, less food of similar low
*aft is Ourchased and nutritional problem become more -severe. Unfortujnately, even those elderly persons who myhave resources
%eadent to prchase adequate amounts of foodsufer from a ver
16&1 pschology of aMnetanty. often anticipating unpredictable
bw~tairydemands, 'aged persons will delay grocery shopping until thi Wabsolutelk secure in their ability to Y, for mnstance, a Yaanmedical aspense. At best, this constant f'of financial inse. Atiit deters largeeconomy purchases and places emhsson smaller quantity, higher prcdfoods.
-Rep isak the skiU to' select and prepae sourishing mnd wdSYeiAs of teethnonry before the Select Commnittee indicate that pr BesOf alISO s~rfo ako baic nutrition knowledge. The
hyd inreae ath number and types of food items as well as the baanaloical "Mivations of food processing have made nutrition
edemore important than ever, as well as more dificult to
Trwelderly persons this has been a particularly difieult tak. As
qli geaprochscertain metabolic cagsrequire a reduction in 461nqflake while n mestylevels for vitamins and minerals remain tihOme-i4n essence a omllr target to shoot for. Radical dietary changes require extreme flexibility in consumption habits. 'However, more than any other age group, the ealderly are
ecptionaly]rgi.i their food patensad are very reluctant to Asqg. The Selc Comnmittee's TteVII Survey Attempted to assess, inednig-other thiings, the degree to which elderly persons participain in the program wer willin to siter their eatinghaisftrepue to the programsatrto education mae iasNot surprisngly, over

-aise the nutritioa knowledge of the elderly ame ftilBe te, point is made that education alone is inanilihitnthandkti education, or eetive alternatives is an invitation to
Nutritional ignorance and, indeed, even the inabilitytopefts much as an inadequate mepl, is a particularly seriousprbe fo older widowers. This dider geeainwent through ife M r&o roles, which, among othertins left the women of the hueodt prepa re the family mals. If the wife should happen to.eb efr e husband, he is left, in mnyi cases, totally without the ablttock much less the capability to select and prepare nourishngmels
(8) They have limited weikg whiehsmay impair their sopca
tind coonfer tedwmk"r:.t so
,This characteristic as it applies to the homebound elelawl b fully explored later in this section. It is important to noea oom that tis factor sometimes limits the general elderly pop though they may not in truly and- in every sense homebon- oe times, the effart to inove outdoors to shop for e .impossible, but is painful or exhausting and required greateot h effort, in trin; neesesitates a, high level of 'motivation hci W .often, but understandably, lacking in the aged. .Limited molilit may plso be the result of the lAt ieuao ,transportation. T is particularly, though xwt -exclusively, true w .the rural areas of the country where a trp to the grocesto.p
reqirea round trip -of 50 or more,amiles. In such isacste"o
reibetsotton, or eeccasnl-eod ao blal or 14p*
trip to buy groceries.
_(4) ,They have feelings- of sejection and loeiness. which .oltmeA
incendee necessary to prepare and eat a meal aeles
reparation of consist4ntl ntritious mals reqursal ol .5ulicients money and knowlde but .tle necessary ime1vti ec ineal' of every day. Maintainij this motivation is a dicutt4 o every Amean regardless of age, especialy in this time o fe ,nutritious conveniencee foods."
For the elderly person, especially the senior who live loeJ lack of sufficient incentive is a piayreason for malnuihet Isolation and the accompanying loneliness rob older pesn:o ~ will ncsayto prepare nutritious meals or to even careal ll1i is often the case, for instance, of older women who hv o h
paoiyof their lives derived incentive from the desiret x4 ~ th usband and family. When the family i's gone andth uap passes away, the desire to cook for herselfdinsh.
William R. Hutton in testimony before the Select omte concluded that the problem of isolation among the elderlyhsadrc is a cruel paradox that forces many -homeon
elderly to scrimp and save on food in order to assut nou money to nav for rent, utilities, and medical expense.E n

Behest BulV Di ra of the. National Insti tute, on
said that maintrition-allU too common am the
141 ZY isnot the result of poverty alone. LonelinesIs
st*and lonely people may. become less intrse in
Theppbemn of isolation has its most dramatic effects on the over
five iu~.eery who live 'alone, often with devastating conecmenes b inadequate nutrition. In a 1971 Administration on
Eaio, then Osmmissioner John B. 1Martin described
t&."aiozidf the elderly who live alone,
Many of them are active, well, and continue to take part
.. .....a.nnmunity lie. But hundreds of thousands of themA*those who are mobile and could paticipate-live in Tir -isolation. The phone does not ring, there are no vtro, there -are no invitations ...There are noinapenie
po, And for the trailest, the tuypyial n
aoud, life is lived in a kind of solitary confiement destrue.
to mental and physical health and humanity.
*;(Thb ah, of course6, a number of factors which create this isolation:Povert il-health, inadequate transportation, feelings of rejection addfiothy 'and loss of a role in the family and in the social structure.
I~ded, te essence of our culture plays a Iarge role in the development
of.theeIbelings. Dr. Donald Watkins explains:.
1.:.7 Seey .is youth-oriented; youth is the message of the
pMLO media; youth seduces the news; youth dominates the Rqetplace; youth satur-ates the labor market; youth filla
har valable hou youth absorbs the time of thoseskle in.,te.learned proleassions ...Culturally, today'steh fi; gi~ eveloped society lias deprived the aged of theirplc
(i hL4in the exenedfmilhes of bgne eras. Gone aren't
V. ~y pleasure, pride, and status of ah patriarch, budlo
t~e m. and emotional security which the exteded
f 007..prvided.
The oleisolation and loneliness play in the nutritional problems
atithe)elerl is substantial and easily leads to specific mutrient d w~ s. For instance, Dr. William: A. Krehl, Professarwand Chir ad 'of the Department of Community Health and- 1reventive
hE~kie:*a Philadelphia's Jefferson Medical College ihas written,
ah of the most common problems for elderly persons is gradua.1 but progressive development of apathyftoward
other individuals, toward the environment generally and particuarl toward food. The aged individual h'ving alone alZoo
"often limits nutritional selection: to easily prepared foods,
piarily those with a high carbohydrate content such as
bread, ja,-elly and easily prepared cereal. food ...Such individuals often have very low levels of serum ascorbic acid, vitamini A, anid Iron, and the quality and quantity of their'
protein intake, may be questionable.,

numerous .eprts,i surveys, and: studies have ehalate 4 a*vn in the geneal- elderly paulaion, -Millions'weH i ..a.....e..
homebound elderly, these conditions are present anfcop de
by thetfurker complications of their spedi l yi& phythdEs~bi. tations.
Itis posible to outline in a er enethl sense'teUW 'l tbiitids 6f elderly 'persons who are consideredBto hmb4 Generally they are:
-Physically handicapped.
-Mentally competent (unable to communlocate due, .od~g -Regular congregate nutrition program participant wwmay
suffer as stroke, heart attack, fall or non-serious -i heha
temporarily -prevents attend-ance at the regular meal site.:
--GM vilescing at home after a -period of hospitalization soray
of a ide range of illnesses or injuries. A
-Rural residents who are so geographically isolated as tw eo
tieypreclude either sitendance, at -a congregate me0A *oor
.euar grocery shopping trips.
--Prhpsable physically to attend, a meal site but t
liabea m nsoftransportation.
-Unable -physically to prepare a meal due to. a loas of
dexterity brought on by old age.
It is iiortant to remember that this list is general ando n no sense exihausative. At the program level, this lack of precise: eta presses some difficulties, but the problem has been overcamiih most cases by well-developed referral systems.
The referral of a potential blient may be made by a doo t the Visitihig Nurse Association, local social service agenexes, Mo eptals, or, in many instances, from a Title VII congregate meal po bfam.
In those cases in which an siderly personm requests service wv thbht a specific reral, or it is requested for then by a friend, or relat vid the established procedure for most Meals on Wheels progratis an interview of the potential client by Anne cor, pr i*b .Apea a
The client is usually asked to desdtC the notawe of the d64tribi onditioh, -and pesible alternatives to meal service (Leo'm nan~t e seatioevb a friend or relative, etc.) are explored. Becanse of 6 generalbaarcity of program resources versus: communtyneed.. l MV is a great Pressure on local programs to insure that on y oe weo are taily cqufined to their r flames and without. alternativr' a@ sre.
A mom complete sense of the typical profile of th4156,bun
senior canbhe gained ly -a review of two studies, one natiaia one of a single prorm the N ighbbily Centeir, Inc., of ES..26 ,
A comprehensive study of home-delivered micaliprograms was conducted in 1972- by D)rs. Douglas Holmes and Saidra'M' owd11 from the Center of Community Research in New Yo-k Ciy. ThStuy survey of 349 different home-delivered meias progt-ams -whicih existed as of May 1971, used questionnaires, follow-up telephone 'calls, and oin-site interviews of program stAff *ad partiesmu as Ultimatel, 82 programs were selected tor intensivesAdy, wit 1 partiWnts o each program selected for further interviews.

b fi or iode-impovelsheeatedImportant fatr i i.h noitak
Ufi sheak h, Oeent, of the parteezpan s oived alone. I his haolds also extremely iportant because a disabled personhliving alone assip re aes assstance mi preparing a meal.
An equall 'hprt *ht fact revtaled by the. stndy Was that approximat 7one- af of those participants studied reported annual mocomes of ua {er $2,000, while only an approxiate 10 pereb of the spopond. eats adincomes of $s,000 or over. The stndy was unable to determine the ifme of' 14 parent, of the -participate, because. some of the
prowasdid not feel it sppropriate to clients seeh questions.
7. a Ary importt issue of the particular needs of homebound PwAriant wasad dressed in great~detail by the Holmes, and Howell Auedi The results indicated a wide variance in the reemns meal service had become necessary. They report that:
t ete was no one. peomiizating reason. which ekphaine
th atciat pee oe-delifibred meal program
pipition. Rather, the reasons are distributed over a
or o factori inluding general ifheties of oldag
percentnt, ambulatory problems (14 percent), and bea
cppled Kor bedridden (12 perseat). Other factors ineleUded
r~~mvenng~~ frm urehormjriess (11 percent), poor
di~w. bits (8 percent), heart problems (7 percent), arthdi(7 rcet), senility (1 percentt, blindness. (5. percent),
ass orne o opmnip (6 percent), and
E~w 5 percent). It is important tq'ziote that, among the
J~og a racaepants, it is an impression of the resafthat a vacantt majority have a wide range of
age Wk inrmities. ri' each purposes, only the
*rqi~p~tdifficulty was categorized..
Eq~ay inormative statistics were gathered in a 1971 study of the qel lr.,Q ter, Inc.,,ef St. Petersburg, Florida, a projept funded, pa D.aTille gan from the Ad Amnrtion on Agig In
Wheels project, meal recipients ragIiagfom o
t 9 xJ wthi 4 a gee of 80.4 years. Of as meal1 recipients, 66 pq at #211 mnornes el $ 100 -to $1990 with 94 percent
ide* mi, po ci urity as the6 ptlinary source. t the same time,
the9;W- "ta1Inoxtly expenditure was $117.80.
pyial conditions of thbclients in this projeet appear conth hse in tse Holmes and IHowell study. One-half of. the
Viswted, aven with the aid of eygasses; 24 sealt
bfihad. Twenty percent of repneto reper be
,while 82 percent used dentures.Na onha 4
*Odm) 'epotedability to walk only with help, ys:qoequattet ii~dng imch'to walk. Eighty-ano percent at. the elienti were
Dn wa tdylwing diseases were reported: 5 percent leag breath n" p ercent kidney, 4 percent bowel and bladder, 20 percent,
*Irtis rheumatfism, 16 percent heart, 5 percent blood pressure, 2
pep4 diabet 35 percent other.
1 ely, the homebound aged: suffer: 76-H O-7 .iiiiiiiiiiiiii2~

other, pesiagrn e tlhnias tsthd idiinl
h ere hs enh much, efforden and, sttian tbF d

the inmrar of persona. whol a&rec m inedof mecrsrv"%Weludn homedelivered meals, It is nota ralcigi though m odtbxperts agree that, at a ..............................
oin h services is suiateatial.E
and them cteria and qualifiers usell todfn -t-ubr ir iw and complex.
Rudolph, T. Danstedt,. assistant to tePeieto.teNt-A Council of Senior Citizens, in, testimo ybfr. bo te
on Health aod Long TprmCare of teHue.e M o
Aging, described the general parametesoteediihm e 95
We are- beginning to'face 11 oteupatta.. mw"
on the- order of 6one out of 6 olderAeiaswokr:3ois i nstitutions -are in need 'of directhelhadsii ivcsf they are to -be: able to manage thionafrsademh.
in .theit own. homiBs and ,communiie.
This estimate -when applied to -t
course, indicate over .3 m-illion elderlyine fsc srks te studies and reports are more. specific -mkn piferbrd t
the categories used in theit cacltos Fo 6.ukaean epr panel on long term care assembed by h Mtln fieQ'Agi
argued in its second draft of recom' ~ain nSpe~iF95 that:
In 1972, 1.7.6 percent of the'nn-nsiuinlzc nP
tion age 65 and over had mobility conditions. They were confinedt6 the house,1needed hiii getting around, or had troublett rid
-year, 16.3 -percent of the elderlywreualto.gX n major activity due to chronicconios c ism n h'
did not have the ability physicals owikoke o one of -the more: thorough studies ath ubr fed~o to. their homes .was conducted by r.,R et:,N* specialists at the Levinson Gerontolo ga oiy IsiueO University. In their report, ."AlterniveoNrig A- Proposal,"' prepared for the use of te eae'SeilCmi* on Aging, 'reference is made to the s<~ aeo AnaBese, consultant for the Special Committee.Sestme.tht26:91o, persons 65 years and over need in-homis~dm*0)00 n n~ujp and 2.3 million in the com Munity.. The final estimate, of te Leins higher figure. Donald Trautman, chairman hlegsaioo of the National Association :of HomeHelhCr.AncsotdM
i~iii~ iii ...........

SW'on before the House Subcommittee: on Halth and
E gTerm Care that:
The PS Levinson Gerontological Policy Institute, Brandeis 'lhversty, found that, in addition to the current iNttuRdh'shed population (emphasis added), it is estimated that
M Titht18 percent (or 2.9 million) of the 19 million nonJAdttutionshmzed'elderly in the United States are unable to
carr obtthei daily activities as a result of chronic disease
W~adrm"Kmin Brewster's estimate of 300,000 elderly .in institutions 16fis esfinte of 2.9 mfflion in the community would bring the total ftiha*6felerly 65 years and over in need of in-home services to 83 dlah
It should be noted that the estimates from the Ievinson Institute were not without some controversy of their own. The Senate Suki.
oun L Term Care of the Special Committee on Aging in
Wome Hffealth Care Services: Alternatives to Institutioalinote of. the reaction to the Levinson Institute study,
Ix -Oxnandm. ng an this report, Elaine Brody of the Phils'N. Adhis Cristrus Genter characterizes the 2.6 million figure
as an understatement. Ethel Shanas, a professor
ofsoilogy at the University of Illinois, arrived at a figure
'TbtA iifion soential home halth bendiciaries by adding the
iisttuinaued, bedfast, homebound, and those who walk wihdifBSIcutt. By this esthnate, one out of every fie older
ricnsisa potential candidate for home care. In an
altt working paper, Burton D. Dunlap projected tht2. Wilion indlviduais needed home health service inudel i r~eal services. He evaluated the abovementioned
$64iwM. reaching this conclusion.
h~ere werew anne e a tA Care
6sedrawhack to ap these estimates to the sseess
'4,.r,,o~d.~rhome-delivered mel is that they refer to the need
: e~zservices: in geneal and not exclusively to in-hame
a~tF services. However, any discrepancy between the two figures
woul likly result in an upward adjustment of the number needing tttiAtion serices.
14f' eal services are, most often, the first and the last in-home service iteedd, An elderly Person generally loses the capability to sho for ad areii meals beor losing -the ability to perform other hg-Zh
.In these: cases of gradual deterioration, the need for a home-delivered meal service most often preceeds the need for other home careo services. On the other hand, there are few potential ciretnnatktee vnder which a..person receiving home care assitne whld not, also: need meal assistance of some type. I.t is alsotrus that the &aalability of meals-on,-wheels prior to the need' for other home-care services may play a substantial roe in

aresneed bmefo thier indom cudd: st.. '
carp. where other hoe-caet sqrviq U-ecae, oeq come. yeofmea preparatin au:ssist~ io e~td.-0 u h be edn hoeeer mesgt

Area preced ount. Wef the lett hs ~qpU nentsev) can bete ganeldry.' nsorce whi mothexert se ninstne dnwihuelsexhes

ainal HelthoSre e, co te.. HEW.eTe Surr providaepes awusfuld samtion of el peraton06sandt over

In the ma... te r mo l are~a eihe tcnfoe to home and lx~ (78,00),er need aothdeere as. Ntheia eitioa sorvry spAl amoin grein round" (sptecltegop(hs.1tdu. O cnesritand heies)canus), whi d mch naalsi catgonale, Sreyacondued byAd oPbi eltreo HW are apabey oideal prearatio rasnnoalteqfo caon eder asipeedsofs homendeliver bsdo oiiyikef~so Asfo the sn major category, iiylmttost oa f. 5 o( 6and ovter -ih o uabe tod c e ,(4,00,arrie,-t-os (78,n 0)jor actiity refer pin to the abilit34;00) includi nh abiiynto sopcandgry pre biiyf e
Tere ardn ettnumber ofnd qualifiers ~ 8uha esiates from' others) sourc as lue well.Id I Ti s ctol ,heaSuvey include onl udterieru. fi~iul whoe 0apaage rake must breacondholthr fonsreasinedo home-delivered meals. As poreviouslynotd,ma ces, figure 3260. Ii 4 6illin persons are "bete 60 ad nmjr ciiy'. m, d on ofcmoiity oefrs atvitye lit to owr iu dt :ka

obtauind th iliey to hat the pretese~tae ntiiot Qliiaios isa7latso ehtls oldere ar onseratier est aimters t h s iueWM j esand s thref -otre ue n further s hfgrsfe ,a percnaealto thre ncu er o l er osePron 65yaof &
1o homered ofmme nuro As PiiiiiiiHHH r evosy oecnu iue niaeta iom tl iieAprsn aebtwe 6 nd6 eas od N riw bi0
dono oiiyo ciiyiiainfr"ag ru ol~

oband ti ieyta h pretg fteemeigfo hoi
iittosiatlatsmwmls thnfrths ewswom
ilde' osraieetnt o hs~ru odb 0pv4

aisteeoe se nfrhrcauxiuiAPU~jn:o s
pecntg o h nme oieros60ti6iiidb a ditoa
1 miiiiiiiiilli oni edo nh men tiinsrie

the Ntd0lost Health Surfey includes only those persons
-M 10abiliii o activity timitations limtations caused by
ates, physical disability or prolonged convalescence are
16 fust1 e for non-chronie limitations would overtA, noNe a ant, positive benefits of home-delivered
atlwdnnedte to Mealse-Wheels pormcnsstabdj
>id tha availabilft of home-deivrered meals often allows earlier -own eals yet do not need full hospital care. In fact, as far back as 195, r. Stanley A. Tauber explained this benefit as experienced in
-th: tenstill young Lighthouse Program. He wrote:
We have reason to belive that by admitting to this
porams newly discharged hospital painsadrnering thsservice to them duribg their convalescence, we have dnbld the hospital to shorten the in-patient time for these
ts. In cases of fractue fbr instance, dwig h haln
odwhen the patients only need is to lie in bed and receive
knent andn a minimum of nursing care, we have made
..i posle for some individdhis to leave the hospital as much
as e days earlier.
Mo eeently, Jody Olsen, Presidenit of Meals on Wheels of Central jad,. provided statistics to the Select Committee which indicated thattheaverage length of service is from one to four weeks. Additioalyshe noted, 31 percent of those persons -terminating meal #0mcedidso because they hadl returned to self care. These statistics
-woud sem to indicate that abort termed service to paraons with non= onditions is an important feature of Meals-on-Wheels.
Teactnal number of persons within this last category is diffcul to determine. One indicator is the number of days per year that hederly are either disabled or confined to bed. Data from the Natina Health Survey's "Disabilityr Days Report," shows that peronsage 65 to 74 had an average of 28.8 days of restriced ativity per yeaad were bed-ridden for 10. 1 days per year. At the same time, theoldst group, age 75 and above, reported an average of 42.8 days per earof disability and 18.5 day of bed disabilhty.
It ehold be noted that since thi portion of the'Survey considers resicedatvity to mean days in whicb "usual activity" is curtailed, thesestatistic are additive to those for persons with cahronic
Nfde these figures cannot be extrapolated into sctnal need, they lm:credence to the position that large numbers of persons other t~mthose with chronic conditions could benefit from short-term
lomemeal delivery. A more complete analysis of this Meals-onWheel' benefit is detailed in Chapter V, Meal on Wheels as an Alt~ative to Institutionalization.
-i, the Survey's figures, as well as those of other sources (except Bre te ), :exclude the mtitutionalized population. Brewster, on the ohrhand, argues that 300,000 persons mn nursin homes and other intttions could return to the community if ective alternatives
e r eiiiii iiiiiiiiipr o v id e d ; o th e r s o u r c e s g o s h h a s 4 0 0 10 0 0 A t a t

woud aai apearlielytha asiz6be nmbe o th intiutina i

POUIA encAttj
ati o n t6tion iza' w
is ai:% e n v t s6l'
J. #MA0,04ese fa liotp v
yerw 'pa4y, 11 inAome,
paper d
1Aa-ud64qr,,over1appi OSUM4
fie a. conservati epA gu
ud". b
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1101 ..nwtv Jl 1?) "elv) jA m) i
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J il4tim. 1. A
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tipj. oaf rmnm 1A

