From "Developments in Aging--1970"

A Report of the Senate Special Committee on Aging

CHAPTER V

NUTRITION AND OTHER CONSUMER ISSUES

Today's elderly must spend $7 out of every $10 of their income for housing, food, and transportation.

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That estimate-made by the Bureau of Labor Statistics in a report 1 issued in 1970-described the situation as it applied to an "intermediate budget for a retired couple in an urban area during the spring 1969." The B.L.S. estimates showed the following spending levels:

The B.L.S. budget-which is not an "average" but is, instead, a statistical portrait of the income needed to provide a moderate level of living-amounted to $4,192 for all needs.

And yet, a 1968 Social Security Survey of the Aged had revealed earlier that only about one-third of the aged units in that year had incomes large enough to provide at least a moderate level of living as defined by the B.L.S. budget for a retired couple. And the budget total at that time was $3,930, or $132 less than the later budget figure.

The 15-percent Social Security increase voted in December may have narrowed the distance between the two B.L.S. budgets, but the 5.5percent increase in the cost-of-living during 1970 has undoubtedly removed even that differential.

The inability of approximately two-thirds of retired couples to meet standards of an "intermediate" budget puts statistics about income of the elderly (see Chapter I) in another perspective: That seen by the elderly persons who, in today's marketplace, must often make hard choices between one necessity or the other.

Transportation and housing costs are discussed elsewhere in this report. For this chapter, special emphasis will be placed on nutrition, a subject which continued to receive searching scrutiny in 1970. In addition, the recurring question of "vulnerability" of the elderly to deception is discussed."

I. EMERGENCE OF NUTRITION AS A MAJOR ISSUE

Today, nutritional inadequacy is recognized as a priority problem among the elderly. At the forthcoming White House Conference on

1 "Three Budgets for an Urban Retired Couple-Preliminary Spring 1969 Cost Estimates," B.L.S., January 1970.

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Aging, nutrition will be one of the nine areas of need to be assessed by a Technical Committee established for this purpose. National, State and local organizations on aging have been invited to prepare recommendations to be forwarded to the Technical Committee on Nutrition, which will be included in the final deliberations of the Conference.

At a recent conference on nutrition, Dr. Donald M. Watkin, the Chairman of the Technical Committee on Nutrition, White House Conference on Aging 1971,3 stressed the need for the development of a national policy on nutrition and aging:

A quantifiable policy on society's obligation to provide nutrition and health services (to the aging) must be defined. *** Selection of (nutrition and health) choices for the aged of today is a matter of national emergency requiring action of such magnitude that it can be mounted only by a dedicated Federal Government using its powers to invoke equally concerted action by State, county and municipal authorities.

Dr. Watkin concluded his remarks with a challenge:

While it would be unwise to prejudge the policies to be developed in 1971 (at the White House Conference on Aging), it is reasonable to refer back to the policies recommended by the White House Conference on Food, Nutrition and Health in 1969 and to note recommendations of the Panel on Aging that the Federal Government assume the obligation of providing the opportunity for optimum nutrition and health to every aged resident. Since the resources to achieve this objective are available, no policy falling short of this objective seems valid. The challenge lies in developing programs to implement policy and to encourage through education participation of the aging of all ages in this development process.

A. PROGRESS REPORT ON AOA NUTRITION PROGRAMS *

The Administration on Aging Food and Nutrition program (established in 1968) demonstration and research projects were designed to test methods and delivery of nutrition services not to only improve the diets of the elderly participants, but also to enhance their feelings of self-esteem and self-reliance.

Title IV grants for this purpose were made to nonprofit public and private institutions, organizations and agencies serving the elderly across the Nation. Thus far, 10 projects have been completed, and 22 projects are still in operation in 17 States and the District of Columbia.

"First Annual Joseph A. Despres Conference for Senior Citizens, Hudson Guild-Fulton Senior Center, "Why Meals for the Elderly-How?", New York City, Jan. 22, 1971. (See pp. 18-19, Watkin paper.)

3 Dr. Watkin was also Chairman of the Panel on Aging, White House Conference on Food, Nutrition and Health. He is Research Associate, Mallory Institute of Pathology Foundation Lecturer, Community Health and Social Medicine, Tufts University Medical School; and Acting Chief, Spinal Cord Injury Center, Veterans Administration Hospital, West Roxbury, Mass.

tion

Abstracted from, "Nutrition for Older Americans" by Jeanette Peclovits, nutri 1dministration on Aging, Social and Rehabilitation Service, U.S. Department ducation, and Welfare, in Journal of the American Dietetic Association, . 17.

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The research component of the projects emphasizes an examination of the effect of loneliness on meal preparation and consumption by the elderly; the effect of social isolation on food habits; the impact of nutrition education; and the manner in which older people are influenced by their involvement in the programs as volunteers or employees. The demonstration projects vary from community to community, serving a wide range of elderly participants from all races and ethnic groups, including the poor and middle-income elderly; those living in remote nonmetropolitan areas; and in central-city neighborhoods.

As the Title IV nutrition program progressed, the following five basic elements were gradually built into the projects:

-Outreach, to locate those isolated elderly in the community in need of such services;

-Meal service;

-Nutrition education as part of the program;

-Provision of a variety of related and ancillary services; and
-Establishing a mechanism for evaluation.

An evaluation, now underway, will determine the impact of the nutrition programs on the elderly participants, and explore the effectiveness of methods used in improving the dietary habits and wellbeing of older Americans. The ultimate goal of the evaluation project is to develop a model and guidelines for initiating, organizing, developing and operating local nutrition programs for the elderly. In assessing the progress of the Title IV Nutrition program thus far, an Administration on Aging nutritionist had this to say:

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The experience of AoA's nutrition program to date confirms the judgment that the problems of undernutrition and malnutrition cannot be solved independently of related problems of limited income and limited knowledge of nutrition; feelings of loneliness, rejection, and apathy; declining health, vigor and loss of mobility; physical handicaps that make food shopping and preparation difficult; and metabolic changes that accompany aging. No single approach can be fully responsive to the nutritional needs of the aging and no single system for the delivery of food and nutrition services is the total answer.

