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Randall Mueck's job at San Francisco's meal clearinghouse is to decide who will get food and who will wait. In mid-January, 411 of the city's homebound elderly were on Mueck's waiting list, 100 more than a few months earlier. All qualify for a hot, home-delivered meal under the federal Older Americans Act, but there isn't enough money to feed everyone.

Seniors who move up the fastest are those in the custody of adult protective services, the dying and the very old. Twenty-five percent of the people asking for food are over 90. "I try to think of all 411 and fit someone in accordingly," Mueck explains. "Age is going to bump somebody way up."

That means Audrey Baker, 79, must wait. When she asked for help last September, Mueck assigned her 750 points out of the 900 or so she needed to qualify for a meal. In January, her score had reached 877. (Each day on the list adds a point.) Baker, a thin woman, is blind, falls a lot and is on the mend from a broken back. She also has hypertension and diabetes.

"I've outlived everybody else in my family," Baker says. "I don't have any friends." Her only help is an aide who comes for two hours on Fridays. Like many seniors, Baker is vague about what she eats. "It's whatever I can afford," she says. What will she eat this week? "I'll eat all right, but I don't know exactly what." Tonight it's an apple and some nuts.

Food isn't far from her mind, though. On the table beside the armchair in her tiny living room is a copy of the food magazine Cooking Light, in braille. "She's clearly struggling," says Frank Mitchell, a social worker with San Francisco's Meals on Wheels program. "How do you say, 'I know you're hungry. We'll serve you in three months'?"

But that's the reality all across the country. Thousands of elderly men and women too infirm to cook or even see the flames of the stove are put on ration lists for food in the most bountiful country in the world. A 1993 study by the Urban Institute found that some 5 million elderly have no food in the house, or worry about getting enough to eat. They experience what the social service business calls "food insecurity.'' In Miami alone, 2,000 people are waiting. Says John Stokesberry, executive director of Miami's Alliance for Aging, "By the time we clean up the waiting list, some will be dead." Another study, done for the federal Administration on Aging, looked at food programs during the 1993­95 period and found that 41 percent of the country's 4,000 providers of home-delivered meals to the elderly had waiting lists. Malnutrition among the elderly is commonplace: Researchers at Florida International University estimate that 63 percent of all older people are at moderate or high nutritional risk. Some 88 percent of those receiving home-delivered meals are at similar risk, according to a study by Mathematica Policy Research.

In the face of shifting demographics, the picture isn't likely to improve. The number of people 60 and older has increased from 31 million in 1973 to 44 million today. And the number of the oldest old, those over 85 for whom assistance with meals is crucial, is growing even faster: Almost 1.5 million people were over 85 in 1970; in 2000, their number will exceed 4 million.

The homebound elderly are largely invisible. They aren't glamorous, and giving them food is not at the cutting edge of philanthropy. They are the antithesis of the "greedy geezer" who has come to represent all of the elderly in the public mind. They have no lobbyists--the interests of senior organizations lie elsewhere. Politicians neglect them; they don't vote or make campaign contributions. Often their children have moved far from home, leaving them without caregivers, a dilemma more keenly felt by women, who usually live longer than men. In 1970, 56 percent of the elderly over age 75 lived alone; by 1995, 76 percent were living by themselves.

For many, there are no meal lists to get on. In Big Springs, a speck on the Nebraska prairie, 134 of the town's 495 residents are eligible for a meal. But there's no money to start a food program. Vic Walker, director of the Aging Office of Western Nebraska, doesn't even have enough money to feed those living outside the city limits of Scottsbluff, the largest town in the area. One man living on a ranch three miles over the line "needed a meal so desperately," recalls Irma Walter, Walker's case manager. "He was so debilitated, but there was no access to food."

The Federal Commitment

More than thirty years ago, in 1965, Congress recognized the lengthening life span and the infirmities that come with it, and enacted the Older Americans Act to help seniors live out their last days at home with essential support: transportation, household help and personal care. The act is not a welfare program; anyone over age 60 is eligible for services if there's room.