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04W if Z.v.mmoa.. *&P,
aw o3 ;Rw, Woe IL Lt. t j eid Ott; d i muk A t &,Id,# ia a jott) 7.1f) 1 4:1 (1 i w4i;iiI, Ld"o-W

_.A kil 11

Since 1943, the Food and Nutrition Board of the National Academy of Sciences has determined Recommended Dietary Allowances (RDA) judged "to be adequate to meet the known nutritional needs of practic0ly all healthy persons" (table 1). These allowances are specified according to age and sex, and assume certain average "references" for height and weight. In using the RDA to evaluate dietary intakes, it is important to understand that they are not nutritional requirements; instead minimize
they are levels of intake which the FNB believes will
the danzer of nutritional deficiency. For this reason, the RDA include a safet factor for most of the population. A common fallacy of recent years isi that, because of this leeway, it is safe for P-TOUDS to consume between 66 and 100 percent of the RDA. This i's not a legitimate conclusion. Though such action is appropriate for a large segment of the population, it is extremely difficult to determine from an aggregate perspective exactly which persons fall into this category. Thus, a diet in that medium range poses severe risks unless justified by careful individual analysis. Doctors Krehl and Hodges, then at the University of Iowa College of Medicine, confirmed this analysis:
It should be emphasized that the allowances are based on
the objective of maintenance of good health and, therefore, would seem to be a public health preventive measure which should be adhered to. Therefore, in interpreting nutrient intakes it is reasonably safe to suggest that those which are less than the recommended allowances may not be adequate,
at least for the continued maintenance of good health.
After careful study of the available data on nutrition in the elderly, the. Food and Nutrition Board reached the conclusion that, with one major exception, the aging process does not intrinsically *increase or decrease dietar ts. The minimum requirements for energy,
however, clearly depart from this rule. The FNB cites studies by Durnin and Passmore showing that the basal metabolic rate declines by 2 percent per decade in adults. In addition, persons approaching old age gradually reduce their activity levels. As a result, the RDA sugyes. t- reductions in caloric intake for the elderly relative
to their younger years.
I -the requirements for other essential nutrients were to decrease as Wei, the dietary ifications of such a reduction could almost be
viewed as desirable. unfortunate, such is not the ewe. Nutritional


research has generally: shown that non-caloric requirements are at least as high as in previous years. As a result, the elderly must manAge to decrease caloric intake while maintaining other nutrient levels t6 difficulties of this shift in diet were pointed out by the FNB m i974:
Many of the essential nutrients, particularly the minerals,
axe distributed widely and in low concentration in. foods, especially the low-cost staple commodities. . (U)nless food choices are made with great care, the amounts of essential nutrients consumed are likely to be less than during the more
active years.


4 E Allis
j 416 Alt
17Y. P. c in on a Ol do 0 co 0 + x
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eel an mf m Oft m w qr so -r M Sol 2
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040 a w 7
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B. IwDiviDuAL Nummew CONOMIfs -W *QVW *M *t
Thojiot& ]RDA, a=,.vAIu&bIqJor,a&se.5sm; pitritio an& ys 6f Me *'eU'dNh6'61&zI m fsf ert4B
betweefi ndividti&l needs. Energy xequlremonto ar
An estfin*t of u'M needs can, be, made buf Uyo tbkt
caloric-'::,jMak dwujd'be,. 09sely:. orrdai d to 6 activity.
'It obvious tt, as
ActigitY, bf ixot-tba doid variable. is
person .. ages, t6'or s&'derpatt I-urylef: ahA fitrther friom aay, 8onwpt of "avori ee-of infirm res sh!Lrply. Doctor
addition -ffie
ard -Xrehl ofAhe rson edi
Will j Re, IT Cal College repor *dl in 104
... ... .. ...
Me loverthieaiiiink p6olAe hii*"nf6M
m6n ebirdnic illnesses, such as atherosclerosis, digestlVe sets (including malAbsjorptive phenomen,4) -r uwatol
disordon, liostedporosis, and -a whA.: host oj( o Li
medi al und, psycholo& problems.
The RIA intended pnmiarily for populp#wa an ;gs*, do not
account:, or'. =eos-g 11*Wy .,Th hChtioni'Of wem
pointed o'ut-- y Doctors Solomon and Shock during their mahAtoloff researdhi Mitryland:
The major prerequisite for effective nutritivez thC&PY*,4
the Aged is careful and- detailed individual::. "xiation.
YSICIAzo ould consider each aged individual
Ph first, S lo
hovi bk nutritional needs Mer from4he requvmwpnt, of t6,5).,
younger years due to piologic Change9, second 3o
rVIM 4h. Often.
how nutrition can minim disabjAitiesivhi ',a
eICIPAY People.
After- understanding these factors in the nutritio i the 614AY, one can begin to examine t e various assessments of, &*.trui(sr6n the
aged which have been conducted.
Studies dft4 dto Oke -out 6 tid
gne SSW itatim U tie 4d have
focused-on two -basio-,,types of -w9lhutrition: (1) -"ifnAernutxr1iILfV9iOn, the failure to obtain: aepessaxyamoun-ts of,, es"e iig -hutri .1 1$ enti3j g4id (2)
excesslv e caloric M"tAe and -ltg u n' p, the le est
act on vej of ob iity lThere are Of course other dietary problems, but these iwo apppF ic be the most ividespread as.WbU as V hi6at..-bb, Olu4-ie : .rove

As bkttlin64 in .-Cha peo M. 9 1 6re Aregle bisic causes of malnutritioililn.- thd hq -X&1 8 .- 1) 1 Councfl a recent
revievt of 9 stAi 6 nutrition r Eh the' Iderly suffer from i ee of n dwpie n1cl %l, llhizhincidencelot d be MiaM009 WO
Fhese. include erre4 Ir"- number of information sources.'
the iwcii ft "t many aged five uAder eircums..
w. o m n oji lovi i*me, isola. on
p land
a iiii prevallnbS of disease. TheN I'S a ge n6ml 0011sensus that diets of elderly individuals are often nutritionsAy

no $4 Mth the result that the aetritionall status of some
a weE.indivduals is poor..

!Ae ye, a number of Ioeal researchers have examined various
edits ofelde atioulons.Thouigh the specific methodologies
IWave'var1x' bewen studio' there is a consensus that the
e>l c derdutritiopni intolerably i~ One of the earliest and
n 'fqently. mentionedstudies was done in San Mateo County, 0 69'nd.The study began in the summer of 1948 with the eaxn96-,don of' 511e~ons over the Wge of 50. Follow-up studies on this group
conductqd,i as complete a fashion as possible, in 1952, 1954,
1 .Usinfg 24-hour dietary recalls, the authors of the 1962 study
the nutrient intakes of the 141 individuals who participated
Thuik eamninations. 'Mible 2 indicates phose results:
TmBLE.2.-nvensans INTAKES Or 141 AGED SUBJECTS OVER A PERIOD OF 14 YEARS (Penient with Wpake below 2/3 RDA]
me 148 Woma4 (n-73)
is" 1952 1954 1982 1948- 199 1954 1982
.. I -A22 7 3 14 II
.. 6 4 6 12 11 7 5 8
I2 25 24 25 37 44 37 45
9 '15 15 24 16 23,. 26 27
A-3 8 7' 12 5 7 4 4
3 6 4 7 12 10 7 10
---------SI 38 53 SS 64 66 59 62
19 15. 1Z 25 26 22 11 .1

In ". ~v~g tese resort, two ,notes of caution should be made.
oft: ffi) iac ,defialencies are very high because only pire-formed
i, w related. Since an intake of 60 gm. of protein provides
pproimatly800 mg. of trytophan, and since this is equivalent to
tht&ig r6ng, element of bias in -the sample.- Onlythboswho atris10"d ii Iall baur studies were: included. As the sathors point onut iiith~.oidpation was directly related to educatinal level.- Thug, by xclding those: who were likely to have lower incomes, the sumple aotnd to underestimate deficiency levels.

Cbia Le Bevit of the USDA's Agricultural Research Service )d ted itfood* consumption survey in 1967 of .288 'hodseho1ds RStmal eaait i. ochester, MaNe York. TPheeheodsi,
at their food intakes. Table Spresents' the compilation, at that data.
.. ... .. .Njjjj 67 to 99 Less than 67
Nutrentprcnt of RDA percent of RDA

m .19 4
E A~iii 17
..... M

21 of the households met the--1
i4ght nutrients; 26 percent had diets which provide* W
ds, of the 4awaam for
thir. 0Ae Pr IMM 4
govit R180 rejeted'diet t
hou holds run by A person 1athe
tho 'RDA for 41 ew" 4 n to "A'
f19W to nro-Vide at lwt. t. JAMR fl,
75 eaxs sand 0 e I veA 34
full RDAwhile ADercent W" tor Coe OF
Wed tow6vide stlwwt tw04&& Of WAtt W4ACeA-'(
it ii 1W auz Agw
ely that i 1 8 underestimate t4# rii 4
.since the cadculation Of Autziogts was b *u io A than food consumed. Thwv M,
consumption was excluded.Davidgon study
Dr. Charles Davidson, z d awoc4 lho A nw
England in Boston, Massachusetta confined 104 eld"11
M In: as _v ovAr -2 *ftk -via"
and I we6k written racoi& 2-week' woo 4mly
those persons in the larpr, original sample who-mme-, iddead
sufficiently re4able.
Since the Wakesvere not relied to:,dietaq aRowencei4 &U 'Maust be analklmd Mi. term% of values closest to. the RD& TM intake of 167 percent. of the gro4 was betwelp 0.8 and 10
-kilogram of body w* ht; 4 percent felI betwftu 0.6 &Ud 0.9 APW=
and i son -proWakilogram; y one per (I -V&cejit) had 6 inuaw
0.6 gra, plot, k gT4M Vf bodr w(W "yo: $Ww: 1X4 In
vitamain A Aakes Wow 4,00 LU. T-Wout intxkm 1b 1W.. 1.0. jMg4 lper.dzy., Yor 6W *VM1191 37 pwroqt below 2.0 ,.mg. parday,4nd. 8. peros4t W ktakesi bdo#i too, day. Ten percent had vitsMm 0 k"kps'Wow 80 aW lppr Aoki 0
Pereftt WCM hd** 20 : veriqlay, hi 4jh%
T tW pxoftt,
took Im than:.01 gwL 0710-alciuM,,44, md- 4 pwcmf h6d Aft, GA *hL' im was
VandIew1han-11 mg. dailyfm alum" 40..,PeVW*0t r4
J.: A 11 :K:Jfl L 13,: la If wvnq G.1 i-A -441
Dibble study
Irl October 1963, M. V. Dibble, %ad Associates from:
versitjr begAA. *A oveluxtim bf "tfiWnal StOus'4414aketly
1 14 1-11
111f.,Vnift. 0 TvA .01W16 ---in locAlpilbrx Ions,
buL SiRM h0vmtralldtches W" im Ns, or, hwojm foodiThe, first r tavren4io V: 1 1 I
102 zukeets. Thmel-An-pravidedflim-AmOk X: 'ar 'N.-Ci &KII 1;

.... ....... Amu se
TMole W
-J 4 r
ASMbic qCi&
.. . ........

Autritionilat mo o
......... .. .- - - - - - - -i

Mftver thi stdy my, ot eqi towhtal curaateeecausethsapl

saidede canheto racial mixs
exide onlfne by th kg j0a Ea

Ry the as Goverment eedit prgrm inrea-sedl
msercerg- ega tyin t asws the nttioal imact of,. thee orts 01 suc sld a -conducted by Elizabeth Jouring -of thi A Mount SiiiJep in CincinnafL. 'Twenty-four lioir reull, p foodintke er taken from 185 elderly in four senior
ifid ~ L aI delivered meals service in Olneinnati Tlk~e *redivdedaccrig to -whether the individuals had eaten
prgam d fthe recall period. Tables a andI


MO ir. NO
IVERED M n- 27)

Ca so

---.---- --- --- -- --..- 9. .. .75..7

.a. . . . . . . . 9 5L ( 7
65 -
C ~ m -- - -- - -- - -- -- - -- - -- - -- -- - -- - 1 06
Ir n - - - - -- - - - - -- - - - -- - - -1 5s
Vb i --------------------------- ----! --24s
Thlann| ------------------------ 57
iwla i - - - - - - - - ---- - - - - - - - -1 57
Nii i - - - -- - -- - -- - -- - -- - -- - -- 57

icacw-------- -------- -------- ----------- ---------- ---- 6 4

It-'sonld be noted- that, these figres are seergam htie~
and do not inalease the exact percentsg of helrea the RDA. However, sInce," for many of 'the fgures thkaiixs;h selves fall below the recommended allowances, the total'e~i) experiencing efficiency is huge indeed. Given the significantly i-intakes of thtilebtibj ectA who pglcpated'if 66 meaist webranIti study demonstrates the benefits which 'are possible through sucefot' Guthrie siudy
Doctor Fre17uGithrie led a research group, from Pn
SaeUniversity in an early 1970 study of senior citizens a I
Pensyvania. Nutrient intake for two groups of elderly wa ~tr nine by 24-hour recall. Group I contained 5-5 persons front5 lt blds, all of whom were eligible for food stamps. Group'l II S 54 persons from 35.-households, all of whom haid incomes- '. 1t allow eligibility. The results of the recall are shown in table 8 .........
flatrient Bo 8 1 Aps Gmgg I *iol
Calories. . ------- --.--- ------ --...------..------ --- .-.------ 46 SS
Protein. . -- - -- - - -. ----- ---- ---- -.. -. -- ---- --- 29%
Caklum ... -.-.--.-.-.- 6410
tron .--.--..--. .. .IsB
Vitamin A. 6 . ..., .. 6 7

Teeresults clearly indicate defioient intake for the rY whole. They also show a definitooearsalat n,of nutriom income level. combining these rei.51s~ intot ervew
the same area, the authors tou ,, ghjultiple repeasa that increase in age was correlate to signieant'decline in qw

K ols study...... .........
:nother local ptudy was conducted in 1973 by Dr. Mary es1qi
T"imeni- tiimurinity's Human-- Nutrition Renarch. T ah- i, This study,: ike that of Dibble, used both biochemical and die4 realuation;,of nutritional status, The rest ee- h sapl e50 meine eciti ans in Missniuri are shown in'tabhim 9V anti iff .
Test mase 1"


Mio Fanni
C~~~df~ ----- ---1s22.

oady ~ ~ ~ ~ ~ ~~. th3br.tdis9 ha n utiioa ttso C U erl show---w---e-variations-----in------- gre------o---de-- e- ency 8 worea on
k" ----- ed- for---- this: Fist there-- are- dii--re--e--y-regions-in--ype

Obvoesyhe nbwie variato frme th nusuioal itake.)o

beconcluder thaFt, er high lfenes f reinst in thpe
evel 44 -nageouseians tha In 1 12o ieas the
ofn 95f6 the Trmryeen oft uvy f.087
mamure l ofod euwty-ii onr tev u auvre Bae) to

use S bthreultu*nwdra eearcofomte iceviua usuthentaken) Thuof athsamwile 6EI 19o hib leelom fen cy andan tuh Uonted 8 Tood~~ consumpritions wa dtriebyery rhelcal surey inl e reut fro 1 w43'pai onsit ve to a0eof8W h stoing: abclew the rsulgs bevhistof eiinyeiti h

2. .

go~ inf

as~~ IIW.

C#2 ~ ~ I !1C n o C
MO,%T lm "ifo

as 1 'eIsNCw&a MM ee


ES dot E E


IIto I=9 f I gs


Iti 11 11 11 It 1 I I I s

1 0

a c

Once ag11ain, t mu. be undestood thbat mean intake levels at or abo the RDA do not imply "that tar dietn ot the group are fully Laaqhu ate.'These mean figures do not specfk the percentage of persons
fadg to meet the RDA. In fact, even .:for the utrients for which average intake'is w61 above the recoladended allowances, it can be assumed that even an optimistic distribuitton would reveat a signtficant degree of undernutrition.
In additional.,Point of eutian should be adle in reference tollie .iptake of vitamin B12.'"Ie aslowanCe need in tis survey was 6.0 micrograme, daily. Since the standard ha -since been lowered to 3.0 mierofpams, the above table greatly overestinmstes the extent of vitomm Be 'defidcindy
Tik-8atenutrition survy
The Ten State Nutrition Survey, a its name lilies, is not representative of the aOtir 1Mtp orbe r, the groups studied were also not representative of their yartientar States.'As the data presentation below indicates, th:uve involves faimited number of
5 race and income sifctions.
Income level wais e'pessed Tn terms of a Poverty Income Ratio (PIR) for each family. Famlie with a nea 'wr eo h
a ppropriate poverty line, those with a positive-Iai were above. The income ratio of each Stt a'dtfie by wehrthe median PIR was above 1.0 (1R hi-ncm rati'te Ir bew 1.0 (IRS, low
income ratio state). bepte the name, toein the high income ratio States were generally not high income fiaie. Of the subjects in the six hihinoere ates, any those in New Ybrk had a median
income greater than twice the poverty line. The average _poverty

inoe ratio for all subjects was 1.89. Thus, h nSat urto Survey sample w"s prunaxll adlow-income groups.
Unhike the -Household bd nsmtion Suirvey, this study
utilized both biochemical and dietary mesrsof nutritional status. The results of these tests are shown ine folwn tables.