The provision of meals in a group setting is a highly desirable approach to these interrelated problems because it fosters social interaction, facilitates the delivery of other services, and meets emotional needs of the aged while improving their nutrition. It offers an effective device for teaching by example the importance of a nutritionally adequate diet and what is essential to such a diet. It provides a framework for dealing with such everyday problems as transportation and housing arrangements which contribute to the nutrition problem.

The President's Task Force on Aging, in its remarks on nutrition, concurs with the AoA assessment:

Article cited in footnote 4, pp. 19-20.

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In examining the incidence of malnutrition among the elderly, the Task Force concluded that insufficient income was only one of several causes. The lonely older person who can afford an adequate diet but does not eat properly; the older person who finds going to the store too great a burden; the older person who is nutritionally ignorant; the chronically ill older person unable to prepare a hot meal—all are part of the problem. The Task Force believes that programs can be designed which, not only provide adequate nutrition to older persons, but equally important, combat their loneliness, channel them into the community, educate them about proper nutrition, and afford some of them an opportunity for paid community service.

The Task Force made this recommendation:

We, therefore, recommend that the President direct the Administration on Aging and the Department of Agriculture to develop a program of technical assistance and, when necessary, financial assistance, to local groups so that such groups can provide daily meals to ambulatory older persons in group settings and to shut-ins at home."

Continuation of nutrition projects.-The Title IV nutrition research and demonstration projects are, by their very nature and purpose, temporary. Although the Administration on Aging has encouraged all project directors to seek out other sources of funding from their States, communities and municipalities, so that their nutrition programs can continue after the grants have been completed, such funding is hard to come by today, when most State and municipal budgets are going through financial difficulties.

Thus, there is increasing concern about what will happen to the thousands of older Americans benefiting from these nutrition projects once the Title IV funds run out.8

Indeed, so much concern was generated in New York City, where one-third of the elderly population live below the poverty level,” that a special conference was called this year to discuss ways of creating a funding mechanism that would allow for continuation of nutrition projects. The conference was conducted at the Hudson Guild-Fulton Senior Center, where one such nutrition project is still in operation. It was attended by representatives from Federal and State government, professionals in the field of nutrition and aging, many of the Title IV nutrition project directors from around the Nation, and by the elderly participants themselves.

The project director of a Title IV food and nutrition program at the Henry Street Settlement in New York City, which faces termination on March 30, 1971, urged that some means be found to continue the program because:

If these programs have to close, thousands of people will end up in nursing homes or homes for the aged at a higher cost to the taxpayer. (Emphasis added.) Many older people

In "Toward a Brighter Future for the Elderly-The report of the President's Task Force on the Aging, April 1970, p. 48. Report cited in footnote 6, pp. 49–50.

8 See Developments in Aging, 1969, pp. 50-51, for example of a nutrition project that terminated.

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According to Alice Brophy, Executive Director, New York City, Office on Aging, who conducted a panel at the conference cited in footnote 2.

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will face the prospects of malnutrition

By far the largest group (of elderly participants) includes widows, widowers, with no one to cook for them, or single persons living in a furnished room or resident hotels where kitchen facilities are lacking 10

And, an elderly gentleman participating in the Conference discussion, appeared to sum up the feelings of other elderly participants in these nutrition programs when he said:

Three years ago, the Federal Government gave us a bone (the nutrition projects). We have worked hard all our lives for the United States. Now we are entitled to some meat. Mr. Jack Ossofsky. Deputy Director of the National Council on Aging, spoke at the Conference and called for: "A national operation of loaves and fishes' to assure that no older person in the country goes hungry." He suggests that: "The core of the program be community meal services in a socially positive setting; and that it include, wherever appropriate, home-delivered meals for those who are home-bound."

He continued, "The development of such a program would not only meet the nutritional needs of the elderly but the income and employment needs of many older persons by creating job opportunities for those (in the communities served) who can and want to work-in the preparation, service and delivery of meals. This will help establish community ties to the programs, to say nothing of keeping the community aware of their availability." Mr. Ossofsky concluded by urging: "We must pass legislation so that the Title IV Nutrition projects that will be terminated shortly can be saved, including funds for adequate research on the nutritional needs of the elderly. But we cannot wait for evaluation and research to implement such a program. We can see before our eyes the validity of these nutrition projects."

B. A LEGISLATIVE INITIATIVE

Legislation introduced in the House of Representatives during 1970 would meet the major demands in Mr. Ossofsky's proposal, and would also provide the "meat" which would allow the Title IV Nutrition projects to continue and grow in number of such programs.

On May 13, 1970, Congressman Claude Pepper introduced H.R. 17612, "Title VII of the Older Americans Act: Nutrition Program for the Elderly." The bill would authorize:

-A new division within the Food and Nutrition Service of the Department of Agriculture for the administration of the Nutrition Program for the Elderly.

-Making full use of existing services within the Department, including, but not limited to, the Federal Extension Service. -And consultation by the Department of Agriculture with the Administration on Aging, Department of Health, Education and Welfare in the planning and implementation of such a program. -Federal, State and local funding on a matching basis for these nutrition programs, including the utilization of surplus com

In letter to Committee on Aging from Mr. Edward Kramer, Project Director. I and Nutrition Program at Henry Street Settlement, New York City, Jan. 11, 1971 Kramer reiterated his written remarks at the above mentioned Conference.