In his 1972 budget message, President Nixon noted that "a new commitment to the aging is long overdue," and two nutrition programs were added that year: centralized, or congregate, meal sites--now numbering about 16,000--where seniors could eat a hot lunch and socialize; and a delivery service to send a hot meal to the homebound elderly. Meals prepared by a cadre of local churches, social service agencies and nonprofit organizations, many with similar names, were meant to reach mobile seniors and the homebound in every nook and cranny of America.

The food programs were supposed to promote "better health" among the older population "through improved nutrition" and offer "older Americans an opportunity to live their remaining years in dignity." Nixon pledged that the federal commitment would "help make the last days of our older Americans their best days."

At the beginning, Nixon tried to make good on that promise. When the Office of Management and Budget thought the initial funding should be $40 million and Nixon's adviser on aging, Arthur Flemming, suggested $60 million, Nixon upped the amount to $100 million. Throughout the seventies the funding kept pace with need. After that, however, it did not. Adjusting for inflation, per capita appropriations for all Older Americans Act programs in 1995 should have been $39. Actual per capita funding was only $19. Although total annual spending for all services has gone from $200 million in 1973 to $865 million today, that money not only hasn't kept up with inflation but it also hasn't kept up with the number of people who need help. The 1995 federal appropriations were down by about 50 percent relative to what the government spent in 1973. Money spent for the two food programs has shrunk by a similar amount.

Though payment is not mandatory, three-quarters of the elderly who get a home-delivered meal and almost everyone who eats at the congregate sites contributes, sometimes as little as 50 cents, toward the roughly $5.30 it costs to provide a meal. Half of those receiving home-delivered meals and about one-third of participants eating at congregate meal sites have annual incomes of less than $7,900. "Those least able to pay won't eat unless they put something in," says Larry Ross, the chief fiscal officer for San Francisco's Commission on the Aging.

One Meal a Day

Most Americans eat three meals each day, or 1,095 meals a year. The elderly receiving home-delivered meals get only 250. Only 4 percent of food providers routinely offer more than one meal a day, five days a week, and few offer weekend meals. In San Francisco, 765 people lucky enough to receive their food from Meals on Wheels, one of the city's nine providers, get two meals seven days a week. The rest of the city's 1,660 food recipients get only one. If the city's Commission on the Aging paid for two meals per person, as many as 400 people now served would not get any meal. The trade-off is constant and stark: Do more people get fewer meals or do fewer people get more meals?

The Salvation Army, which serves the meals in San Francisco's Tenderloin district, resolves the question in favor of the former, but there is pain whichever way it's answered. Richard Bertolovzi lives in an S.R.O. He is a skinny, bearded man with greasy hair, missing front teeth and one red eye that looks infected. "You don't deliver tomorrow, do you?" "Bert" asks the young woman delivering his noon meal of fish, coleslaw, fruit cocktail, clam chowder, corn bread and milk. A curtain of disappointment falls over his face, and he looks away in disgust. "I'm hungry," he says. "I can eat anything. I have a loaf of bread, that's all. That's all I got. And I got some instant coffee." The Salvation Army is able to offer him only a can of Ensure, a nutritional drink, to get through the weekend.

The Limits of Philanthropy

Food providers have always had to look for donations to support their programs. Now they have to look even harder. "We're competing with more folks than ever," says Mary Podrabsky, president of the National Association of Nutrition and Aging Services Programs. The conventional wisdom these days is that philanthropy should do more and government as little as possible--or, as Heritage Foundation senior fellow Dan Mitchell puts it, "If it's worth doing, the private sector can do it."

When it comes to feeding the elderly, private-sector funding works a little bit in a few places, not at all in most others. San Francisco Meals on Wheels was able to raise $214,000 last year thanks in part to benefit dinners cooked by the city's top chefs. Its New York counterpart raised $8 million last year from direct-mail campaigns, social events, grants and corporate contributions to provide some weekend meals and to whittle down the city's waiting list, although some 700 people are still in the queue. This past November, New York Citymeals-on-Wheels fundraiser extraordinaire Marcia Stein raised $675,000 throwing a women's power luncheon at the Rainbow Room. Guests including Brooke Astor, Diane Sawyer and Lena Horne plunked down a minimum of $250 to dine on vegetable terrine and risotto with white truffles.