76-540-- 7M 3


vi ad "i f%: a; Ci ui cs W; C%; -i 0i


C-4 en r Cl
C" -W Ln cc

ci ci 4 cvi

4= P- r% co m cn Co f
LU cc r., r- P, -cr cc r en en U*
E C-A Ci
cm E



U Ch 00 CO
C; w; 18 4 C


E .0- CJ P en U' cn U
-cr -4 W M cl r to 00 --;r Cj to
0 cm Cl Chi en

co M mqro C4 cn W.) 00 to
cr- w Id _; r.: r : 00 ui rz Ci
CD 0
wi co
:2 04.1
uj CO r c) LO cm al cl 40 cn
(:) 40 4m C%, 00 "r "Io
E! Cj en cnE

qp C-4. Lnl.- 4t -W us, cm -400 C L'i -j ci 4 .i C; r.Z c; 6 W; Q:p C" Ujqr .C"

CD cc

'9 C" U'j U') -d
.r CD co m M 8
cc cn U') r, C-i m

-t Ln C W Ln U) M rnt 6-4cd 46ui cd -4: 4
LL- qr M -# "LnM cm
CD 0


E to 0 dcacm -Ar -Rr CO
F04=w Rr C), m C:5 -cr
>. ME

C3 C;
C ;

w 'E

-j -.5
0 4D
m m 0 m
E3 YE U- a If

Two adional. tests Were also performed: Urinary whbolarin v al ues qc) r s' anine values. However, no I ealedown by sex was

.*..Urinary riboflaevin Urinary thamine


A*-.-4---------------- -1536 5 149 1148

&Memmn ammmmemwmw......1,515 5.5* 31 1


dC r- < M -4 co C" -4 C*
LL2 ED co W LO 4w Rr cc

v v

4D 41 34 40 A 't -W ;JQM
v v Ow

00 Im CD cc unj C4 cm r un AD
LO 4 0 CO wl -cr ul qr -vt W mr

to P_. all 4= to C W C:3,.W
.1cr M "r r_ M. -cr In qr qrw&n
v v

CO.*= ca -.r 00 CD -a, C%& Im ch
to a r to 1 r- cc


ui CD 4' C).Wg Mi 4" qr P -m
U- LO I= La cc r- go winLn -w ko t o
v M
dCC Ul ft: V2=


4n CD
< -* Ck.
75 M r- r 00 cor'm wq aw WL000

v v

to -W to wcnw 9:) < W l -t 00 w CD cv)
-4 CTI-4 -4m-f r C C) CV) Ln C j cm lot r .LLJ v lw= v em

dCC C W) 611) Lnsm LOW-* wwr% 0
I= r, La &n r*- r

r- a ir w r -qr Ln Ln r- Lowto Ln I-- uj
ci C= v 03 W

ID 6 06

"-d-w =.*r,
cc: Lnr-W U) r 40 0 r cc r r 00 rLAJ cz crv v 0

cm "47)- -4 Go -T en
P- c C-4 C-i CO "Cj
.LAJ v uc= v

06 41

-Cc W W) Cj
cn 1r) -W cr) "r m M go "qcr


UVJ C-4 -tr CD -4M M C:O Ln Ln Ln
f u-) r Lo Ln r- 0 cfz",2 mr
V v

0 CL 00,
Lnw CD m -W U') go
a rmcp r-mm
cc cr
v v



E, E
CE ICCV 1 11
cn Lai

43. Eir ci


m-ntam -ny fia, th e sope o thReonlw & gtmtat renyttfbo IrpeetiVensfthape bt

k eodsusd Ti isc itil for the over-7
mcomes, ntitonea dfithest nuritionly unesreabInete grop
- Aa -0 rollc i ao larg i soegmntrents pha thtldryhouleo attmpin to insootte peeomanutrition in ththdry
"it~i 4,44 iiiia ure
4.. 0 Te f n oi ndest n die ary e atesul t for 1,9 tidonasessmn
al ?hoNuinten follo in to talS re.I pi

It'l as]Wof a atemp to stalis an ogggeing sto na tional ,I~ To N ,It atWite gonToal Whiter fo egroh Ttalitc Whi a

2 76 27 .. 82 2...67.
lectin.. 4aafo 1414917 6eron 90e 41-064. 99e.96r1. 83ug 13e r" e .... (7 2.cet 65 le 2o 60ll 3ee 28e 2.ure et 82 2o44f7 .4

... ... t .14 .13 .27 0 0.09
T*isligesiae r uc oecoeliersna fiv o:.he ii annonintitti nal dpplaino h
Unt&ttsta siae rmaypeiu uvyo
1, J nurit
@e ddbt iceia addeaymaueet
iurto@sau.,naewsmaue y2rhu eal ic
teestaxn lprlmnrtesoefth cuet

Caoiesoa 0 0

Less than 250 -- - - - - - - - -- - - - 1 0
250 to 499 -- - - --- - - - -- - - --- - -2 08l '4 8

3,50 to 399 - - - - - -I- - - - - - - - -1 .416 427 8
3,500 to 12 9-- - - - - - - - -- - - - 4 93 21 .2
1,250 to 1, 9 - - - - - - - - - - - - - 9 4 7 6 8 1

1,50 t 1,9-- --------------------------------- 48 3 t.60
4,750 to 1,999 ---------- ~--------------------- 41 3239

2,000to 2,24-------------------------------- 21 17 :A -73

20 to2,49 ------------------------------------- 8.68 62
2,00to2,9-- ------------------------------ ~ 930 9-4
2,750 to 2,999R -- - - - - -- - - - - -- -95 19 .!AW
3,000 to 3,249 ------- -- - -- - --- -- - - -96 19 59 .8
3,250 to3,499 ------------------------- ----9 .49 .6 73
3,500 to 3,749---------------------------------------------981 .9973
3,750 to 3,999 -----------------------------------------9.7 %09.3
4,000 to 4,249 -------------------------------------991893597 5
4,250 to 4,499 --- - - - - - - - - - - - 9 4 9 6 7 3
4,5009to 4,749 --~------ -------------------- --9.997t.4
4,750 to 4,999------ -------------------------------------9.8 .09.4
Greater than 4,999 - --- --- - -- ---- --- -- -- -100 4 .0r .0

...... ....

0, Td ----------------- --- an0 W0 09

m ag e 410 .2.

4.w1 416 &3

------------- ------- a. AmA

--------...-----------------.--- me amaman St .t3

esa- 2U.9 U. SL2
it -- -- -- ......1....... ..4 9z. s.o
ass RS.a 5
a 35 ...... .0 ..

a a :.-..--.---- ----------------- 976 S2

-r .._ .. -------- -- -------- ---- law*

ftn 2 ... ------- W6 9a4 wasO
M -A us -- --- ---- --- --------- 2 e az tas
ao ag- 1. .-- .- .-.-- -- ------------ 9100 IaL 1& a
In9....-. ------ ---------------------- 95. SA IRW
t.. .... ... .... ... ...-----_R 8al W
ap2Lo ----------------------------------------------------- IO s 00If Iff.0

14 23 --L ---------------------------------------------------. La g I 2M 1 .97

111 Z .--------------------------------------------------- 1a 0 a I4L WW

igti r1sim -4----------------------------------------------.-- 10A. l 07I

UOLEiiii i i Irc LirivEiiiiiiiiiiiiii PE iiiQW iiit 9WR~iIWI ON FARTRINUVi~~ffr W ~ f$$ .

To a - -- - -A A.............................. 10ii0.00iii~@ @ii
..... thaniiiiiiiiii 5- -- -- - - - -- - - - - -- 2 9 I I
-- -- - - - -ii3 4' 4
.......- - - - - - - - - -1 81
is t 9- - - - - - - - - - - - - 0.. 11AI
20t 4---- 3 .3 .4v
25t 9-----' .867 C ,k
- - - - -- - - - - - - -
--- -- --- -- -- - -- - -- - --
30t 4-- -- ----1 2
-- - - -- - - - -- - - -

.3 o4 5.42.6

49 -- -.. - - -- - - -- - -- - - ---.3 .1.0 0

-- - - - - -- - -- - -- - -- - -

1=--memWen agtae 12420tr s1 tadfr)mlsa tnsa

..~ ....... ...... ..... ALwNC M

-------- ------- a----- ..1 .1.. . .
------ -------emm1.34aewneanmm.ame3

----.----------.---. ---- t --- ----m------me68m7.19..o

-- --- - ---- ---- ...... iK74 a44.5g8eed***unpe.w
-------m--apasammnnpnasaemtptm 51.44 LU 59
----- --- o mee---------ggmm pagqagymu w*=w**55.49 54qapu.4ovsmnsme
649~. m w e ww o --- -- - - -- - -- -- I 36( 1 L

------ -- S 97..8

100. OD.0 m l



W. 53.S 1.

.47.51.4787. ................... 8
$W 10 ...--.----.-----.-. 10 .-367 4

owth ~ ~ ~ ~ ~ w income.-----------------7.1 16

i ..iiiiii iiiii00
UBLEM-Ciiii ULii i VEii PE-N~GIITMIif~~~~ ...... OPESW'"MW-Abb
[The stadar ....... inak for.... pesnige i0ymii vr s1 o
iiiiiiiiiiii~iiiii iiiiiiiii .. ...... i c
Irn@g)Tta h o
Total -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --.1....00 0
Le st a - - - - - - - - - - - - 1 1
0. D 0 9 - - -- - - - - - - - - - - - 1 1 2
1 to 1.4 -- - -- - -- - -- -..-- - -- - -- - -- -.54..
1 .5 ...... 1iiiiiiiiiiiiiiii9iiiiiii --- - -- - - - - - -HNHHNN = = - - - - - t - - - - - -. 8
2 o 2 4 - - - - -- - -- - - -- - - -- 7 5
Z i to ii9i -- --- ---- --- ---- --- ---- ---- --- ---- --- ---i---iiiii.8
3i to 3 .4 -- -- --- -- -- -- -- -- -- -- ----- --- -- --- ---- --- -- -- ---- -- 2 42 L = ~iii===iiiiiiiiiii===== =
3 5 ...........................................................................3 .
4~ !I to 4. -- - --- - -- - -------------------------------I. II[.I~. .L] L L. ...................... U L=== ii~i
5 to 5. -- -- -- -- -- -- -- -- I---- -- -- -- -- -- -- -- -- -- 1 40m . -I u
..... to ...................-- -- -- -- -- --7 -- -- 2 9021 2
7 to7.9--- --- --- --- --- --- --- --- ---- --- --- --- --- ----i3i23X 54493
a ii~iiiiiiiiiiiiiiiiiiiii t o &............-.--..-..-....................................................
9~~~~ ~ ~ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii -- --- ----- --- 5& 42 &9
1 0 t o...........................................-...........................................................................................
....1.9 -- - - - - - - -- - - - - - - 65.61ii i k m...
12 to..1..-9.-- - - - - - - - - - - - - - - --...... - - --...-..-.................
1 3 i it oiiiiiiiiii: 1 3 ................................-............................................................ 41.... .............
1 4 t o..14 ............................................................................
15 to ...... 9 -- - - - - - - -- - - - - - - 83 6 S& .........
16 to1 - - -- - - - - -- - - - -- 6 7 L I0 A
17t 79- - - - -- - - - - - - -- - - 9 3 & 6s .a

IlAwskaW for I= I*kG for persons aged 60 yeaq and-over 1&10 aW Tote
WIMP Negro

----------------------------------- 100.00 10D. 00 100.00
------------- ---------------------- .19 .20 0
------ 4.- ----------- mq ----------------------- :: ---------- .19 .20 0
--------------------------------- .46 .49 0
------ - ------------------------------- .49 .49 .48
--------------------------------- .50 .50 .48
--------- ---------------------------------- .84 .82 1.
- - - - - - - - - - - - - - - - - - - - - 1.98 1.94 21
---------- 3.46 3.38 4.96
---------------------------------- -- ------------------------- ------ 7.49 7.37 9.8s
11.74 11.33 1& 64
--- ------------------------------ 20.74 19.73 X:56
---- ------------ ... 29-73 28.91 44.76
-------------- 40.05 39.31 51.96
----------------------------------- 47.99 46.97 64-57
10.9 --- -- - ---------------------------------------------- 57.02 %is Wes
11.9 ------ ------------ - 4 --------------------------------- 64.19 63.54 74.27
IM ---------- ---------------------------- 70.52 70.14 76."
-------- --7 --------------- 75.73 75.63 77.37
-------- ------------ ------------------------------ 7& 29 7L 15 8& 71
-------------------------- ------ 82.97 RL 76 84.
------------------ 86.24 86.21- 87.20
--------------------------------------------------- 8L 39 8L 52 87.74
01-90 92.11 89.11
------------ 92.30 92.50 89.93
---------- ----------------------------------- 92. 93.22 89.
---------------------------------- 95.31 95.29 96.47
95-63 95.63 9& 47
Us ------ ----------- -------------------------------- 96.19 96.24 9& 47
r than 23. ,,: ------------------------------------------------ 100.00 100-00 100L 00

lJoW Wdudsi A 6ces.
4*Wa persps with unknown income,

.. ......... .. ....




[The standirt fbr i6iiin.4 inbko for persm aW 60 years andldv& Isl0i 4.U.1

Vitamin A CtU) Total I Whitk-,p, )
.. ........ ... .. .. ...

Total ------------------------------------------------------- 100.00 100.00 ja0l)
Less than 250 ------------------------------------------------------- 1.21 1.08
250 to 499 ---------------------------------------------------------- 3.01 2-.92
500 to 749 --------------------------------------------------------- 15,14 4.97
750 to 999 ----------------------- -------------------------------- 65 &29
1,000 to 1,249 ----------------------------------------------------- .12.f)9 11-41
1,250 to 1,499 ----------------------------------------------------- 17.65 ff; 46
L500 to 1,799 ----------------------------------------------------- 23.18 ft-ft
1,75D to 1,999 ----------------------------------------------------- 2&51 -ft2t
2,000 to 2 249 ----------------------------------------------------- 32.59 X
2,250 to 2:499---- ---------------------------------- ----------- 38.17 37.99
2,500 to 2,999 ----------------------------------------------------- 47.95 -47.90
3.000 to 3,499 ----------------------------------------------------- %.-21 S& 34
3 500 to 3,999 ----------------------------------------------------- .-61.74 161.-95
4 to 4,499 ----------------------------------------------------- 67.47
4,500 to 4,999 -------------------- -------------------------------- 70.52 71.11
5,000 to 5,999 ------------------------------------------------------ 75.51 X-06
6,000 to 6,999 ------------------ --------------------------------- -78.65 78.97 45
7,000 to 7,999 ------- --------------------------------------------- 13.96 -94.10
8,VOO to 8,999 ------------------------------ 7 - - - - - - - - - - - 16.86 '87. 22
9,000 to 9,999 -------------------- -------------------------------- -0.82 -0.14
Greater than 9,999 ---------------- I-M ------------------------------- 100.00 H&V
Total-.----- ------------ 160.00 H&"
Less than 250 ------- ------------- --------- 7 ---------------------- 4.05 3.962W to 499 ------------ ------------------------------ 6.66 -6.85
SOD to 749 ------------------------------------------------- 7 ------ 10.26 1-0;84
750 to 999 --------------------------------------------------------- ic so 14.30,
1,000 to 1,249 ----------------------------------------------------- 118.78 IS."
4,,2%49 4,40 ---- ------ 2L 19 25: la .. ........ -M 79
1,500 to 1,749 ----------------------------------------------------- 30.97 3a.#...- 92
1750 to 1,999 ----------------------------------------------------- 37.53 36 66
2:0D0 to 2 249 ----------------------------------------------------- 40 95 H" 51
2,250 to 2:499 ----------------------------------------------------- 44:74 43.19
2,500 to 2,999 ----------------------------------------------------- 56.35 56.10 57.21
3 000 to 3,499 ----------------------------------------------------- 61.65 61.45 62-40
3:500 to 3,999 ----------------------------------------------------- 67.59 6& 44 64.68
.4 000 to 4,499 ----------------------------------------------------- 71.56 72.27 ft is
4:500 to 4,999 ----------------------------------------------------- 77.34 79.29 70.78
15 000 to 5,999 ----------------------------------------------------- 80.74 82.79 73.86
6:000 to 6,999 ----------------------------------------------------- 82.92 85.41 74.54
7,000 to 7,999 ----------------------------------------------------- 88.89 90.70 St 79
2,000 to 8,999 ----------------------------------------------------- 91.36 93.30 SL 91
9,000 to 9,999 ----------------------------------------------------- 92.96 95.15 IL 62
Greater than 9,999 ------------------------------------------------ 100.00 101). 00 100-00
Total ------------------------------------------------------ 100.00 100.00 1(& 00
Less than 250 ----------------------------------------------------- .74 .70 1.43
250 to 499 -------------------------------------------------------- 2.54 2.53 72
500 to 749 -------------------------------------------------------- 4.48 4.37 1 34
750 to 999 -------------------------------------------------------- 7.89 7.93 4.40
1000 to 1,249 ----------------------------------------------------- 11.00 11.80 11,41
1:250 to 1,499 ----------------------------------------------------- 16.67 16.74 IfL 36
1,500 to 1,749 ----------------------------------------------------- 22. 11 22.21 19 34
1750 to 1,999 ----------------------------------------------------- 27.44 27.5o 2& 61
2:OoO to 2,249 ----------------------------------------------------- 31.73 31.66 32.14
2 250 to 2 37.48 37.68 .33.86
2:500 to 2:999 ----------------------------------------------------- 47.15 47.30 44.84
3,000 to 3,499 ----------------------------------------------------- 55.36 55.56 SL 24
3,500 to 3,999 ----------------------------------------------------- 60.50 60.56 59.47
4 000 to 4,499 ----------------------------------------------------- 66.21 66.42 62-75
4:500 to 4,999 ----------------------------------------------------- 68.96 69.26 63.91
5 000 to 74.37 74,71 68.93
6:000 to 6,999 ----------------------------------------------------- 77.42 77.32 79.23
7,000 to 7,999 ----------------------------------------------------- 82.41 82.56 80.49
8,DOO to 8 999 ----------------------------------------------------- 85.74 85.99 82.12
9,000 to 9:999 ----------------------------------------------------- 87.74 87.86 86.23
Greater than 9,999 ------------------------------------------------ 100.00 100.00 100.00

Total includes all races.
Excludes persons with unknown incomei

kr.v)fimin C intake for maks aged 60 years and over is' 601 mg and for fornalas at tft i as", 55 MR; how Ivisir, sex breakdowns are not given am! fm stdndafd of 60 nij is useM
Totap White flegro,

-------- ------- ------------------------- -- 10D. (0) 100.00
4.45 4.06 8.28
8.63 IL Of 14.76
lo to It 25 11.58 1& 86
to 19 ----------------------------------- 16.04 15.34 22.94
7 --------------------to D2, ---- ---------------- ----------------- 19.39 it 65 26.77
25 to, ----------------------------------------------------- 23.26 22.46 31.44
to ------------------------ ---- ------ ------ 26.86 09 34.70
35 to ----------------------------------------------- X 21 1.55 37.04
40 to 49 --------------------------------------------------- 32.52 31.76 40.38
*1 *D !I ---------. e 36.29 35.4 44.67
50 ja 54- 38 46. it
-H ---------------------------------------u -------------------- --------------- 41.11 a so 46.57
------------------------------------- 43'63' 42 69 53.71
I to ---------------- -------- ---------- 55. 9T
to 7S ---- --------------------------------------------------- 51.24 5& 14 63.02
1 #9 ------- ------------------------------------------------ 56.33 55.52 65.11
Ad An "IN, 61.17 6135 70.24
------------- ------ ---------------zV* W ------- S&DO SL 50 71 70
In= f ------------- 7().39 69.90 76.23
m ------------ ot 73.11. 78. it
--------- ----------- X 48 7 79.50
---------------------------------------- 08 02.59
---------- -------- -- ------------- lu"00, 100-00
T" --------- ------------ ------------- 180.00 19D. W
us ------ --------------------- ---------- 14. 19
---------- ---------- -------- ------- M25 12.93 23.03
-- ---------------------------------------------------- 2& 57 1& 31 21k in
-------------------------- ------------ 27.96 2,L 43 36.32
--- ---------------- 35.02 33.59 39. u
---------- 11 ------------------------- ---------- 3L68 42.79
42.53 41.67 45.49
------------------------------------ 47. 94 47. 47. m
--------- ------ ---------- 51.86 61,98 51-33
--------- 53.14 53.43 52.25
N. 11 7- ---7 ------------------------------------------------------------------- 54.65
------------- 5& 11 59.16 St. G5
-- -------------------- 9. ST 6CL 29 57.52,
-- ------------ 60.72 61.31
--------------- ------ --------- 5a 7P
------ 64.62 64.60
------- -------------- --------TA 68 :69. a
--------------------------------------------------------------------- ----------- -------- 7L 94 7Z 90 S& 24
----------------------------------------------------- 73.51 74.81 a. IT
----------------- --------------------- 79.2 ft 98 72.91
- - - - - - - - - - 83.91 74. gr
-------------------------------------------- OL 47 SL:u 7L 0&
------ V. 77 ft 19 M 63;
10100 Ide. 00 11". W
--------------- ---------------- lw,, ilih
------- ------------------------------------------- lK 00 Im 00 102.001
MR& than 5 ------------------------------------------------------- 3.63 3.54 9.S5
---------------- ---------- 7.63 7.43 a SW
-------------------------------------- 10. a 10. 414
------------------------------------------------ 14.25 14,11 1&
1& 79 1& 52: 2L45
--------------------------------------------- 20.0 2151
2W 43
Pt 75 Mtge
-------------------------------------------- 27.93 27.67 31.93
40 le: 44------ 30.02 ALAO 3L 40
45 to 34.26 33.79 4? 10
7- ------------------------------- X 90 42.89
so to Xm 43,73
55tD 39.
'Go to ---------------------------------------------------------- Al. 41.12 51-36
65 to -- ------ 44.16; 4430 SL. so
70 toi 777 77-- ------------ %-7 ---------- 4154 4&N 6D. 19
4 55.0 IM 71
8D to -JLJA ------------- -I90 to 99 -------------------------------------------------------- 6(L 09 59, 71.07
100 to 109 -------------------------------------------------------- 72.95
Ito to 119 -------------------------------------------------------- 69.25 6L 77 7& 6F
120 tD 129 -------------------------------------------------------- 72.94 7L 55 K 99
130 to 139 -------------------------------------------------------- 75.29 74.97 SL 24
140 to 149 -------------------------------------------------------- K 25 80.06 85.53
Greater than 149 -------------------------------------------------- 101L 00 10100 lK 00
I Total inciudes all rams.
2 Excludes persons with unknown income.

The subjects of almost all nutritionsres -olunteers. Ths factor i of critical the isolation, loneliness and withdrwlhihsofe m
-old age can cause volunteer-basedstdetoigfimbl ,mate the degree of malnutrition. Fo: h oeon le ~hv both physical and attitudinal barrsto attiain hi i~ be extremely severe. Dr. Charles Davdoi eorig1i-B Ae Center evaluation, confirmedthi rolm The members (of the BostonAgCetraxnoa ndw
sample of the aging populationinBso.Tear d "
first, by their ability to ecoie to h etrAhr, ft studies are made. Second, y ar eetdi tesnegt they are motivated, interested nairMth-Cn&i
belonging to the group, -adudutdyti eso
Despite the large array of d#aoteedry ti ifcl M
a single quantification of underntion hr x rbes hiding a dilinition (f undr-Mosf prach is to find the fiumber of aged proswoedesfil ilet two-thirds of the Recon pointed out earlier, south a definitionted gieainorcpcue of the actual incidence of deficiency an aggregate resultfor use in public best tool for providing a reasonableyecosraieonui-"!11. Even once such a definition is seleted oeedfiute e Since there has besp little integratioofntititaedab
-various research groups, it is almostipsbltodernewA the deficiencies discovered are suffert- ywihsbet.Te ,exception to this shortcoming is thesre odutdble. She found that 26 'percent -of the hoshlshddit.1hc for one or more nutrients, to meettetotidD ;Since Le Bovit measured intake :a 24-hour periodI her findings maybqut oclfth aged population. Moreover, the ohrsuismnind generally found individual nutrientdeieneso prlmov* same, or greater, degree. Thus, it ca< easmdta h'..A estimate of -overa diet quality is conservative.
The implication of this 26 percenesiaes ht.aprim 8 miillion out of the 30 million citizsovrteaef60res cantly undernourished. This figure i ofre ytoewtcf experience in the field. John Martinfre omsinrolh A
ministration on Aging, has testified:
Specific information is limieabuthindncof
actual malnutrition among theelrybtscasw v(,
all points mn the same direction....I:smysrn eif that millions of our older citizesaevciso ndqto
nutrition in varying degrees.

Ote basis of some admittedly crude calculations I have
dnfrom research evidence and survey information, it is Pr~bft*sofb to ay that 8 million of our 20 million elderly Alberiws are, at any one time, conumn diet inadequate olbrb dr health This calculation is bae upon the extreme
dfcencies actually Ipicked up in the Ten 8tate Nutrition Su*'Veysseral diet record: studies, the income status of cetal city and rural aged poor, and the inCI'dence of chronic

A. I telv the exact level, it appears that undernutrition in the TIA4,J*L &public health.problem of majo dimensions.' Moreover, it ht: the relative e stant of these defielencies is even higher
0,*eldrlywho are hoimebound. As was pointed out in Chapter
ulipwhick afflict the elderly in general are intensified
ebound. This prblem Is borne out by the: data of the
inR which thood persons with the lowest levels of nutritl= Ythtagwere those who were in: ned Of, but not receiving, homedelivred eals.
'Teterm overnutrition can be very misleading and may even seem conlr~t 7.,Yet the same factors which cause such severe nutrient d; notes mf the elderly also bring about an alarming degree of excesscaoric intake. The decline in energy needs which makes it so Off~cut t- lect foods With the proper balance of essential nutrients aftik' eas'o obesity. Dr. Olaf- Mickelsen of Michigan State Uniais considerable evidence indicating that the caloric
ioae should be reduced with the advent of old age. This
1'.'s AM8 nd1t the. recognized reduction in the basal metabolic'
hidhwbk occurs progressively with age. In addition, meet
pleaakedly restrict their physiest activity as they grow
ol.these two f actors reduce their actual caloric reguire .
Idi& Unless their zestorio, intake is reduced aecordigly,.
bir pebphb are likely: to become overweight.
,o,4e..hobound, the element of activity reduction is particularly &pverL person confined to his or her bed has little chance to wor
excessie calories.
JAadition to, these decreased energy requireetalfsyeo ,1an results iIn poor. food. choice. Doctors Solohou, anad.Shock ex-4ad tis cause-in 196199
Both social isolation and loneliness enhance the tendency

I iit"
degree of social isolation and found, that those
this scaldjite axnxicham2fiw above desirable weikht0
Finkflk -the'edikdiWwdpqverU*A NutrWo4
Often "results irklMgm sive
Obesity;. theni. U*: W Ar: th* a oa., V wiom 5
provide&.veight,,stittisties wIrhnh-jooqfimAhiV.I study cited above, fc4!-'emw*&,J6itn and of the mAles...were 10 1, reent or In
"i ,; percent, All
we gr cot We ro
uc. 4atisties Casa &ItO
esk S ;h N., 41
p dwaneq 101
non7tfkt'iPortipl QIt A 6'... '-#
1 44- 1 I'll, I
X07A tthelR 'Q'(*e:9w0 "A J &6
ed 1476W I too
weigbt W*Ii. qwOr, ''o
groups, tat contoo d, I n' C irr
tive an ounts are shown ih t 0"22. 44
TA13LE 22--B00)WLqkfAf'V::. kD SEX
6e.D Fo rh IWTI 111)
H 1,r 0.9. 0' a o 415il "Iffl. I

45 tD 55 ------------------ -------------- -- ---
55 tD 65 -----------------65 to
% lj:J'I j
MU6h Of thig Iiik&ea9b mitay) b&Atn Wsnm4wtoo Awnkaa
M orphO kgTit' ChhilgeS W"Peth M*'- ti0ovdaw.-Aut'' Jewa this is Arne, it only- h*hteims ike ae"a for owftit.
i.:':..A'..W i o
The1:..rr,6w. SW Swvay;w A WInpte(to A,
individuals over the 4
ter h n th
Cwth, )erce ile d measure nts JDAVntr Xr
w 1. e oun,
. .. l I t.. k.'J
"h'6 i:dii ts .1 V"
obese. 14AT 4t iil.b"I b
breakdown bv AvOla Ip t2 74 e gr0U*'
*0' r Vtri d 0% et Y
the health h ted to suO malnu f
The tremendous increases in sdentik kziowledp *hich' kave
occurred inthis century.114ve touched many fields. One of the most notable areas is nutrition. Yet, despite the tremendous amount of

Work devoted to examining the interrelationships of diet sand health sakey inportantl relatienships need to be exaie aorh closely. tOProblems of funding and prac tcality have sgeifeat y hampered nutrition research.Fo exmlteei a great dealof unoprtainty as to theargh effects ofnti nicecies. V&4 ,boipgption des exist, however, indicates that the current 16lak p twiiitY zixay significantly understate the pevalence of
a ,lrt" d. disorders. At minimum, the analyses performed by the 4,titrition Board and others in the field indicate that the
aihriion .experienced by the Nation's elderly exacts a t& Moa prce in terms of health. A brief sampling of the available rfek 4 4pecific deficiency effects can verify this conclusion'. Ekery and protein
the poblem of excessive oaloric intake appears much more
fg" ip this country, the implications of insufficient energy must iso be;eighed. The Recommended Dietary Allowance for calories is so a's ~ring to the Food and Nutrition Board, "at the lowest Eht to be* consonant with good health of average persons
ine'' { hugh niedds certainly differ between individuals,
it c claimed that very low intakes present no difficulty. There
i9a a0du level trhich must be miet. The Food and Agriculture Aftikiti of: the Uniited Nations explains: Sce the-body continuall converts and replaces it comJO~gnpar ts energy is ..needed for synthesis of new organic -, Adtfees in this continuing process of maintenance. . .
The -body also bas to have energy for internal work, such as. the action of the heart in circulating the blood and the
e~s ofthe diaphragm in breathing. Less obvious is
virr]k done in maintaining the concentrations of salts and Il the Wel n oytus. Sodium and chloride are the
163 in the blood thd potassium and phosphate in the
2 m T110differenice Min the ionic composition of the fluids
And outside the cells is essential to their normal
Wriiivand can only be maintained by chemical reacifkhsbtiimg energy.
One apeiist pqeblem in the "energ crisis" in the elderly is the impact on pfgen atthezation. As the FAO po ints out, energy is needed to fnel protem pynthesis in the body in order to assure continumg maintenamce. Yn addition, when an energy deficit occurs, some protein must be shifted to this purpose and is therefore not available to satisfy proUfABhds: Theimportaib of assuring adequate protein intake int be Wvdi f'W"s Akpitined by' Dr., Anthony Albanese, dtetor 6f the Ns uti sion and Mitbbik Research, Division of the IBurke Rehabilitaties Center
Th'Aelderly, libefal amounts of good quality proteins
Ie speciallyy importatit to counterbalance the prevailing
tlalklle processes of old age.
Thus, though growth is not an important consideration for the aged, mtenance neeeds demand adequate mntake of protein.

76t-540--76 4

patii~i i entcotiaieto atwel utilswlle p
inyhar d biirowin TheViom in e lain some of pigiitatiiiii subyeero a diet i of ascorbi acidbt nurtfatige and poolesnss pheerme folwdniky.
pearedtner 90 drays. .n .cin .nbns onsad uce
atheiepints anu ture ofl evilswen arkeltum vaeMrn, datnsual bromot e San Mn o liscussed arlier re theasloing com'nlusionInahot:
low~c onadesfeefacorbic aecidibuakeadignificatnattthe'
acientakefaergde a 49o perernce ighe thy d~lla
thate of tswihiksoer 50 dayspe.d
Othoug sudec hainrtela onctdoe no in daker poshiltis ty wlas'
The imotlnce of iosne whas asesse hn5 6 acri
Ioi ita copondyws prent hihe epoltin n myocedgi chrtomes tlase, prindaksoe, a50 cgertayn ,0prcn,
lss em.hat ptoeheg cnpe
Thug suc ia soreaiodes not fundcten te incrae moral ity cel adet resplo itan epickp the ptnilv4iain
mIroyooni n o ot no
Tritionorande of funamntal importaesdb toeFOm"9
prmar iacmponcesn fhewdeats, mobinfe"
seriousy twake, ill healt, and subta ote pym
andcellrrsiain..Dspt h eysal"oz
ndd the bodiro seo hemia mesrmt shont wni nd ict o a eseial fordmete hemolobnc toes. .Irn
Indeficiency anemia is ery ndpi high tm-o Ouimry wnostudeancte Darten of Netsut nri~n

showed that biceina Bo stnt Rowur sne' eeus

percent of the elderly are anemic, both a:ogm44i


*wther mineral, calcium, also is of great importance. Bone, once rwed is not ermanent. There is a constant turnover in adults of approsimately 700 mg. of calcium daily. A large portion of this amou ranging
nt is excreted each day, from 50 to 300 mg. according
to t1w',FAO6' At &H ages, there must be sufficient intake to cover these lossm. The result of inadequate intake is generally a softening of the bone&--osteomalacia.
. There is some disagreement as to whether inadequate intake of calcium aIsG contributes to the incidence of osteoporosis in the elderly. the impact of this disease was explained by Dr. Leo Lutwak of the Los Angeles School of Medicine:
Osteoporosis may be defined as a condition of too little
bone. Radiographically, it cannot be diagnosed until approxi. mately 30 percent of bone mineral has been lost. By this
stage, mechanical instability of bone and resulting fracture ri ay have occurred. Various surveys have indicated that approximately 30 perce.nt-of women over the age of 55 and m6ri'over the age of 60 have had sufficient mineral loss to have produced at least one fracture. According to epi'deniiii;lo ';:tudii6s, at least 12 million women in the United States: a suff cient osteoporosis to have produced verteJ ral fricturo.
I : .. I I
The-*wt role of calcium in this problem, however, is disputed. The FAO reports that:
Orthodox medical opinion holds that both the growth and
-atrophy. of bone proceed at rates which are independent of
the calcium in the diet.
Dr. Lutwak has criticized the support for such a conclusion. He offered claims to the critical role of calcium in 1974:
:Dietary surveys of patients with osteoporosis have generally indicated that these individuals have been consulmlln
diets lower in calcium content than age-matched populations without bone demineralization. Metabolic balance studies have shown that such patients are in negative calcium balance and that, when dietary calcium is increased, calcium balance eventually becomes positive, indicating retention of "Iciuni. . The rational preventive theraphy for osteo Porosis would be supplementation of the diet with
,Adequate amounts of calcium.
Glv len the-great risks involved, it appears that this area should receive further attention from researchers. In the ihterim, the only valid conclusion possible seems to be that stated by Dr. Willard Krehl
It makes good nutrition sense to insure an adequ** int4e
.,of,,calcium as well as mWesium and other npn erals.. and
vitar D to minimize the hazard of osteopproEas


.of iFvl ftio 6t'Fe e
by iirw & iai iniak : oUvit'aWn tl J*A 414
Abn(Rtlauties (AAhe eye am t6 dnlv "Telhib
diaposing- oy
ocular changesindica vitsn in.A.defici.M","'W.
4PF - -k-1
Untatnakdwo, M ; 1, at T
IbIJIN"ON11 is im" ..bry 10mm '16f
Mameaed tylbapazAdut of. vWna ut lawfigh t 04T
preceded by a decrease in dark.adi0bo&m
,a dyskaa osio..-qf Ahe tr*nWa woepW j'*. C d 'he .444,,to J ipd )e fill
evidiae6dl y p4 r *4we;4wot 140 COVO my
11* ,
keratiuizatapa. ot th ithe 'e i v n
by twns'. co L 4:0"
A, as t
ed I T 6 ON
ments iki6 e v. Xem' 'Ponsist
W apw
process i! s rioid one, the' conleal, strucA*U*eM*'
cloudy gelat nous mass; ex of the le an all
iou. ps om
vitreoiis htiMor.intfY',,ftiitt. VV oW i Jfhir R kod'
sibly affected to a varying degree
TheB riftvKM
Three vitaxi ks wMch h e'U6 i o ;,Ii d
status surveys of the elderly are Bs, 13 at
12 0 -"O
not iJAPlY ihitt ,4iVY *ft tulimpwtak UAW iMP04 iff, was reported by Di: XMA.iin-074-v Ic"I 1h r 0 1 n. ht 4,11diTt ji4
A co"iftWft of I
ttwtv 4
kthiw feft ,or vAwpft*,i or both
Some of omf of Vfiwfii'to d rted
ou it of 01 ni il'?Vu in t&AjUtrioan 3 4 ml
In a dLoub-le-bWd, f 4
VVIrem 66.'140 MO*M, 1AR 4 _Wboin. )I&A-Prvn6u$01 40*r
fatigbe$ RdMW ob* "t4 t"t Mpwadmfained of MWO
of vitamin the symptoms oRWI
c t I . JU:.
to All
rt rq6iih r, 1), 11 f 'I 1 tic r
as a 0 e e y
Q-1-1cm Of eambrd +]-Pr 96 which is
because of cerebral ather ed to,
H.V. Ld i 4 ,g it af6d4* PAIO 8v 11f fJA f
of vitamin
Subjects on a vitamin Ba deficient diet have been ob-erveA
to develop perso-iality changes manifested by imitabMty,

tvi dep sonwa losortesn e posibility. The subajes p s developed filifew yerr of the goal
L POUpal hthous stomatitb, namlabi seorea and an
aeneiorm popularr rash of the forehead. Abnored1 electroencephalograms were observed. . .Wrdoie (vitaminh B4
foa)repletion corrected 11l of the abnormalities noted.
edefliincy symptoms cited above do not represent a come
hensive review of the available research. Further, the relatively' unadednbed state of the science of nutrition: illustrates the tentative nUatute* of tondlusions about such: diet impsets. Yet these fmin .e
c~erlyindicate a 'range of nutritional problans which must be d est w1ith-by polcymakers. Public health problems of such, degree cannot 91be -tolerated.

-"The harmi~ful impact of obesity is equally tremendous. A study'b the Society of Actuaries' of 4.9 million individuals who purchamdt life insurace from. 1-35: to 1953 indiested that obesity led to increased mortality_ from eadiovaselar diseases, diabetes nephritis, and diseas of the gastrointestinal tract. Doctors Faquhar, Hirsch, and Stuhkard have concluded that,Obeity is. considered to lbe an important contributor to ixydiferent dissiders such as coronary heat disease, hyprfinsiah, stroke, diabetes., gall bladder disease, arthritle,
pubtrydlystonetion, sleep disorders, social disability,
an4ecreased ability 'to withstand trauma or surgery.
Piav.y Doctor's Mickelsen and Selileaker of, Mie ian State

'The- evidence Soi a relation between obesity and morbidity for some diseases is so convincing that a ntumber ot
J ;4 .yers ago Mayer suggested that the prevention of obesity is
-a, mkj or means of preparing for a healthy old age.- If t A
-vice .were followed, then, according to JoliE& life expate44cy 'woul be increased by an average of four years. Tha 4je declared, is greatertban the two year inexpase that aght
resltfrom the discoeyf a cure for cancer. Turthersuarq,
.a len individual is less h'ely to develop cancer than an olese, Th taging poess and ambritionI
The ed~ets of malnutrition cited above, however, ane sot the whole
-story. Gerontologists have begun to study the haic proposes of
-agminh an attempt to determine the impact of nutrition. Theme is a
grow g Selin tht, aongthe environmental factors #ffettth
health of4th elderly, nutrition ranks near or .at the top of thelist in importance. As a research group at Michigan State T~aversityippints

,Many factors determie the health and longevity .of older
.people. Over some of these, the individual has little control,
eigk, heredty whereas others are mutabl by puli helW
Kmeasues, such as arand. water qaity sad axposue to
b io lo g ic a p a t o g n s iiiiiiiiiiiiiiiiiiiiiiiiiii86 11 o th e r a a m
,contro"m i ,L e g.,. fc od, sm ql a;, and p t ity PF- is

i~i ii,50
nutritional status and food h habits m ay be ii ii Hm poiriiiiiiiiii ............. .t ........................... ,=..,........
ponents of life, haviiiiiiiiin fa-edingefcso elhii
rate of aging. Proper nutrition throughou.t life has been.... iiiiis~qq ........
gested' asoe ftebs en oiiiiigdgnmip
changesiiiii an hi ueimoeiiess
Dr. NthanShoc, thn th chif ofthe eronolog Resarch
Cete in Batmrepandoesc.psiiiyij

Wei knwta n ftepiay rbeso gnis.i
......................... l o s s o f..................... .....................................
c o d i io s s u c a s ..........................................................
t h e, fi~iii~ i i e l ..................................................x p......

in g r e a te r d e......t a il.ii~ ..................................................
Empirical data supporting the critical role of nutrition hag bem
povide in~ som nurtinl suvys.r.Eeao.cheke..ih igan Sate escrbed he rsultsof oe suh efort.
iiiiiiiiii I n 1948, Obison and Assocites randomly selected a.
samle f 7 wmen rpreenttie o al scioconmi
levels wthin th Lansin communty. At hat tim the,:groupii ragd nag ro 0 o80yar. Oeitenetsee
yera elce neras hs ivsiaor olce
d ie t a ry::::::::::::: ::: 2 r e c r d ...............................................................
mens ndsoiocoomc taus Ealatonin195.evsI
that physical well-being was directly related to nutrienti .... iiii

ehiM r izations for Inependent giving for
*gol VOIA) "documented the: overall problem. in June of

146ti, lless, particularly depression, increases with a.
Thd ercent of the U.B. population is over-65, ths
accounts for 25 percent of mental hospital
this01dr persons sid er from a complexity of mental
di~rdelqmiAdy limke d to physiealildes intensified by unme t

The~~~ p ~tiar aiding the elderly who enter hospitals for geriatric and c care was explained by Dr. Manaice Linden mn testiNre Select Committee:
'Exerence with over 1500 patients in a period since
1966 has demonstrated, in two institutions in PhilaSelphia, that the capacity for response to a total program on thae par of older pepe,: mecluding good nutrition and a good
tik n the hopth is tremendousu; much, getrhan pr
P~vohwe wh t6nd to be optimistic in thle field of geron%la predicted.'. About 93 percent leave the
hosptaland go back to some -form of community living.
0, Wysbqou five parent have had to go on to longer term
is tiutons such as State hospitals. For those of fqQJ Ymwa mow the figure over the years, this is almost a com)1A'.rversal of our earlier experiences with older people.
otnow stay out of long-term hospitals. . The average
period of care is approxanately 42 days which we think is
quite remarkable. I have concluded from the foregoing noiiA'F8 ei observations that the rapid improvement of the
Od~lypatients in large measure may well have been owing *
Pio-tomediate attention to dietary needs.
or4ate, a major barrier to the acerual of such advantages Mag aeweareqbu ol age. Dr. Sylvia Sherwood, Director
ero al~ 'a Research at the Hebrew Rehabilitation
...'e ein sonexlied this difficulty in 1973:
IWO I~hre are also important relationships between malnutriton and behavioral states of irritability, moodiness, depres4 and the inability to make decisions. These are some
cT behaviorisms that are often quite descriptive of y persons. A question may be raised concerning the enbto which~such symptoms related to undiagnosed
nutrition. It is possible that this kind of diagnostic
Ateetype applied to the elderly may have detrimental consequences. Irritability and other manifestAions of semistarv" ation and nutrient deficiency, along with "aches and
pains" may be anticipated and tolerated because they are ifPcepted. as an inelable acopnmeto If these
maniestations Arek not consieesymptosopo elh
hit~~ weacpe merely. assp growing old,,then atho

mh alntio anion odOer Are di
eatsotl level tat ae n .' 4n

saviiii ing i oheiphhlyAna thSetor Carlie has co...dh
We are realy taidyg atadof antiowma9

lustilesd i the mpar cnem hu si di t i oan d enns.which... ......e............
whee it is souted.a r

edaiecar atd oer.. ..lvl o diflthoes a he welderl hav&e eliy fesisas ahW 1

ictnt ton whexcts of hetvhe iia
m a l n u t r i t i oniii ...................................................
Ineatepn to feiveashon ouirsmn nip h" ntedrlyo we muist bge crefwuld esbtniay0sV
menalo aprach which has conrbu thsjdmn seerardeie arey taned Firsanvsmnttatcn nutrtinialielng tendeavior. h Web n,,ba 6 There we us atempt ond
w par e htte datgs of nutritional needs'Ai ande whoi~l needi.ce she reraticumeno ere fdnt6o task wilen freair

everyeotin to rovide slt s ande.prbe fWAto adteay ThderlTile VIIt progaramu isaodtOlaeh d";'A but itpaha been h prove inequted to u urn Q mi.,h sean hoe- M Dii t........n tv

Theyretai he capcity to sbiover mneralizenuthirones we'nd tbypoingfd u

utriets ien adoeuiae uan tmtehsitynes fmr pagefproisnecificisaseswic ih nitiowhc iybexetdTh zinlCuclaAgghs

Grat numbers of older people, particularly those who live in --very, or on its fringes, do not, however, receive sufficient .qutasof the foods that provide the needed nourishment that thei sytems could utihsze. Providing nutritionally adequate
destherefore, becomes an unportant weapon in combating
..halt pablems in the elderly, supporting emotional stability,
Xteningwork c aeacties and maintamning life.
obld b <,ildbed tb'thes to ms. First the'provisif o Llanced miask9 stdt nuttain edctoUn would help lower culric' tke to proper levels.,Recondl the reduction in isolation brouht bout by the socialization element of Title VII would eit domittib te basie'estees of excessive censungtion.
yffany9 esem i nprovements would bring abdut temendeus inets: Administration on Aging nutritionist Jedante XV~~it~r~tsthat:
ti Es' ctidns and reactions demonstrate that the
substantial. The regect this in improved appearA s' d&eater* interest in other people, involvmn
]h 011 clivitib, and renewed vitalit and monedl outlook.
Membilof their 'faihilies often reniari that involvement in pro ram has made them less demanding and more self..hnt It is common to hear such remarks as, "Without this
-I'd be in the hospital," or "I am a different person

rintfti e owe it to: our senior citizens, as well as to ourselves to niw,!vY et the nutritional needs of the aging.