Towns like Ramona, California, population 30,000, high in the hills northeast of San Diego, have no such benefactors. Chuck Hunt, board president of the town's senior center, tells how he placed ads in the Ramona Sentinel and North County Times asking 1,000 people to pledge $100 or 2,000 people to give $50. He collected exactly $1,600--twelve people gave $100 and got on the center's "gold honor roll"; eight donated $50 for a place on the "silver honor roll." Hunt also wrote to Allied Signal Aerospace, where he had worked for twenty-six years, asking for $25,000 to pay down overdue food bills and repairs on the vans that deliver meals. He says he felt "let down" when his old employer said no.

Raising private money in places like Ramona or Big Springs, or even San Diego, is not easy. There are few large corporations and foundations to tap, and if there are any, they have little interest in feeding the elderly. "If you flat-out ask people for food for seniors, you don't get much of a response," says Daniel Laver, director of the Area Agency on Aging in San Diego. "Private foundations are looking at cutting-edge programs--new and innovative. Basic human needs programs are not as sexy."

In the new world of corporate giving, charity is often tied to the bottom line. During the holidays Kraft offered 600 meal providers $100 each if they placed a story about a Kraft promotion in their local media. Kraft said it would donate 25 cents to meal programs for each special coupon redeemed. To get the $100, however, providers had to submit press clippings showing they had fulfilled the deal's P.R. requirements. If they did, the $100 donation bought about twenty meals.

Such corporate "generosity" doesn't insure that seniors have enough to eat, nor can it build the necessary infrastructure of senior centers and food preparation sites; only adequate, continuing federal appropriations can do that. Says Bob Tisch, New York Citymeals-on-Wheels board president, feeding the elderly "is the government's responsibility."

State and Local Aid

States must contribute at least 15 percent of the total cost of the two federal meal programs. Some states go beyond that. Pennsylvania, for instance, contributes its lottery proceeds to services for the elderly. Local governments sometimes kick in money, and where they do, those funds help keep the food programs afloat. County funds including a dedicated portion of San Francisco's parking tax make up about 38 percent of the budget for home-delivered meals. The City of New York contributes 55 percent of the food-program budget. Voters in Cincinnati have twice approved a property-tax levy to support a variety of services for the elderly, most recently last fall by a margin of 65 percent to 35 percent. Eighty-three percent of the Council on Aging's $4.1 million budget for home-delivered meals is funded by the tax levy. "It's a myth that people don't want to help their elderly," says Bob Logan, director of the council, the agency serving the Cincinnati area. He says the levy "was overwhelmingly supported by the young, the old, Republicans, Democrats, minorities and non-minorities." But even a generous stream of local money can't stop waiting lists from mounting: In Cincinnati, local money just means those on the lists don't have to wait as long.

Furthermore, food programs in some localities are in jeopardy because of diminishing local tax revenues. Take, for instance, Saunders County in eastern Nebraska, a suburb of nearby Omaha. In the past few years the county has contributed around $68,000 a year for both congregate and home-delivered meals. Still, that money is inadequate, forcing some communities to serve the elderly only two or three days a week. (The law allows a program to provide food fewer than five days a week in rural areas.)

Service could be slashed even further, a result of reduced inheritance taxes, which have funded food programs for the elderly, and the state legislature's recent imposition of a limit on local property tax levies. "Some services are going to be cut or slimmed back," says Patti Lindgren, the County Clerk. "The ones that will be are those optional to the county, like senior services."

Penny-Wise and Pound-Foolish

The United States has no national policy on aging. Instead, an unwritten policy directs resources to the most expensive care in the last places the elderly stay--hospitals and nursing homes. When malnourished seniors go to the hospital, they may end up staying longer and costing more money. The Massachusetts Dietetic Association estimates that for every $1 spent on nutrition programs, $3.25 is saved in hospital costs. A study in Little Rock compared two groups of hospitalized seniors who were the same age and had the same diagnosis. One group had received home-delivered meals; the other group had not. Patients who got food stayed in the hospital half as long as those who didn't. Ronni Chernoff, associate director of geriatric research at the V.A. hospital in Little Rock, who supervised the research, figured that the cost of eight extra days in the hospital--some $4,800 at Little Rock rates--was the equivalent of providing someone with a meal a day for two and a half years.