Current Govern meint -nutrition efotanoermo ig"
providing services for the elderly-hav:ntaeu lymtth xi
tional needs of the homebound -edry Svra eAoa~Q
provisions exist within large GovernetPl ~*P
Title XX of the Social Security ActanTil Hot'OdwAmx icans Act), but the combinatten of teeCmocuPOicol minimhal nutritional assistance for: h oeoi&fih" ul
compelling 'nutritional needs of theho a ui ldiya6tobde ated fund mimust be appropriated for h. pcfcRxO
A.- FO oo AMP
The 1973 mnendmhents to the Fbo tm Aticdd 'h
first time a medls-on-wheels provisinfrteedry.hlUdp ti provision, oeaebouad eldes awith:icmbeo th 4A& eligibility criteria weeallowed to usethi-sap.o uhmbW on-wheels services. Thuhthis amedntwsapiiv diio
to the Food Stamp Act itdid not stsytentiinlneso the homebound.
The primary problem is that foddap r itne orteot but the nutritional prdblema fte lel iedrma udid
of causes, only one of which is p bound who desperately require asssac.Tehoeon il
incomes above the food stamp inc Even for the homebound elderly hs nblt o tana
adequate diet is income-related, fo -requrements.
First, the homebound, by definitiohvseredablts Mh make leaving home painful if n.totalimosbeYtM to be certified for food stamps, a persnms eeal ot 8 fo stamp office and often wait to be intriwdToecvehesap requires another trip to another office. oeon esnmyhv an authorized representative apply ftrhmo ebt idn oen willing to undertake this tedious task sdfiutfrteioae le person.

Second, food stamps are of little help to the many elderly who are homebou-nd on a temporary basis, such as a few months. All food stamp recipients must undergo a time-consuming certification process. ]By the time the stamps become available, the individual's need for nutritional assistance has often ended.
A third barrier to participation is the purchase price requirement. M food stamp recipients must pay an amount up to 30 percent of their monthly net income to receive their stamps. Poor people are faced with an economic situation which makes the financial benefits
-9f:tbe food stamp program difficult to realize. Many of the most Impoverished homebound are simply unable to pq their month] Ourchase price, and. thus are unable to receive their stamps. In aff,dition many poor families are unwilli to spend a large portion of their Eimall incomes early in the month aithough the eventual benefits are substantial. Sandra Howell and Martin Loeb described this problem in "Nutrition and Aging," published in the Autumn 1969, issue--af the Gerontologist:
I Albeit irrational from- the standpoint of middleclass, edtic ated person who is future-oriented and "appreciates" the ielatively good return offered for investment in food stamps, the poor person, with no cash savings and no borrowing resources, cannot feel secure in obligating his meager income in
For' the homebound person, who never knows when an expensive medical emergency may arise, the disincentive to invest that money 'M food stamps- is greater than it is for the poor *in general.
Finally,,Ue all elderly, the homebound elderly resent the "welfare" implications of the food stomp program. Food stamps are usually administered through State welfare agencies. After a lifetime of work and taxes, the elderly do not wish tosubmit to questions about their finances ahd resources. The result is that many poor elderly would rather not participate in the food stamp program than be associated w ith the program's perceived stigma.
Title XX of the Social Security Act became law on October 1, 1975. It represents a new approach to the provision of social services, emphasiiing decentralized planning with the States determmiing the tyle and scope of services to be used. Basically, the title provides
billion to the States in the form of block grants and places only broad limits. on howAhe money may be spent. Unfortunately, this altem'ative ha's also fa'ile-d to provide significant support for Meals on Wheels.
As With Food Stamps, Title XX is meant to serve the needs of the low-income PoTulation. Thus, many of those in need are not even eligible. Even or those who axe eligible, the means test prevents adequate participation. Jody Olsen explained to the Select Committee the experience of Meals on Wheels of Central Maryland wifth Title XX funds:
The eligibility requirements are demeanin to those who
are potentiallY eligible. Most older people, have worked all their liies, Paid taxes, and contributed to the general

mental is mnbinlt. tTo thev-o'6tI619V-h
tod rpse imatin (aou idohey~
contins with thex servie:ab hi ~dt oVp~o

In addition to the~esinie 81ect- no0blU w

this w&at in her tesionlt 4"
Assistance of the 8 use Wiv &aid opo 1976:
(To administer the means tos n4.O o~gr#
New York City will have to spdi:tefm W3
percent of theo amount it uses ~~Ucn~.I
quent years, 95 pedtent of to &Wl
means test.
Even for those who snhmit to#h~om44 tkemm inadequate. The priorities of fundinallcto r ett tt
to decide., and the result, foneals nwel, a infr

We had hope that_ Title XX'-fie'
would be a new stinese of, funads o.gas0;W W
for the elderly. To date, onea boe xa zt o eizd, Title;'XX Provides a lished: xwuto ay" )w vm
which grops in and oa
the local and, $to levels. Mrsdone v
never fared very well undeas0 a.V19V35 States report the inclusion ofM0 l nWeespo~m in their State Title XX plansamsVh~ qna rvd the service statewide, and the pere ittl lmne
is less than I percet in mstt

Alabama-- - - - - - - - - -
Alsaka._ --Disttc of Ca4Ria ..f Florida..__ ---...
Georigia ..................4..5
Hawaii......--.-- --.-- ---Idaho --.------ .-..-.
Inlinis----------- -------- -Ir W--In iaaws .. ........ 1 .4 ----. .. . ..

a n a liiiii Aii i* *

j a . . . - - - - - - - - - - - - - - - - - - - - - - -....... .
33 3 .54 1001
---------------tt .2t 1, 479 W
QA? .31 agaN/
-----------0- ---- -a '130 NA HIC
-- -- -- --- -- -- -- A 514 1.70 461 H
------- ------ 3 :3150 1,416 N
-------I--- .13 500 gift

27af 1, 736 .5M
------ --------------- 1,33% N33.30 1,727 C
-------------------- 5,9" 010 3.20 211 198HI
Sod ------------------ 326. 3*.A1 8
------ ------------- ------------- ----- -------- p'iii

-----l .---- !9 ---X ,1 03050

------- ".,07 .81 533 N
-- 016 .98 $80 1W
-- -- -- -- ---- -- --- --- -- 2 4000 .36 4114 us

g li~d t WKbut s lkelyto mmpa a Ilpi la t ithrb of eldry reeipient

1 1Tbi~s eanfill th sae onclusion reached by another aging theNatona Concil of Senior Citizens. .Executive
,Wilia Hutontesi before the Select Committee that:
It vtalto ndestad, however, the very limited
funtio Tile X srve infeedling the or, The Adrniniscr stmaesthat the Tte XX nutrition
0: erie, hic inluds bthcongregate and home-delivered
receies oly aout>ne percent of -total fundasialocate ihdr, itl XX Wewould be hesitant, Indeed, -to deped uon histite t sustantially alleviate the problems
of or hifi~oun andundrfed elderly eitizens..

bow Prqambegnwih asmis of demonstration programs cared out y'te Adinitraton n A under Title IV of the -Older Ame~wiw At. he-proectwea desied to test a variety of meal sericedeivey sstms o ases the ideal framework within which t* povie -utrtiou mels nd eeded sup portive services
In 14 2 drwmi uon he exrience of these demonstrtin projec~s: Cogmm d~d itleV11> thes developing network of services
for snwr ctien, cmid ut ndr he utorty ofth.... deriii

Aeriuay ser .Ire coiton as tran o ind unq
tion, etc.
The program is administered by theAmnsrtoonAi
provides Federal funds for 90 percent h eesayep 6s Because Conigress realized that low itcm a o hesl ~so malnutrition among the aged, there aen:noeelgblt to
ards; anyone aged 6Q or over, and his o e pue, program's benefits.
The Elderly Nutrition Program iswdl iwda n"1R1
tionally successful -and popular -progrmItedclbnfs:hv been proven and its social benefitsca.eslbeenby94'00 visiting a, meal site. Last year, aprxmtl 5,00prb1..
received a noontime meal each weekday Title VI ,' however, cannot be relienasl ouinfrtene of the homebound elderly. The basic ls opyo h rga-i to provide meals in a .congregate faho tslctdma1ie. Indeed, this emphasis on serymng the neso h has been.daintaind despite 'the .fact .... limits the amount of meals whi .ch may b o'-eiep.Te8~'' and projects h ave realized,. quite corrlyta Cnrs ne~ the Title VII program to serve grous o sltdidvda8 such as the homebound.
The results of this group orientation aemd la nteporm2 statistics. Of the 250,00 meals served ahwedylatya,.l 30,000 went to the homebound. Indeei Title VII were relied on in an attenpi opoieinrae oe
delivered meals, the required budget ouly nutrition of the elderly. But it, is clear la oe rtoa Loc to the shortage of bome-delivered nel st rvietenee support directly to the homebound thruh-atsucre
Since the 1954 establishmient-,of Phiqpi' ihhueMas on-Wheels p rogram', m any other com ru'te a'" be'n rgai of a similar type. These local prograre motofestrd.b community church o rganizations, civcascainowaiin concerned citizens. For, the most :,paltteprosinovdi h
organization, from meal deliverers to- prgadietvouerthr time and effort.
A review of 'Meals on Wheels prograsmteUid ts, Qp
discovered that most local home-delivrdma ogacV:()ae
located in a metropolitan area: (2) serve2,t 0prss()dlvr

e of.aul aurtoit mieal. Tefor s hoeeooinclud not onear ttf fod't th reipinself, an recwiche haymincreased son T'Reyon~~~ phs eea iiais seveal yeogarsutai ouso oa num~rof obemswhch av mid otairscpct to ee re th~~~~~u6 aoto f hs nnd f uilitie eveiin h erichs. Tileeliitaionsexit bcurse there are ncidetal prseram riah~thn ay filues n te pat oftee fro s h relig sdotheso

8XQ~ a ierneo tss wases, cthebfees thio these lotua cost f prpanngand elrge armeal baese onfanctos dot fonl the 6 a cot ofthe ooditsefo ite wverag hadernciiensdsb stanialy i prie oer he ast seperatingeadeficit whiohs quick

neces~~~~~ I ar.epntue.The fre, aiste the itan Losts ad purc ;,n'i Idche eqipn the cintsaility to kepy Everi durniigI~~~v:ula clr aecotint, tpramoses moirneya co and l,( essonalnutrt is Cet ayand' diff~e ve he itcen

expenses~~~ monp n iceaeths agdo th rogam asd otedub
stnta theh financial reouce ofe thoserre. However,~~ ~ beinin ofy f o otcss thime eriod, thseloa n~~~a~~~a~ grup Thisl haoras chang ae a ed tolyon whers fte to
it~lfThi, o corse maen t esfof the lientae peorithiset afford but leavn. On atmth oeandfiit i h mportln

9 on~fi th, prblad toe this, exes.ted wand o b owuin poits utareusulrybaledothe thies shiityt y creatingaporm fewre ssne fo a artcargeiet, tuall costses roneam

T ~~~ ~t a w ayl w r n o e pnt s o e rme e very onet toh gusble
lig hefiancial askuce of dong so-

local prbeivateasort for d-.b querilg
doubtfulnt tha suckyagyzes c
agegr es, nesitte higr pulives of 46fn *l
aomty sodartes.f thes ofud 84 nmn4is~wsof"-w

.eir oiv os u iely on heprgr...........
frmoths pres aeies sl liie.Frhroe4hd~f
o n shlort, td g painfriv the progra ms-hsuaesA vald rale yen t p estlis aeededrible reuainnte Tht erdte lmot-otimss jinhamut'f ks Thabe abl tdometa mos amalthpor dcts,-u r rvne
otCever c ommunityi assisaci..cnimd hscnI i
esetialoto bexpand thescop Cofmte inS-e4~r f 99

Asxwercanse fr o n tthet revousZr g
speficll dpesind Ti poide ntiutr ~ nuc 4 s u
b o.I grs inhcte foresucn n< 0l P 4 newitnd dealoio of support. Dpte toi~f~qt The l.pivt nupr, outritiona problems, of~ the hou'J
vitdtoughfucurrnt pcy option
Peraps th ot mpressiv endors a addii ie.ooeo the ho

S t The.s thbrouhty o sche pr~ a e~hi of hearmg s vausitl nuitrithem1ryfam~#
o p ae 21eang exets n 'i'l 'ies.i

recomendpthpus prnrit on gad avplyd wxetoiy fealoeding pro ingo theed gevthe totepmbudfi m
eesry mnwy egislin wastac for trvtlporm, f

mAs oen hee program opraediu tlxmntino ooSu
Title VII. ThanTte -e bv s p ecii~iii~iiiii~iiiiii i fi c a l ........................................................
boud' If..... ned or uhnes~ob Mti 1s

newii an ietaloaino upott hs rtclydeeit M4

enl a ""Ir uO, c
S tu dy ................................... ................................................................................................................. t iiiiiiiiiiiiiiiW: .iiiiiiiiiiiiiii
...........g h t o p t h e r A s 1 p r r i es

ofiiina home-ele om ee an
-ai&I.'fttipcoras.hav benesabid ton Cner nayna 1),1) : tma on weel" pogad hsbm moreapret

ofortleI.iig coenig,, Fhima
-1tt *ram m scia se t ree iao the Comittee members
of~ ~ ~ ~~l reintroduced ele.y Y58t thrremn he antioa
weth $80tna micon iewn sa er17 n
toea beueds eilyfr homestance withiprivaecmitiative. Whil
>IllQ thate the priA sectracks H~~wa r _a~rneed ofipe thepp hus rtebounde8.358

co Ae, tim~ ~e of teeha fpia oga nations. Laguage
so til 1ha Stat*esAenies iv pefrec
rarde through theeisigptrctr
.~~~~~~ praft on eno iiaei& grops. In i way the
r9411'" ~ ~ ~d ck ainlAscainonroelverteir anonrecats, "e~ ~ ~ ~~~Io gasFodRsacanconder eansionl of the
NaiosStt Ofce o gig admmycoorato etweh il
On une17197,Snatr Gopoed lcegilain, henrman elderly Select ~ ~ ~ ~~u bomteaogwt hecomesrdisabledeormotherse Senaors ercyKenedyandole rfered to355 the Natingl Meas-*-Wee Ac o 196.'Tsm tokn, whamnen temoraritly
$10 illon n fscayer178tha perusonwd eal rferhed-c ome-deivere sevieswoldcese The ~ ~ ~ ~~r thatna anepneeals on wheels Ati natmtt civ harmniou bled ofFedeal stnc reintegratte isoliatie ele

latersecton, he gantsmay ewrsons capable fiattning arupr
of 'Ttle VI by ontrats tothe pivategroup. Inihis wy th

v olu n teer grou. riiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii ectsiiiiiiiiiii
ps reain easonble ontrl oveitieriow
yethav sffiiet rsouce toalow onideabl epanio ofthiiiiiir~

S. 585woud aso equre axium oopraton etwen he ieii
VII cngreate rogrm andhomedelieredmeal rojitsifriieerra
and therpurpses.Undr th proosedlegilaton, heninielerl persn i th cogregte rogam ecoes dsabed roheriiii limied n mbiltytha pesonwoul berefrretotheconraciiiii

meal onwhels .op. y te sae tken whn atemoaiiii
diabedpeso egmsmoilty hatprsonTi| wol b riiii bc


meal site .. -would in, stead 1mviome dependent on meals delivered to their homeSW
.A gain, the Title VII Sukvty idtompted, to assess thevali4Apof this concern by asking proj ect, dir etors if such an expansioji ..Would undermine- the. congregate progmm.- S only. 9 of1the 125
directors responding believed lhis,,to be a serio problemi- Ujstaff summary, noteiv,
proj ct directors 6vei*helm n b Veved'thif *fi
danger .0oul&be am li6kot6& by caffii Y h' ui e
t own g Uffifi"
Indeea,'-severiil: noted thAt #.?Fbgram 0 Ome--de1iv4ed-wb6U
would increase the contact -- betweenn the isolated'and projftt personnel and -ther by,im *e th6,proj'ect s ability to encour&
dge the congregate' involved ,bht of those who'are
mobile. J 1
This'c'on tii uum of nutrition "service is vital -for th6- sew-Or bifiien. As it is no!*,-and mthe ib enxe -of FederiLl s kpoit for meals W, heehq" very f ew elderly will 'Doinpfit -from any, End 6f -in-hOM6 MH091"Lw ser oe.

i r I


1)nm BAcronouxo
P olicymakers, in analpaing budget priorities, often attempt to eales the benefits of a program ageaintthe money meeeenary to fund that program. The goal. of each efforts, minmzng the burden on teAmerieen templeul to a worthy oe.a Unfortunately, these budget reviews smtesplace excessive emphasis on short-term bo to *IM ignoring ln-embeet.
P nowhere is prbeamre apparent than in the ftid of N6" CAre. In fscal yer 15, the Nation's halt bi reaced $118.5 bifimpan average of $547 pr person Snee 195,halth care outlays, as O 4 Otion of ONP, heave risen from5.a prcn to 8.38 percent.l Ninioiaert have claimed thfatt uhofti money could Ibe

i*fiwthdn with prvnigte. The Geea.Accounting 0ff1ce confirmed this beifin 1972.
The -importance, of 'prevetiva efforts gaining greater
attention and aretance than the hav on the past takes an increasing sinificance as more indltidedl arn either provided access to or strie to otiadqtehealth caee.
Unles seek atention and acceptace is fotcmnthe ,esant deltrary system, wich enphasizesreamn and hot prevenion, probably will become ovarburdendad' will
not be able to meet these demands.
A atcyo prevention, of coarse, cannot be offered as a panacea for
owur ge problems. Bidt we have an obligation to measure costeffetive mna manner wich ensures maximum use of our budgetary
In the Rield of griatrics, it has become almost *riomatic that the optimal system ofcare for the elderly js one which offers a fiarshis continuum, of services between independent living and institutioilisation. Such a continuum, unfortunately,. does not exist For those who wih to remain in their own homes, income maintenance is the only aid., If a person iunbetmatinsl-care, however, his
tions are limited. For hundreds of thousands of eldery, th nuri' home is the only ready alternative. One out of five senior citizens I shter a nur m e a some point of his/her life. Elaine Brody of f#1e0 Philadelplua Geriatric Center explains the basic problem:
Studies that have been carried out and the accumulated
knowledge of professionals indicate that, in theman

tdexidlingtwervies arele insdqutitutioinaloiat o eat deenedwith odreonalesemytedge foem n.Ie

now beliePorthaton ost 8tialvres neddi oe
lauli~ebaead cohevewepressd h avje Corsoteted ma or Ccilep fom gn ntstmn fi the prosect ofmm min meecll idae'at
fears of -,Alma mycn'hwr the t e.e forf
thi ETd iggde aggc and aned inncoesredcsl
4srppypddetive ashin. W

taldougf 'ewnmeal- devrpw haebefae nyaqn
dtengwih reasonabl pauqrat the perem of let-avgapWi

Both ~ ~ ~~o MeicicedMei4W,.eer. Suggreinag'Ue lnthyeaten,- aio td spetu of armee jv araeesnciie opu
citizensfrom t1he 10t of1kasin beml eident. tht 1
pinning ofor uchservices based ncepacteae mqdF ihs toy proido ae-i-hM. tOfetv ahin etk Onepofed basi eas as an l-mackt-cr ofIIVI codesrect e
lack~~~of alentvst d n.r Asc careo gays physica why b-quepta reaea. s
Phile not, of tallaoing sety, howv theenuk isIA btwisesentisel-carkwand apare. Indedas: eArl ug etion, semsomebeWJ Mlery hae beat ospexan lie byote- ee puyg moe4own thpobme. y o nomtem thcame. suporgtre sere; thet motefe scappredsoac Ws proid th seciic neesary leve ofsie orascset that le el a ossble, oreac. seor ciien. utbesxciwait

14WOOp nuof these intermediate services, however armaisgin froms 9M~utprogas for the agd. Helen Kiatin and lobed,. Morrs of yeaitys Irmsn Gronolgical Policy Institute summaried the empirical support for this elanin:
ismount Mg and consistent evidence that many
s~ely and hiandicqiped persons are placed in nusn homes
other ~ ~ ~ ~ ~ ~ ~ ~ u intttosboeo eiclraoscause
eential services to maintain them in their own homes and
synaunities are lacking.
Teexact degree of this fait fure was the subject of research by hLm Kwomat the University of Nebraska at Omaha. She found that:
At did arle out by gerontologists in the last several mej ie *Ven more disturbing. As many as 40 percent of the
--OI if nursing homes do not really need to be there.
'APOWanagement Sciences, in a 1975 report to IHEW, reported
ob~v' faanpal implications of such misdirected efforts.
.-HU Wha emearges from the studies (on inappropriate in-tttionalisation) is a conviction that various types of aernatives to institutionalization are needed and that these ifenatives, properly conceived and finianced, will offer a gol-ly satisfactary solution to the dilemma of public fnds
being supplied in support of inappropriate and expensive:
la4pterzs institutional Care.
Weed the, nursing home industry has undergone tremendous 'iff bi the Ist 10 years.. As of .1974, there were 15,700 homes holding '7)80 beds. As these figures imply, the amount of money spent in Y etor is tremendous. In fiscal year 1967, total funding for nursing gome was $1,751,000,000; of this amount, $90.7 afflon was from pubicfunds. By the end of fiscal year 1975, the total price-tag for nrig homes had skyrocketed to $9 billion. ThBi represented a 2 .esent inereaseoverthe isa year 1974 fiere of $7,450, 00,000. Te majority of this money comes fod the public bugt (In thetAt 4 yeasrthe proportion of nursing home expenans mnet by annieioroes has risen from 42 percent to 68 percent.) In fiscal year 197:j Gvernmnts shdre in the nring-home sector was $5.201.00000Dr. Weiler draws the obvious conclusion:: With the tremendous amounts of money we ard now spendig on health care it has become imperative that: we approach the problem from a cost- effectiveness perspective.
'jRme-delivered meals, as stated earlier, are a crucial component 1We foi; the elderly. The homebound elderly do not necessarily 6 ie institutional care, but they, must seek some support. in maintinna themselves at home. Often, nutritional support is the major oj e;g shopping and meal preparation are exteml difie'ult for soene who is confined to bed or whto can walk only wit pain. ,1many other cases, home-delivped meals are not:'thteonl sup kt ended, but they make itposs be for other sources support to

)e usd Jof mels~''r9dn to thed -hosofb i i3lb hk Deth o th'nvttof-aY6d9V0 adif B asi Oe _mus be14 ~ Agimp, of evren decisiosAsilt in h

ar m n vaibe ..i, fo vari '11iW
M,,anry end peific coshode le u etaiOc a 1thid the ivr o muhels on'a6"t_6i~ acche a trous. In et e rsn to'contpuetatiii eial Prvn ttempt o wpr

Thelivsely obtainestofte homebnsee cn pyatm
savingeniiidiih bamielatiiiereiimili
e eineiiinthepdin S dhibatiinal

tuodalinti tof the gee of uheE1t h wheeiclt: Win~utb thiat ~ie te in Onia0~u
(1)ac The cosretsde~os s nteetr of pu' ".4 ofe mdiviales uri or cous aos ano 4 a nal Nuagsei I ttozure., oeeiliy kr larne toat oos perrede n daccutoynetaiyc s prsentiloe c!an appyt teah r

1973,g which was 11.4 perdt The :ol rv suhe estraponto bgadyi i ocmaeth ot si
whes(a)h to istalk' endiures eesryus.-l.'. f rat 7e csof 5npercetina tos ,h yes rcn 4atkMn b i n crid al sing attet s bpod y.

NainaNursing Home Sdrs, thy ~~i~hale aeatio cit s ti factr. rsdna as being4 roea 4 nreass of the apasthe eiag ye whancotA Pr3,wic wndex1haspexceet.ded thiltia t40Txg Mulpication o $22.71 pe a nt 365e (dss'si

(2) tcotal ofxhoediere meusn oe roe ta vr pubisedo a5 puret of the 3itear I: data proviein athisurve is nclud tteefremto "i
program After exing oasbgrespoefrms f he* i th ese s aes, ifth wast foundt thas, . .V ,. o
hedthe aldi l oftisfgre. ItrviscopntofheCPe program (such as hat ropoed tir t,, h
Wheels Avqact of 97 anhta causetonfe
Wigioe ero i n

yeariiiii ..8

siivb Ioss f fl
rox up-at orUh
p|gasAtiO i ~pns- hc ~tiieu ths sidti,"twsfudthth'vrsecs e e !
was, $ 1, Nuiierc i
iilililiv lu teriia sp ft 'jiia
bewenihlCniitte ifiniigli dmhitrii6h heldthe alidty f ths fiure It s, o corsepossblethata Feera
Droram(sch s tatproosd i S.355, teNatona Malson Wheels Act of 1976) miht cause this figure o rise slightly due t

.. .se. t by the Government. To allow for this, the Aiggrp, of
a sggeted. This figue (X 865)! yielsa:ana el-n
**eq1se~t of appresimately, 620. It should be noted that this f re at overstate the costs since -meals provided on weekend
BS2 days out pt the year) bave lower costs than the weekday
ii s~n wich the 8 1.650 figure was drawn..
(3)A We assopecisone.-To plce these per capik 4Afgures into a
ojow; 0ey ontext, one, may use as an example the level of home46eals ($80 million) proposed in S. 3585. Assuming the e
peam~ oat ea sch a program to be $620 per year, first year appropria44m~p0 W million weald allow the partieslpatioA of approxunately 1801100ad. ($80,000,000--$620). For a group of that size, tta peang ae cost's for one year would be approximately $107 9,O0000 (9,000}. Thus, the difference in costs between homeooneals and nursing home care for 130,000 people is apoi
8l 1 billion.
aulv Aeare of nursing home costs.-As stated' previously, A DTO ent's relative share of nurin home costa s rapidly inQ41,1EqjCarajily, the proportion ii. bout 60 percent. Thns means
a0$o the costs are offset by private.sources. Generally, it is t~o aoess of the patients. that are used to defray the nursing home satf report for the Suboommittee on Health andA the EnvironMavthe Hose Commoittee qu Interstate and Foreign Cmec
oxp~uedthe reason f or this in February 1976.
Te great majority of the payments made by patients and
their families are paid out of thiwn incomes, savigo
Oerpersonal resources without help from private insurance.
Pri~~eansurance has povided little coverage beca, Be of the
4W-ty, of. distinguishing between medisagy-oricated ceare
and custodial care and the high costs that can resutilu nless courage is carefully limited. For example,,Blue Cross plans,
Ydolkb underwriite 88 percent of the' rivate isrn ln
im rising home benefits that are leld by the "a 'Id
aut onl one-guarter of one percent of the nation'Is sa Year
18 nursing home bil.
4f op -e to assume that, for the 130,000 eldel whood reqfive lgwo,4l~vredmeals, the 40-pereent-share is app able, the governcosts weald be reduced to about $600 emiion (1 billion times 'W rentt): However, as will be explained laer we can expeeA those agdto have very low incomes,-In addition, the nurag, hm
patient is usually allowed to retain $25 per month for personaltmeeA ',Therfore, one cannot reasonably expect a member of the-group cOnsidered, to be able to apply more than $2,500 per year t te ot~s of-care moa Aursmng home. Thus, thboenet hr n e cost
differencefor the group under consideration., would be $700mili.
It should be noted here that, in the next: few years, the, magnitude..of
gure wil rise rapidly if governmental support frnrm oe
satinues tp increase at its: current rate. Meals-n-wheel costs onth orjhand,;.increase far more slowly in ,both relative an asout
(5) Percent actually averting institutionalization.--One cannot claim
A~~~~~ux~- e *tL iN it. -- ,- t L n -A -. all l ohfd

necessaryy to detirnilne the proportid@ bf this. groupE &Y wdgig@ savings analysis. is applicable. -* l
Doctors Dougla. Holmes and Sandr beHf 'tl ofe
Community Research completed. asr -ot 4040 pat homne-delivered meals programs ht 1972. Theid'u rey fundec, T1V achieved the most comprehensive and representative sadit ito aged persons to date. The researchers chose 16 seiiior CAteif-p each of 32 programs. These 32 were carefullirseleetbd on hw, Isaghe size from a compilation and categorization of all honie-deliveied, ish programs which could be located in 1972?1:Thi&,result 6t d*V tw provide strong documentation of: the cost savings possibe4ffitneis on-wheels. AM I
(a) Participants were asked the question, 4'Whjat W"yeur alideMie to home-delivered meals in the case of program-, terddind ?a4
(1) 34.8 percent explicitly responded; that theywould Mtn 6,0 Ynisk home if the program were ended; (04
(2) 18.3 percent said they "would try to cafe for thler *S; Evs"his viould indeed be a valiant effort for an-individitWwhe 4941ro@ years of age and is so debilitated as to be. ahable to aWk4o. .lsos or bed;- we must, however, realize the unfortunate Nkti thme*1dal independent alternative i" -for too many in this. gibip, deosti tak possible and certainly counterproductive;, attmptw" Ao Utdidist namce by the ho rebound elderly will too oftenlead &der -6 1sY~tal and mental deterioration. TIhe Subeommittee on Lo0nYg. 2Ti6nales of the Senate Special Committee on Aging coucluded in No~vemiber 1974: ;.
"It appears evident that if teelderly do no he tit i
needs for home health, supportive service an~d,:b& Ma 0Wit
met, they -will dateferate to the point where itlttuti
tion will be necessay or they' wI dies"a ki
In hisgroup,, therefore, elimination. of home-deliverp ed qol
be a sure-way to force much premature and unnecessary yit jffnalisation-; thu-s, it is reasonable to add part of this'18.3 pleit t the count of those whose only alternative to home-7 etpt s i nursing home.
(3) 8.5 percent stated that they had no alternative, that hey di~t know what they would do this -response is almost the I san ita abid maintenance, except that this group realizes the futility of b ARtt care for themselves; thus their indications of hopelease so deandlit strate that most of them would also be forced into the lan resort Af i
-nursing home. e.n
(4) 22.7 Percent said they would be cared for by their miliefhad
4.2 percent said they wouldobtain assistance from a neii hbqry such hep is desirable, but we cafmot assume that it wa Olsen pointed out earlier, families and, neighbors ofte "fd se too dxl'cult without home-delivered meals;' the min tsi would therefore result would, as for those Iwho attempt IIadi, cause a significant degree of premature and unnecessary entries MU nursing homes.
(5) The remaining 9.4 nt indicatdthat they we sesk a
level of assistance lugher than provision of, honmes-dlivered Ik bMt

dowedganinstitutionalization; while these people would be able to da~aintain themselves in their own homes,. they would be doing so is )Mk appropriate fashion; the new services would all carry a mueli Mpric tag for both the individual and the government; it is
lywasteful to provide a nursing service, a home health aide, or
e~andimiar program for those: aged whose need is ol o oe
Adhiered meals; moreover, given the inadequate fundmag for such informediate services, one must question whether these elderly would escoseful-in actually securing them.
(b). Because the, participants an the Holmes-Howell study differ in J1hes1 albpenb from those who would participate in the National Meab-en-Wheels IProgram, the study systematically understates the amount of cost savings to be expected:
(1) The researchers found, in a separate question, that 40 percent Of those interviewed were capable of participating in a congregate meal program; under S. 3,585, however, eligibility would be restricted
itewneed for: significant outside help would be far greater. o,() litedies of past meals-an-wheels programs are, of necessity, thaited to those which must charge some fee for the delivery of meals;
ashiutions to program. funding was approximately 50 percent; .8 poeasnt of the participants owned a TV, radio, refrigerator, stove, dder. bath, toilet, and hot, water; over 90 percent had all but the abibrision; the authors conclude that "economic criteria indicate that
may of the participants are not really in the destitute-poor cateory"; clearly, budgetary limitations have forced many meals programs 4oexclude the very-poor, the. group which generally is in the greatest danerof institutionalization; i n S. 3585, however, there, is no fee ,reqireent to limit participation by poor elderly; one significant ,trt of this change would be a reduction in the number able to rely ach, alternatives as self-care or assistance from relatives and ibors.
Would be unreasonable to conclude from the foregoing analysis that 100 percent of those receiving *bome-delivered meals through
8. 3 5 woud be irecl ae rom institutionalization. But, it woul be equally unreasdnable to insist that savings only be counted for tbe34.8 Percent who explicitly indicate that nursing homes are the .only alternative. Each of the above' considerations represents a Cleaftinerease over the base figure of 34.8 percent. It is, of course, impossible to state the exact quantitative impact of these determinations. It is necessary, therefore, to establish for each a reasonable rang e of resulting increase in the number of participants who must seek"a nursing home. It is th conclusion of the Commttee. staff that a program such as S. 3685 wduld M9Ve between 50 peredht and as pet ot its participants from nursing homes; within..his range, the best estimate is, one of ,60percent.It. should be noted that these figures are equivalents. One cannot state ,tat evefyn i this 60 percent has a direct choice between home-dlitered. meals ind institutfblialization. That desetipion only applies to abbitt 45--510 recentt of the bartieitianki.: Tiaee .is an
addx~tonal g of W40 nret for whom the reductioit in. ineth

76-F O 7 6 6

For ease of reference, however, the savig for: the end expressed as equivalents of the first.
We can now make the find computation of po Vn"a aA minimum, the figure of 34.8 percent explicitty i M,10" respondents to the Holmes-Howell survey poes* that, saved by home-delivered meals through decr'eased: institutif would be approximately $240 millionprya annn
expenditure, of -$80 mihl "on per year).- These savage ae* beyond the cost of the meal program, which were ubmd three. Further, if one accepts the presceeding aasi l Howell survey, the savings produced by meaila-onawhe o"
actually be in the range of $350 million to 4525 miion itA estimate of $420 million most likely.
Annrronz, Coron-8[IATrxows:l
Though the savings which can be accrued through ho
meals are tremendous, we must remember. that am~nd bens part of a larger picture. Elsewhere inis reportthe direct human benefits of nutritional support have been dimcused. in unnecessary institutionalization will also lilsuc ba
First, we must commit ourselves-to provide the edry
guarantee of dependent livn to the maim m "e
One must question the goals of a society which places its, geriatric warehouse when life in the general community is atil Not only do we give those senior citizens the message tiest-" unwanted and approaching death, but we deoy oursdelvi t which we can gain from a comnitaity: which containo.ti o their years of experience.
Second, research is beginning to disclose: that,, its very e entry into a nursing nome has severe impact ont lifeexe
on Aging reports that: 14W
Much evidence clearly indicates tha looka
nursingL home with fear am)j hostility. It has *e doue
that old people believe entry into a*hme is 'ap
death, and that there is a negative reilait,
survival and institutionalization. Substantig#Y e ra
rates were recorded. among those admitted to
tbhan among control groupq, generally those on4' a"&tig''for admission. This phenomenon ha been tem
plantation shock" by one researcer,:who recorded 42
cent death rate for those admaite to inst 44onaffeeg;Bu
ad28 percent for those w~aitng admission.
Third, we must face the fact that Ursin:tfg he em beset by substandard conditions.Ms. Karnes write9thatz::::: i 41
A U.S. Senate, report in IPecember of t167 qps ue
amjrity of this country' usn~ossaea
wit i-hreatenng violaticixs Of steadar
Increased enforcement efforts,-Of eommn wiH h81ln4 hit emOW -

nally, there are cost savings which can be gained through re4fion an hospital utilization by the elderly. As Dr. Tauber noted
haper II, home-delivered meals can bring about earlier discharge
of1opital patients.Tonaldl Trantman ot the 1NTtional Asociation of Rom Health Care Agencies, described a GAO study which found that "2:th B0 percent of the hospital aetnded-stay patients have been retand hacause of seeial rather than medical reasons."*
Th atnualf ~. a tion-btweemn hosilsI ani meals progr was delin.ted by Bernita Grogan, one of Massachusetts'
TitleV Nutrition Project Directors, in testimony before the

ah home-delivered meals have become so crucial that
franutly Nantucket doctors will release a patient on condiai~ hean be enrolled in a meals program.
As iarning home sector, hospital stilfization is also significant
an. d at fye nt the National Eealth Survey reveat that persons a s~oer spont over Or inillion days in hospitaIs in 1974. There wer 2.4 dischagg per 100 persons and the average length of stay was 2 1 S7ays. In that same year, secordmg'y to the American Hospitad Assbition, expense per patient day reached $113.55. If the home delivered meals program reduced hospital stays by a total of 180,000
sys onefor'esch participant) the annual eavimgs wold be approxisatly. $15 million.

It is not the intenion of this section to claim that nursing homes ni uldbe completely replaced by community-oriented services Such aift weald be unwarranted. But we must understand the implicaiono of our current system and the ways in which it diminishes the poseffectiveness of our tax dollars. The addition of meals-on-wheels Jothe services available to the Nation's elderly is a vitally needed ,p and one that is especially justified on the basis of budget eflip~le. Perhaps the most fitting conclusion is that expressed mn testinoybefore the Select Comanttee by David Alves, director of the Rlde1y Ntrition Program of Greater New Bedford (Mass.): As e ll ecgnize, nutrition competes for attention within
t funding system. Congress must go beyond intuitive thinking and demonstrate their concern to provide the comprehensive services required to meet. the. demands of our nation's homebound. With our increasn elderly population,
many f whom will need help, the decision seemIs clear. We canchose to either spend more and more on institutionalizing senior citizens, or provide the services that will keep them in their homes where they declare, they want to be.
*Report to the ongremssStudy of Hlealth raclities Coastruction Costs, y the Comptroller General of the United States Nov. 20V'1972.

iiiiii~i ~ iliiiiiiiii~i~iiliiliii~ iIi !iliii~iilii4 Wiiii

T h e......e.......e........S................d...............r a ms............