An acute episode such as breaking a bone, healing a surgical incision or the flu makes demands that a poorly nourished body cannot accommodate. "The people I'm not serving but know in my heart of hearts I should are those just coming out of the hospital," says Gail Robillard, a nutritionist with the Jefferson Council on Aging in Metairie, Louisiana. Without such assistance, they often go back to the hospital, a vicious cycle that Robillard believes can be prevented with good nutrition. Medicare's home health care benefit covers the services of nurses, aides and a variety of therapies, but not food.

Without food, the elderly also go to nursing homes prematurely, adding to what is already a huge national expense. The United States spends about $80 billion a year on nursing-home care, nearly half paid by taxpayers through Medicaid. A year in a nursing home averages around $40,000; a year's worth of meals, $1,325.

Needed: A Champion

Despite the compelling statistics, no one in Congress seems willing to champion the cause of meals for the elderly. The closest these days is New York Senator Alfonse D'Amato, who pushed through a 3.5 percent increase in funds for congregate and home-delivered meals last year. In fact, says one Senate staffer, "there has been a general push to cut back on Older Americans Act appropriations for many years." Money from the Department of Agriculture, which also contributes to the programs, has been cut from about $150 million to $140 million, further limiting the number of meals providers can serve. A House staffer explains: "No one speaks ill of the program. On the other hand, no one gets excited about it." Lack of enthusiasm makes it an easy target to cut or ignore.

"The Older Americans Act has suffered because it is such a feel-good, sound-good act it doesn't translate into tangible things anyone can look at and champion so it gets the necessary increases," says Bob Blancato, director of the 1995 White House Conference on Aging. Food competes in the same spending bill with the National Institutes of Health, Head Start and bilingual education, more glamorous activities that are easier for members of Congress to embrace. Last year the N.I.H. got a $900 million increase, boosting its budget to more than $13 billion. This year the President has proposed another $1.1 billion. "There's a lot of exciting scientific stuff happening," says a House staffer. "Everybody knows someone who's sick, and that always gets people's interest." Sickness caused by hunger doesn't have the same cachet. Head Start and bilingual education have also fared better, thanks largely to the Clintons. Indeed, last year bilingual education got a 25 percent increase, one of the largest in the entire federal budget.

The President's budget calls for no increase in money for food programs for the elderly this year, although some fifty members of the House recently signed a letter to Clinton urging such an increase. One of those who signed is Frank LoBiondo, a New Jersey Republican who has also circulated a letter of his own asking his colleagues to oppose the President's spending freeze. "It's difficult when the President didn't recognize the importance [of the programs] in his budget," he says.

In the end, it will come down to a question of priorities, especially those of Representative Bob Livingston, a Republican from Metairie who chairs the House Appropriations Committee. Meanwhile, the nutrition programs in his district struggle; some people wait as long as thirteen months for a meal. Gail Robillard says she, too, is "prioritizing on top of prioritizing," trying to allocate food to the neediest. "Livingston says he's interested in the elderly, but nothing specific ever comes from him," she says.

Ask what they eat and seniors say they manage, putting the best face on the most dehumanizing of predicaments. It's too demeaning to say otherwise. Confessing hunger is an admission that you can't provide for your most basic need. Pressed for what they really eat, seniors are apt to say tea and toast, cereal, cookies, a sandwich of peanut butter or baloney, even scraps foraged from the garbage.

"I'm not proud to say we lived out of dumpsters," says 74-year-old Helen McCleery, whose disabled son scoured garbage bins before McCleery got on the San Diego meal program. "We were eating whatever my son found--mostly vegetables. We washed the vegetables, sprayed them with Lysol and washed them again." They didn't touch meat, McCleery said; they were too afraid of E. coli and salmonella. Macular degeneration has taken her sight, and she is diabetic. She knows she wasn't eating right, but she and her son were living on $700 a month; their rent of $635 left little for food.

Unless there's renewed federal commitment to the elderly, their story will be repeated. It's the responsibility of everyone, says Michel Roux, president of Carillon Importers and board member of New York Citymeals-on-Wheels, "to think of these people as their parents."

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