Amercan ishgad epn rako ny hs rgrm ii

siiiiiiiiiii l c o m m uniiiiiiiiiiiiiii~iiiiiii i t i s ......................................................

th Fdrlleealnteeae3prgaswihdrcyS'Q
theiiiii iieiiiilely.iiiii AtteSaelvl epcalic h
XX, her ar may moe pogrms ith iffx pssae 0
eut puiiisesia

digiin ........ A nd,
andiiiiiii priii vate progras to fill perceive gas in the srvice iii
Twmai rbeshv ofote h rgasi hi foU

to reach those in eed of service. I has been difficut'at theioutsiiit

identify the senior citizen who may be in need of services andl it has::::: ben qaly i otmre dficl tasuetht hseaedwoir
~i~idnifiedaesre yth prpit gec r0gni
Idenifi n poeta gdpriiatsfrsrie,;r f P

theseiiiiiiii persons ofapora' xseneota te dnif h WM
i siiiiiiiiiiiil a n................................. I iiii omiiliiiiiiiiiiiiliiliiiii
........................................................................................................................................................................c h d i c t *0~ii ~ ~ i i iiii~ ~ ii
thtte otned eevesriesfrt
...... tak oeer smd or ifcl b h ye o rbe

WNS or: her own initiative. This has e.reisd numerous instances
'he homebound senior is located only after crises develop.
a aeslt of these tendencies, Imost progrAms have developed out*66 efoA to inform senior citzens of te service it provides.: How-ve alarly in nutrition-iptogramsthese efforts have not always
pbjets, due to a severe limitation Of fundsheha
l~i attractingnmoreta lenough persons to attend. It is
stionable,howeveri whether those who are attracted are ""oin need of nutrition services.: Thie staff summary of the
Survey provides ai valuable insight.
Se directors noted that liie program fundsiur
--the most 41ert and self motivated-of the elderly will --6d. Many who'ar most desperately, in need of
F ot heeft willv not be'reached unti the prqga a
01hs whhve sougVht out the .program on. teir own.
in ~doto* reach the mosat needy,. as previously mentioned, it is
to cnutaggressive oubtech,: including door 'to door
Jeaett Pecovte exliswhy .this is necessary and Vanite te conclusion: of: 4he Title. VII Survey:
..whule a new program may attract many paricipants,
itw1lnot attract those mn direct need-those who are socially imie. The very nature of their isolation precludes parfcption in -such a, program unless coneded case-finding
efot are made.
Unfbfanately, rather than conducting such intensive outreach, nutrition programs have not needed to purue participants lk~-jI An Evaluation of Outreach of the Nutrition Pormfor
Tery, conducted by Opinion Research Corporatonfo the
tion n Agng, t is noted: that. outreach effortswraf
faet#4V te fact that "of a total of 35 sites visited, 32 indicated that
*my e'vinug as many meals as they were then budgeted for within W t *At Aer opening of the site."
T--rslt fti nearly instant popularity was that many programs conduct outreach at all or pursued, it in a less-than-aggressive Awoer.The Title VII Survey found that:
Those projects that do not conduct an outreach pogram,
(tnhad apparently valid reasons. They noted th at due to Ifh 1e funds they were already operatin 'at fulcapacity and m~ftined large waitin lists' Tey. believe that to cozitinue
-xenive outreach would unjustly raise expectationss and
ftth-tthose whose expectations would .be raised and then

Tesecond major problem facing grams for the eldery at all leel -to assure that' the senior extizen, once identified, receives all te essr services. Because: each program often conducts it 0*,Ourtdh effort, there is no guarantee that each program, oprtfgon -its on, il locate the same senior citise~n, Whofe

Tod morinamzti syst em a n y asoAream vendvloe

These systems and the Area Agencies have bee aubeadtp to aging policies, but have not been totally targeted referral. Basically, the. needs of the o bunlOdij cannot be self-assessed very effectively. It is dfiut o uke for a shut-in senior to recognize or eSpeci .ally t It is here that Meals-on-Wheels can play a via oe4irtMas on-Wheels is a highly visible and very attractv rg~i se
elderly individual ean become gradual used to Home-delivered meals have been used orah1n
seniors and acquaint them~with the service viale fe the initial contact, it is often possible to perudth aio ipants to join in group activities --- espeeialywihte o,:r
program as a catalyst.F!T
Second, Meals-on-Wheels provides a near-pr. tsrcu6fo close targeting of additional community servicestth pefcied of the homebound client., Meal delivery personnecabeasltn M to observe condition&s-in the homes: of clients hic ol* ec necessitate the service of one or more additionals mui V ece If such conditions exist, the volunlteer or staf ebrieotdh situation to the appropriate person in the prjcI-cnta fie
who, in turn, contacts the appropriate agencye fe raoa~
period of time, the Meals-on-Wheels office make olwu cw
to determine what action, if any, the agency has ae
This approach allows an ojctive assessmens ftesn-r ii zen' s living conditions and health, while helIlt'sr h munity services for the homebound are coorn~lidin ee't ''hg at the service delivery level.
The experience of 'Meals on Wheels of Centa fyln hi
regard is a useful example. Jody Olsen told the SeetCmite'ht
During the (past) year, 4,100.referralswr aet
other agencies, an increase of ..87 percent ve.lsyar This statistic reflects first, the fact that ma~yo h epe
serviced by a home-delivered meal program
needs, and, second, that it is important'i re,& oe delivered meal program to be linked int.s tersrie
agencies in the community.


teersplay n imortant part in virtually all eI!ldyiW urto
IR*Dra4 whether these programs are public or pivate.
CMiienh; on the particular program-4;Xd. On- the avililit Of v~tutteers in the ara, unpaid workers may generally average oIM
50P to8 e 4o hesaf hsfgure:, wluch includes publicpo
.1% d u rpych k@]her for private programs alone, smece many
a to on wheelIs groups are run totally by community.
bren tw.o major. contrilbuions to any nutrition program: 14 te will ik tWMngnes, work, hard .,without. monetary
,,The sensi~tiviy and understanding which. volunteers
shw for the hlomelbounid elderly isaio important face t
bquaei4Aso the prorm Th~e mea Tecipient can always Aoag~vsto the Meals onWhoeps worker,, and knows
laee Mteebcueslecrsn ai aority of css
di 11iter i a pnir~ctien_ with an udrtandmjg based.
c.Joiseph ,Brown, 'Executive Director of the, Ii e'd eas on Wheels program underscored the, .vita role.
liuter fil ntsiag ree the Select Commttee.
tshmI: ..Vluts.are. the 6.........nnsui of the uMals on Whns
pogrm.Many of them do far more than deliver meals. They
AW" errands, taking them, to 'doctors and .eldinics, etc.
avie meals. on wheels client is aware of and apprece'ia'tes the dffrt ot 6me *olenteers. More importantly, the visit provides companionship'
*hich i* otherwise lacking. Mr. Brown continues,
To Ohe elderly person, Meals on Wheels is morm than just
aL.. ot meal. For many of them the daily social contact is of as
much'value, if not more so, than the hot meal. The volunteer
gmy be the only person they we all dAy long and while the visits are brief, the volunteer brings-i ma lot of warmth and
rendliness wi ththe meal..This vst is really the hglgto
'eday for mayof these Jpnely people.
fin addition to these social benefits, volunteers also Play vital man i 'keeping program costs low, 'thereby extending nutritional tabfits- to many more. For every hour of time -which a concerned citizen: donates to the program, at least one more maeal can be served to a needy peson.
Iiat, tf extensive ueof voluner alosprivat pro gst
serve meals at a much lower cost than other nmonlunteer programs.. Dr. Donald Watkin epliedti comparises to. the Solet Comto1ittee in, 1973:
41i thereM is no question but thatvolunte .rsffrto in
Providing hom&ehlvered meals.have served the elderly bis fia'es well and at a1 dollar cost to seeiety' well below ta
achievable through programs developed in the public or the

At the project level, savniipassociated with heoyelbc ovlun.

iiii i i iiiiii = iii'i iiiiii ~ iN7.. .
homei~iii~iii deliveredi meals. Some of these iiii==oig ms repor ...
pi sngpi
divr pesnnl while other relie upnvouter.Inteage
gateiii! those.. programs===!liii repnigimnssmefoiio aiw inic~ient oriunclearireprted a total of 3i48imeals deivired W

h m esi~ p eri d y a t a t t l c s o f 1 7 4................................................................

av erage::::::: !!iiiiiiiiiii p erilii m eal costiiiiiiiiil iiiiiiiiiiiiiiiiianiiioriiitiiiiiiii..i

Furtiiiiiiiiiiiiiiherstfiaayssofteiuve ieditefolwigciiris
bewenprgam sigpaddeier erone ndtos el!j R
volunteers....... Prgasuigpi tf odeie eh evd26 f

the total number.sered,.at.a.cost.of.$1,46,842..This.......

meal or over 25 ,,,,,, percent, lesthnwhnpadsaf...ued,
Thesestatst ics pin tothiraic singwic

pamulme JL in at least one instance, has been successful *in
achieving a h onious blend of Federal dollars with private administration. Meals on Wheels of Central Maryland, apparently the Nation's largest private -og of its type, has had a cooperative, contractual agreement witT Title VII projects in Baltimore City and surrounding counties for the past 3 years. Central Maryland's 2,600
have found this arrangem
volux ers ent satisfactory and extremely
valuable. Jody Olsen, President of the promm, described the agreement in her recent testimony before the Select Committee:
N we would like to recommend that the use of (private)
organizations be through a "purchase of service" contract.
This way, the Title VII program would buy t4e services of the home delivered meal program, thus preserving the existing structure if it is seen as being adequate to the task.
Through purchase of service, volunteers will still have some part O program decision-making, an essentiaJ ingredient to their continued interest and participation in the program.
It is knportant, however, that this preference for private programs be given within the framework of reasonable criteria. There am many areas where, for example, no effective private program exists and other communities where the existing Title VII project would clearly be the superior provider. The choice of delivery systems should be made with consideration given to factors such as cost per meal, start and equipment costs administxative and personnel expenses, quality of meats served, etc.
A second action which the Federal Government should take to encourage the use of volunteers under any Federal program is to allow funds to be used to compensate volunteers for expenses incurred in the delivery of meals. Many of the volunteers, and many more who would like to volunteer but cannot afford to, are senior citizens existing on fixed incomes. Under these circumstances, paying the fuel costs for the mileage required to deliver meals can be a substantial burden especially at the current gasoline pnees.
Allowing reimbursement for these expenses would not significantly reduce the cost savings of volunteers, but would increase their numbers b d '7 the financial burden of those who volunteer. Bernita Y =gan, tirector of the Title VII Nutrition project of Cape Cod and the Islands of Massachusetts, endorsed this approach,
Costs of the Nantucket meal program are kept low by a
network of older volunteers. Each day one car goes on the 7mile, in town route while a second car takes the 14-mile beach route. With the high cost of gasoline, only the wealthy can be drivers. But with mileage reimbursement, the ranks of the volunteers would increase allowing those on lower *incomes to be part of the team.
A recent Internal Revenue deemon declared that transportation expenses of meals on wheels workers can be claimed as charitable donations for tax purpose Despite the fact that tax deductions of this sort have little meaning for the low-income, programs have informed Committee staff that more volunteers have I)een recruited already.

o 1 M s' aki 04

bar w. JAV





J, e l


JuxaE 17, 1976
Mr. 3CGOVERN (for himself, Mr. DoLE,, Mr. 1C.NNEDY, and Mr. PERcy) inr0:duced the following bill; w~ob was read twice a n erdt the Commnittee on Labor and Publie WVelfare

To amend the Older Americans Act of 1965 to pr ovide a naiond.
meals-on-wheels progrkmn for the elderly and for other
4 Be it enacted by the Senae ad Hoe of Representa2 ties of the United States of Ameriniar onpress assembled, 3 That this Act may be eited as the '.'Natfional adannthels
4 Act of 197 G".'
5 SEc. 2. Section 706 (a) (1) of the.01der Americans Act 6 of 1965 is, amended by inserting "(A) "immediately after 7' (1) ", by inserting after the semicolon the, words "and, or", and by adding af-ter such section the following Aew sub9 ownegraph:

1 "(B) to establish a project (referred tDhrina
2 'nutrition project') for the elderly, blind,

3 which, five or more days per week, provide a
4 home-deliverdF aL In

5 third the daily recommended dietary allows
6 listed by the Food and Nutrition Board of

7 Academy of Bolences-National Research Coni:Po
8 vided, That any nutrition project which el

9 such meals more than five day a week mustasrta
10 minimum, an amount of commercially av
11 for-use nutritionally balanced liquid pro
12 snack, or both, which provide at least 25

13 of such reconunended dietary allowances frec a
14 in which no home-delivered meal is provided.Peerne
15 where feasible, hould be given to the use

16 tions, such s meals-on-wheels groups, wh
17 onstrated an ability to operate such servicsefienl
is and reasonably" .

19 SEC. 3. Section 706 (a) of the Older Ame
20 195 is amended by striking out "and" at the 121 gr-aph (10), by redesignmating paragryaph (11),adilrf 22 erences thereto, as paragraph (13), and by isrigii 23 mediately after paragraph (10) the following e aa 24 graphs:


llt' ( 1. o1 peaan infore ien and referral sysip Atena for. 4omebound individual peiig meals qnder
this title by"(A) gaining the delivery persennal s that
such personnelamay make informed judgmsents about
theaddtioalservice npeeisof myea rediopets; aqd

.79~~ (B) reporting the adlditioa sarviqe needs to
.agencies, groups, or individuals qh might be of
assastnee in meetingesuch needs;
10 (12) to seek and utilize volunte aereen Ie for
At the proyision.ofhoae-deliqered mae a to the.aximum 18 extent possible -and to compensate puch personnel when :13 appropriate for transportation expenses incurred in tlhe 14 delivry of shmals nd".
SEC. 4(a(1), Seon 70 of tha e Older )mppicans
16 Act of 1965 is amended by insertn "Ja)"q ater the -e-r 17 tion desigit tiqn.
18 (),aSeto 708(a) of sch Ac4t (aas rdsga by
19 paragraph (1) of this subsection) is amended by inserting 20 ""and paragraph (1) (B), (11),I and (12) of section 706 21 (a) after "section 707 (c) in the parenthieticaL. 22 (b) Section 708 of such Act is amended by adding at
23 the end thereof the following new subsection:

2 (*44

3 fos this yer17,ad$0,0,0 oPh iclya 41 970o h ups fpoiighm eiee el 512 satt eto 0 a ()():PoieTa o 61 oeta30prcetmo uhfnsshl eue o d

23 mitraieepnewadspotv)erie.Sm p


(b) The Commissioner shall report to the Congress on
2 the results of the demonstration projects authorized by this 3 section t9gether vith such recommendations. includin(r
4 recommendations for legislation as he, deems appropriate.
71 g (6) There are authorized to be appropriated for the

yw 1977 such sums as may be necessary to carry
Odt the provisions of this section.".

76-540 0 76 7

[From the Washingtonian, November 1975]
(By Loretta Schwartz)
It was noon on Tuesday whenj arrived. I climbed the ridwty wooden staircase that led to the kitchen. In the rear of a decaying green house on Kenyon Street in Northwest DC, I found Margarita, a thin, gray-haired woman, wearing a worn blue housecoat. She sat at a small metal table. Roaches crawled across the torn, green!vqW white plastic tablecloth, past the once-white lamp that had no shade. They made their way along the rim of the old rusty toaster. Several growled into her lunch, stopping on the single chicken leg. Margarita is blind. And if it were not for the lunches delivered to her each weekday, she'd probably be dead.
She smiled at me, raising her sightless eyes. "It's so nice to have company," she said. She pulled me to her and whispered, "You know, I live here, but I don't know any other people here and usually nobody visits me."
"Do you have any relatives?" I asked, noticing the pictures of John F. Kennedy, Jesus Christ, and a slender dark-eyed young woman side by side on the wall. Roaches crawled over their faded cardboard faces. Two roaches walked across my notepad. I brushed them off. .
"God called my relatives," she said softly. "I lost MY sister, going on five years," her voice trailed off wistfully. "The last sister I had."
"Cn you go outside alone, Margarita?" I asked. "Can you buy food?"
"I've tried," she said, "but I always fall. My sides have been bruised so badly that I'm afraid to try again."
"What about supper and breakfast?"
"Well," she said, "I save some of my lunch."
Many years have passed since Margarita worked the night shift as a cook and waitress at Eddie Leonard's on 14th Street. Most of the people she knew then have died or forgotten her. These days, as she sits in her kitchen beside the large steel garbage can, or in the bedroom on the brown chair with the stuffing falling out, life is mostly memories.
Looking at the cracking, filthy walls and black linoleum floor, I asked, "How much rent do you pay?"
"Only $90," she answered. "And for that I get everything you see here.)'
Margarita is a diabetic, besides being blind. Even the simplest things are difficult. Her legs were badly swollen, and the bedroom slippers were on the wrong feet. She moved haltingly toward the dingy white curtains tied with pink ribbons that lined the entrance- to her kitchen.
f 86)


t*A-handle burned on adust--covered shelf in her tiybedroom. Magarita told me she3 could see, ailittle light. "The: tanl sfrm
alte,"she said. "I lit it just before youtcme. It's a holy candle and it putx a lovely sensation in me."
When I left, Margarita stood among the dirt and the roaches and A* hroken furniture, stretchimg'~ out her arms to wave goodbye.
4. 'mxata survives. on f-r e nhes. made available by Title VII of the o Asddrians Act and admixistered by the.DC Department of RabonResources.p The program exists in part, to feed old people. who WA4 a the poverty level a third of their nutritionafodsplfie day a week.' The department nwis serving 1,330 meals a day here, WAs eneeding to the 1970 census-outdated now-103,713 semipr aixmslive in the District, of whom 38,000 are eligible for the food
s~tnceprqOrm. Which means that the federal government reaches only -Apercent of the, .servable Population, a tenth of whom are lamiebeead like: Margarita. And According, to Verna Burke, project director for thserea many live without heat, hot water, or plumbing. :Somqe here too,.ashamed of their condition, to allow an interview. Yet t:,hey may be among, the lucky ones,,because no one k nows bow many of the unserved 95 percent are starving, perhaps dying somwhere, in some room, because hunger and. malnutrition have wetaeed their bodies and made them vulnerable to disease. In many
*e"":of the city, people are put on waiting. lists or turned away beeksseoftlimited~funds. Some who -need the service do not know aboutt ib. Others hesitate- to call.
'"Elderly people are sometimes fearful because they have been hurt so much," explains Father Gregr Malletta of the Episcopal Dioces, -hich coordinsids several feigsites. ".And they are often Ve*peoad, particularly those who have konbetter days. Many of
peop a wk serve came here from Europe 30 or 40 years ago and
twlive on very low fixed incomes. The section of Northwest we serve considered an affluent area, but there are about 1,600 senior Mazes livi in' this section alone who axe below the national

Som t thse senior citizens eat lunch at Temple Adas Israel, a he stone balding at the cornexa of ConnecticutAvenne and Porter Str~t.The day I went, several dozen men and women arrived well bftfe -the long tables were set with linen cloths for the small kosher meal. The women were mostly dressed in cotton prints, the men ta-ea as and they listened intently,as one of their members reviewed SAI4iages of Janusalem, a book shed that country's exotic foods. R an the. very old: turned their deeply lined ,faces toward the
alpeker, smiling and nodding as if; they remembered the food of eir own log-ago childhoods.
These are gentle people who seem more concerned wi'th their cultural herita thnwth their own present needs. Yet, some are very poorth-y hive on Social Security checks as low as $91.6: a. month, hardly enough to have survived on years ago before inflation. ...When it, was time to eat, they InstethtIjitemTe meal a itte saghtti with one smnal meatball half canned peach, andA afw alcso quash left many still hungry.: There was. no

salad or soup or dessert. When: the, -food was. finished, MftsasWte, a tiny, ancient lady, smoothed her,- black. flowered dress and sM around a box of had candies someone had, given her a 4 s af explaining that since the portions were getting smaller, peop use this as dessert. e
A woman at the end of the table, in. a Pale; green dress audaka orthopedic shoes slowly wrapped her meathall in a" paper as Ran-6 carefully put it &Wie her white_ platio purse. 'It-was*Th while most of the food' tenters:9are- closed on8turdayt enkd 8mdog Adas Israel is closed on Friday too, in order to prepaxw 94 ;AO Sabbath. Knowing that some- of these people may: havw i#1eve) no thin g to e.a t f or th e las t th ree, days -of -each w eek,. I ws e&t"-a "igot to see another woman,, very old bat. spry looking and dro*me ,,& immaculate blue-and-white-checked dres, place a small~ga.jg with spaghetti into her paper shopping bag..She smiled sta'49e talked for awhile, and she irited -me to go homwit *her As we walked down the enrVd path to he6 r armeetin ti House, a larger, well-Jkept' brick buiiling shout nowblock dy;. "4e Temple, she held my hand tightly, asa hild might- She was more than food. .. .d
Inside, the apartment was tiny but clean and thewalls were his~tme covered with pictures of her dead husband 'and two young sea*s:Mw grown and living far away; she rarelyr sees them. As, w Bateatag that is both bedT and sofa, I learned "ht thd*ent'fer. that apartment is $166 a month and that the Social.Security chanmo Quiti she lives is $200 a month. That leaves hew a httlerrmn tAt441447 to live on. .- R-s.. 0..* ..
I remember the jar of spaghetti and askedshow it wijl-laat the weekend, let alone supper that night.: P"Oh," sheun such a big meal that for supper I usually have~a oookieftbhea or a piece of toast." 4. #. 11**...'o
"What about the weekends?" .a .
She shrugged, smiled sadly, and instead of answerigo.rssehsi small, foil-wrapped cookies into my hand. "Please take (34 said. "It would give-rme such great pleasureif you would~h*ve.Abe Then she walked outside with me a#nd. stood. on thd Codneqv as w MI until I drove out of sight. "I'11 tell youxgP sh&a&ad,"tsA to be a senior citizen in America -today. Look he -we live.W Janted sweet." g '*.. ad
Because of -rising food costs, the Title ,VII program hasibeej
to reduce the number of -meas i serves to& senior citisagg vA coverage and the protests .bt food; reiientsr at som at tiei*PA sites resulted in a promise of supplementaryfederalfunds t the program at its original level, but so far those funds haempt received. OS. I e fT
Perhaps that's why, in the: basement Of-St 8ehna hyoy4
16th and Newto-n-Streets, Northwest, mn f h poiawo 14
the large, dirty room at lunchtime seemed desperate.tSouter :pgh gp into their pockets, some searched thrugh : the garba or mlinog to eat or take home after lunch was over. . s a d 4 1*.

Oreted toward eliminating hunger. Despite the god, itentions, all tbeprograms seem doomed to fathmav,. Th We war on hunger started bck in:97 when a series of hearings bood; the country by documenting -to existence of more wideatdd6 ipoerty, malnutrition, and hunger than anyone imagined. lhe haings showedlconclusively that many of the victims of hunger were, children; rand pointed out that kunger ,sturing school hours nevents, them from learning. In 1000, National Nutrition Program studios in Texas reveale that the diets of low-income school 'children vrwpoor and their gowth rnarkedlv sunormal. Further, hincemical
**lY* of their urme and blood showed that 10 percent had unseeptabl erlofh olbin, vitamin A; vitamin C, pasma
aelapsemm, albumin, riboflavin, and thismine-which supported the 'ontention that the academic backwardness of impoverished
48rersngh' be due to mahnutrition. That was the same year that aftce breast program: was estabiabed in D.C. pubie schools. eday, .ery ,one of. the Distriet's 1,1000s children is supposedly igiblofor thit breakfast. Only ahout 21,000-are getting it. "'Many kids come to schULha every day," explained Joseph towart,. the articulate, weldes director of food services for D.O: pubic schools. "Sometimes parents will not fi11 out the forms cause they: are too proud. Often a .poor family may not consider b"L priority, We have no disgnostic tool, to determine hunger in or schools, but we do know that hunger and malnutrition make "sildr~n dull. It results in slowness and inattentiveness. It makes children more susceptible to disease-and if hunger is presenting sal tose obstacles, how the hell can they learn?" .Stea,. alio sai taseverali schools stil do not participate in the program, perhaps because it's not court mandated. Neither, he added, i.the: summer feeding program, designed by Mayor Walter WashingUon, who said, "'You don't take a three-month vaention from hunger." But: less than a sixth of D.C.1'sichildren get that meal. And unfortu-ately, many of the children who do receive is tire not the ones who soed it most. In factJohn Cromer, area food innager for the summer (tdig.program at Johnson Junior High in Southeast, seemed unawee that the program was designed to feed the undernourished. Rickh or poor, it makes no difference," he told me as we stood in the 11..ll 141, sparsely f urnished ofice behind the kite an where lunches were

"Thd. who is eligible?" I asked. "How many children eat at each motionn? And -how, are they selected?")
Gromershrugged, and I figured I mdght do better talking to the
hilrenthemselves. Several dozen had just Aled into the cafeteria for lunch of fish and french fries, the menu of the day. But due: to some mix-up, about half were eating Sloppy Joes with tartar sauce. One of them was a skinny little black gir with uncombed hair. Her name was T ammy. I asked her what she'd had for breakfast,
"Nohin."she answered, her brownlibyes wide with surprise. "We eaer have nothin'."
"Most of our children don't eat breakfast," says Bessy Wells, the warm, mtal-l. -1 1a1ssi.-stan prnia of.* Johnson JuTni..- orw TC.


Sixteen hundred kids cat here during the regular school: terny, Am over 90 percent of them are eligible for free food. But in the samratr they axen't eligible unless they axe in the Title I program, whJ& nV6 ns that they must be performing below the 50-pereent level on their standardized tests. This means that a poverty-level kid, evm ithali critically under-nourished, can be denied summer lunches, sirnplyb6cause he somehow manages to do well in, school. The, only exc6otion tb this is for those who are in the recreationDrogram' But that is I'MiAted to the very young, who don't have to be disadvantaged at #A to qualify.
Now I knew why so many of the children eating lunch on tbb Ady were well dressed. But what about the 51,000:poor children, li'vilw1in the District? Where would they get food during the summe -.,Aljqd what could they do if their -mothem -ran out of food?
Some of D.C.'s poor live on cheap, inadequate, mostly- starch-Ake so it's not surprising to find even obese children who axe dange Wd undernourished. And since children are relatively helpless, most 4nni7y eat whatever the y are given. One young mother of five living in7.46 sin 0 room at the top of a brownstone on N Street Mi Northwest:,DG 6Xplained proudly, "I used to run out of food all the time, but I do:.betttr now because 1 don't buy any meat or fruit." I looked at her, 6ildi6h' aged four, five, seven, and eight, sitting almost too quietly on lhe floor in the daxkened room. One little, girl smiled &Vme shyly,.. Mhat do the children eat?" I asked.
"Beans," she answered. "They never complain as long asT: Ab&ok enough beans to fill them up."
Hunger does not stop at the District line. Inside the laxge' jai nine-story Presidential Building on Belcrest Road in Hyattsville, the lines for food stamp certification start forming at 4:30 a.m.; despite the fact that ther e are no posters or signs directing people to the proper office and no information posted about what qualificatio w they need t9 be certified. They come in droves. Many wait all day without food and go home without hope of getting any.
The food stamp program was set up in 1961 by the Departwent of Agriculture. The stamps are sold to low-income recipients who. 6aA them for more dollars' worth of food at a grocery or super ln-ark,6t While it is technically possible for a family to get an adequate, &A with the food stamp allowance, it often is difficult for thepoor and poorly educated to acquire, the nutritional expertise to make, A-6 complicated calculations necessary for this kind of shoppmg- And it is un'ikely that there will be extra money in any household, :Mto price of stamps increases along with the yearly income of th6, pifrchaser. A single woman receiving $194 per month mi Social I Seeu4ty would pay $33 for stamps worth:$46. In effect, she is given a $13-a-1 month subsidy to buy more food and upgrade her diet. Unfortunately, it often doesn't work that way. While some well-to-do students !A-nd. other ineligible have found their way into the pr6gram, the Deo 016 who most need the stamps often cannot afford to!buy them.biters cannot adapt to the rigid program regulations necessary for corti fication and, as a result, large numbers of people are in desperate circumstances. I I .
I sat down in one of those stiff, straight-backed- wooden chAA6 designed for those who must wait, and began to talk to the people

09ound me. Several explained that they had called.before comn g (ad had been told that they, wdald hate to wait sit weeks for ani eppjointment or comes in and hope~ to be seent in a "free
"Prve been her& since 4:30 this morning, said one young black wOgman, fired and angered by the long- wait. "I worked as a nurse WUi I tp uas. Now I can't get freelhealth care because my
is we o' .We don't want to go on welfare.. We want to
.,4fat 6ach month, whenti the medical bils, and other bills are
thereA only S2' lett. So, wef sit around and-look at each other...
y' usad works too, said a middle-aged redhead sitting a iry."So I have to travel. down here every month and wait all day I'cn povetothem that we are'still as poor as wedwere a month They say they're afraid he'll, get a raise. But it's the same Job sme income. I don't see why they don't just call the Autorama
,Where hb's a. t~nmission specialist, and say, 'Is Herb
"An by heay": she added, "did you know that we' can't get toilpper ork soapwth: food stamps? I could understand it if we <,tihaveto tgo tothe bathroom, or wash. But is seems like they
epct poor people to go out into the woods and use leaves!"K
Everyone laughed. But the lailghter masked embarrassment and pain. Mary Mordhouse, a heavy-set-blonde mother of three, came out
ihe certification office located in the back of the waiting room.
"Well, I'm finally certified," she said, her voice a monotone. ".My stanywill cost me $23."
"Dol you have &23?"
"Do you have a place to get it?"
"What are you going to do?"'
"I'll tell you wha~t she'll do," said another woman. "She'll either let her kids starve or she'll get her ass out into the stredt and get it the best way she can."
Young white woman who sat staring off into space wiped her eyes 4rith the back of her: hand. Her lips were trembling and despite the fact that all her lower teeth were misnshe was still very pretty.
She to, hd arivd at. 4:30. "They want my husband to sign ti support slip," she said, holding a form in her hand.
"Dboes he support yOu?" someone asked.
,"No," she said. "He disappeared a few weeks ago. He was living wit his girl friend but. then:hemoved out. I told them I couldn't find b6i and they said, 'Okay, we'll give you more time to fnd him.' But 197omied mpy idds I'd come home with food today"-they haven't
esnanythn since yesterday morning"
Itsa buraucratic morass with people as victims."' said Helen lank., She's the energetic young director of the Food' Stamp Coalioia non-profit .corporation dedicated to ipoy outreach
ilort ihad increa-sing food stamp participation."Thh maor problem

%0 get too much 00 tboy WV %R Awl JA, 00*1
refuse to, hire Oe ja=ber 4 Oki
now there are on)w 26,poopleh(Ve tp servqp"VW
In an effort to help reduce: lopg waiti4gpen64 treatment. theYirst UmoA Churth o4 jj* Hyattsville hm,::wA up Oood 4tamp cooraip n Centex"
sit$ in vpiftijwij "emp
food stsmp&, owe: avo 144 j pRljm &W Ai
than wocan hand k eople, 040 tP1d.:,*qi.. WWP
W P- pall
will then see if they qualify. After that-14hey must wait t Wf1&,oeks, to get an atmw of theu Pos: thr.04&, the they. ha
v*wer t Ve r
Whathor or.not:, ey are, elwb the Arst 6w they, rA #mWWi wat,-thrpe weelw..': me put lheWq hol
evaLup the supervisar0kk.p-,4 f" Kveciol, 4VP we always get desperate pebl becaiise ibey sudAe y re t a wholleweeken m with i q loo44-Aheftd of.the.
IMO there!s, nothiiRg wwcaa one 1" "Old W
know, you're -v oo) Wpt hAYo Whq. W
1 have no foodl'
"Tho)people,, an a jhqiB 4whQ,4?w
for help be 4qy1VO paid ir taxes all their livpo,
they're .u.#9ubje,, theyy:pan't dqT, w4y help. Others apeept tboir.,pfight quie y., Z i; ntly e., from Congresswoman Gladys Speffinan.'s office-,*WV was taldiag food from.Safeway'-s gqbAgejn m,s' tit), 4 grandchildren."
The woman-we'll call her
children and has been caring f or ifiem Smee'' eir mg mitment to a st*te mental iustitutioni t, Use,
axe.not leg&Uy her4,.shq._*iuqt ehipNek T eRden4
pir aidio i en4
Mrs.RosipttiWhoaes hqjia.ji T vitht4e, rent w e4 v Ji
month in'$Odal ec=4., The fo1 stamp ce
$87 0, ceW L
far, as tbgy axe wucwiwd Ae, &P
her mmme is toci*ih Ior food: IstamP. e, t4 P"ally A"d . .... Air Roset turnela,'
state:.ageppy she,4as applied io.... No,- One continue to support a hr 'less t4 t;2 2
0 V po qu less tb 4i;k 9 means a- 2 jimej
she and her I g rtn sow, ago. aila
eating garbWe and erap4ing 0#.s4,b ns j4 9 1; ,,to
Tb ws Awe m0h; Me k
-pot p W qW,
igher)t 'qounty in Am v It",
91C %c
they 9 W:(_ 'Y C4aseWW
yfteA xefeX _,,e,
$100,ooo-, or to the. Potom" 4m -U
fenced p#aUs,, Dut
Of 1ha $t 11 U.1% ii.. 111 V ..W ti
VI-, A- &n
P exgOPT
9-ry Wj I
9 X..Pmum. r9$ EA., Y -JP
-P th, Y" out
are W Our group wasiafo ed ca on We -e MWD

we~ ~~ found tht..........lw wr tyigtotec
.W~ to h ng~to ear Ibeg n t C ok o people d ors as igil
1hem, ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ .... abu 0 .T e tre edn lest h m tt iiii
lo tie'v ............................................ .......... v o un ee s T he d h a
lvo~~~~uldn't~~.. bei orah l hs a i,,,iiiiiebymslad eve nw

14twta hr r tl mn htw r o ecing."
Th Mngoey ont eprmetofHma esuce l
1W'hv''trulerecin istage oplain f eio ities
itwe eeg bout200 ederl peole on mea a.dy,.fi e.das.a.eek, ......... ............................................................ ... i i ii
witktio prgra. "ut een n 170,thee wee 6000livng elo
.the overy leel hee inthiscount. No onlihasihatiumbe i~cr~sedbut e knw tht thre ae for orfivetimeithaiman
.~~~~~~~~~~~ ~ y dif..............s a t ke p og a eo l
t M'andmak reervtios fr lnchon daly asi, b tiin
Vii .fid up he rseratios ar cloed ad te ret arisimlyitrne AN*y. ~ha ea wedo Tht'sallthemoey hatwasappopiatediii
-ff ji Godwi, ntriionst wth he ontomeyiCuntiHe liiiiiiii Bepaten eplins "n ontomryCouty ulik i Piiiiiiiiiiii
Cterge' Codty, hereare o lnes t ou foo stapioficesibu
,*&t's ofen bcaus thepeope wh nee thee priiiidon'ieve
know boutthem.In 171 th US epartent iiiiiiiiii wa


blocking mne. If I weated extra workers, I had to request month mn dvance. At one point, they even refused to tel an man people were using food stamps.
We've got this system, but it doesn't work. Even the f 6 -U
certification form that these people- are expected. to fill outis technically difficuk that our college graduate volunteers haveVO with it. There, is an almost endless list of questions to anserA receipts to provide. And until you answer every question and.. "U with every receipt, you get no food."
Jim Turner aoke uwp at six one rainy morning. His wife~adf children still were sleep. He knew that there was no way theiaTb0J of rice they had on the kitchen shelf could sustain thena aq pgr At 51, itsk hard to admit that you're still making mistakesBiti time Jim knewr he should have asked for help sooner. He shbul have let things get to this point. Jim dressed quickly, thenwoc wife and told her he was going to walk to the Social Services.fle* Rockville and- ask for helpjst one check, just enough to ge 8~ thing into the kids' bellies. Then, somehow, they'd get on their m feet again. Turner, a small, slender man with gray. hair and,'t rimmed glasdespaspentamost of the day at RockvilleSocial.9tc0 before he was told that without a doctor's report cardg ying o emphysema and chronic bronobitis rendered him too weak -owr4 they could do nothing for him. After explaining that he had. nanae for carfare, Mr. Turne walked with difficulty to his dos~.esce The doctor signed the necessary forms and added a note sayight Jim had only half of the normal lung capacity and could ot oY do any heavy waork under any circumstances. But by tho-imd note was written, it was four oa'clock antd too late to Waalk Reckville be fore the ofice closed. On Wednesday Jim returned.ji on foot, ad presented the forms. This time he was told thet-hi-4 must come back with hitn and sign up for a work incentive e before his* request could be considered further. So ence aaJ~ Turner left the Ofice of Social Services and began the walk j4 without money or food.
Inside the Turners' smallBparsely furnished Montgomery C-ut home, Carol Turner sat at the empty dining room table: ad m~t One wall had no plaster and on that side the rain lesad in.1,M Turner, an articulate, middle-aged woman whose short I ownh* was turning gray, explained, "For a long time now we've .been~eafi from day to day. Ever since the elderly woman I was takin- a e, died, Ihe been looking for another job. I'oe borrowed from.-h neighbors 'til I feel I can't borrow anymore."
Her daughter Leslie, a tall, slender 18-yearaold wti lig -'bev hair, came mnto the room.
"The kids have been very good," Carol added. "They, havet complained."
Then a small blonde boy with large brown eyes toddled over. Io picked him up. "Are you hungry?" she said. From the refrigerator took the last small bowl of rice for him.
Down the road from the Turners, Sherri Mitchell was fryingfou and water, making a kind of pancake to feed her four-yearos daughter. And this'strange pancakewas famailiar: to the chfidy beespoo
th a t w a s a ll s h e h a d e a t e ii fo r th e p a st t w o w le k s e v e r s in e e th e f od

bdturned them down because a student loan the woman's .eceiveduxnd used for, tuition had rendered them "over
as Geunt, te country's, second richest area, emergency
iterdqdlxave become so great that, the United Community 4an. emergenyxcisgis ier~ention agency that serves the
I4 sort r* frequently finds; itself .unable to meet the need.
#,t,.6200 North Kin Highwa-y, next to what will he a Metro ,this rundown, yellow cimderblock building must.:often turn
away because its own kitchen is completely out of food.
r we cn,. give them enough to last three days," .said Sue
.44~~ instr' oug :jeans-clad supervisor. ohonvITsa
we drove downm Richm Hgway. We were bringing food, to some
ttthe most desperate cases. In Fairfax, County,. that! often means
.ts ~148, he McGovern Senate Select Committee established beyond
A-4644 br-A. daipage and, sometimes death are caused by
maltmtr onin unborn infants and young children. The severity of
.isvey mcldependent on the time: of. life when deprivatiozi
Ta. the period before highb,, the brain growing rapil an i
:mkost seniie tthe effcso undernourishment.I te WAe giadequatglyinourished, :the newborn. will have fewer brain twood suppleatation with foods during the first six months 0a_ can correct the damage, but unfortunaeytemteswod
*00"gToperly during pregnancy also are unlikely to provide adequate teir :newborn infants. And children who are not provided
OW 4*rW~drates. or iron in: the form of meat and animal Protein 10*4y,,b4 0ber' develop, or sustain normalbrifucon AwPthese reasons, pregnant women, infants, and children under the ,ga r, thave:been elgble for lipecial supplmnafodin ay
of be country.: Tbhese include the milk, meat, vegetables, and tialfor normal growth,. in D.,C. for example, the Department MagympOfa Rsourecruns W supplemental food. program.-: Eligible
*-en wpk.t bags.- of food at ten different. centers. But the ingidled wth problems: -It's operating with 3 5 percent of its
.41 miwa,andW wit outreach so inadequate that 1,500. bags of U geXWueaken every two weeks. But DC stil is way ahead of Fairfax
Voibw hichW has never acknowledged its need or established.such..a
Now, as wedrove Ithrough. the county, Sue Jacobs explained, 4tyddgivesthe.Women peanut butter and jelly,, but it's awfully aeheivowe cabn't always-do it. A. can of orange juice and a package 6% ter are also luxuries. Luckily, we gert day-old bread from Grand Union free." *
d-ol pulled off the 1high:wAY and' stopped. dilapidated wooden house. Outside, a thin, 'brown dog barked, straining at his leash. Wils, drawn by the dog's feces, buzzed around us as we climbed the wickety steps and opened the rusted screen door. nside lay Brenda Alexander, who'd been 'living with her mother since her-hus-band, left her.4 RedA plastic, cardinalsand "I Jew plastic flowerev decorated i the place Brenda raised herself with difficulty when she 'saw us and
takd86# dtebow lsiylvnrra couch. J,
ASkw was, egh mAthe pvegnanti She satdown nd e S Mmoexdloded1 int ie n ote beedkddlcaefekefc n


"How long have you been without food, Brenda?" Sue "ked.r:-u "Well, they took us off food stamps two months ago beca'ua#** brother turned 18, It's bee rett rough since then. We c Ct' Yot here we didn't
from Kentucky and when we know hoWr*t h
it would be. My father was supposed to give us $100 a month,'but,910 doesn't give us anything. My husband left one night saying h6 was going for a pack of cigarettes and he never came back. Mom's out now, looking for work; so is my brother. But I'll tell you, these days work is hard to find."
"When did you last eat, Brenda?" Sue asked.
"Well, I don't know. I don't remember," she said in her Ke"idw accent, her face turning deep red. "I'm not too big of an eater."'
"Did you have any break t or lunch today?"
"I'm a real bad eater," she said.
Sue Jacobs said, "Please tell your -"Mother that when this food it gone, we won't be able to give you anymore."
"Ohq yes," she said, 4 91 'Will ) and thank you for the fodd WMA you so much."
We drove on up the highway and Sue explained how she haf6d to tell people she couldn't keep providing them with food. But -UhftM Community Ministries is only an emergency resource, a three-day supply, and they simply have more requests than they can handle.'
We circled in behind Vie's Tavern and Sue pointed to a group of little one- and two-room huts.
"The owner of this tavern allows people with a lot of children *ndbad credit to live here," she told me. "Those people have a terrible, time finding homes, so they end up taking these place. The rent 1$250 a month. But, when you have five kids and no place to live- what are you going to do?"
The time flashed 4:30 on the Bank of Virginia clock. Just beyond it at Sherwood Hall Lane and Richmond Highway, we turned up & dirt road and there, behind the George Washington Restatvknt, hidden from the view of commuters and vacationing travelers-stood half-a-dozen filthy, dilapidated one-room wooden,. shacks. They have no heat in winter and no hot waterb Betty, who is', snic months pregnant, lives in one of them with her mother and they, often, are without food. When the car pulled up, the frail, thin 19-year ~ came outside, bent Eke an exhausted old woman. She never askedus M, perhaps because she was ashamed of the tiny room, visible tbrou the doorway, and its rusty sink and torn sofa. But from what I coul i see, even if she hadn't been ashamed, there would not have been enough room for all of us to stand inside. The place was that small.
Betty greeted us without energy. And we asked what had Dow begun to seem like a natural quesGn. "Do you have any food inVie house?"
She barely answered.
"Have you eaten lately?)
Again, no answer.
"The baby needs food," we suggested, looking for somethingtol say.
Betty put her hands: on her stomach -and pated it. ntly-, sadly with resignation, like someone who was resting after a Ong s e. "Not anymore," she said, her voice trailing off and her dark ey" growing misty. "I've been to the doctor. There is.,,,no heartbeat., Food doesn't matter anymore for me. My baby is already dead."