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By Thomas Goldsmith

One in five North Carolinians older than 60 lives under the threat of hunger; placing the state second worst in the nation in the category, a new survey says.

However, the growing reality of hunger among older North Carolinians didn’t get a response in the accelerated drafting of the state budget, despite a requested $7 million hike for Meals on Wheels and other means to address the problem.

The state’s ranking for the threat of hunger, or marginal food insecurity, among older people put only Louisiana worse off than North Carolina in latest available numbers, according to “The State of Senior Hunger in America in 2016,” released this month by Feeding America, a national organization representing food banks.

Eva Poirier, right, 71, a native of New England, eats lunch with friends at the congregate meal site at Garner Senior Center. She’s been coming to the center’s daily gathering, funded by Home and Community Care Block Grants, for about two years. Photo credit: Thomas Goldsmith

North Carolina is also fifth highest in the share of older people who feel the risk of hunger, ranking above only Louisiana, Alabama, New Mexico and Mississippi. For the lowest rating, “facing hunger,” North Carolina ties for 14th with Alaska.

According to the survey, 20 percent of state residents over 60 gave said “yes” to one of a series of questions such as, “In the last 12 months, were you ever hungry, but didn’t eat, because you couldn’t afford food?” Those counted as “at risk” gave affirmative answers to three to six such questions. Those facing hunger gave six “yesses” in households with no children or eight in houses with children. (See bottom for full set of questions.)

Last week, Orange County social worker Kim Lassiter-Fisher told a meeting of the Chatham-Orange Community Resource Connections for Aging and Disabilities that she recently had to call in food assistance for older people she met who had gone without for two days. And Jacquelyn Blackwell, co-coordinator at the nonprofit End Hunger Durham, related recurring encounters with older people in the community who face no-win choices around food.

“They say, ‘Should I pay my light bill, or should I buy food?’” Blackwell said Monday. “‘Should I pay for medicine, or should I buy food?’”

And at a recent state Council on Aging meeting, Department of Health and Human Services aging program specialist Audrey Edmisten presented information on hunger among older North Carolinians, including this stark finding from a UNC study: More than half of emergency department patients 65 or older were diagnosed with malnutrition or the risk of malnutrition.

Advocates for older people, including members of the state Coalition on Aging, had asked for a hike of $7 million in the state’s share of 2018-2019 Home and Community Care Block Grants. They point out they were asking for a very small amount this year, about three-thousandths of one percent of this year’s $23.9 billion budget.

But in a departure from typical practice, budget chairs from the majority Republican House and Senate presented this year’s budget as a take-it-or-leave-it conference report, leaving no room for amendments or for advocates to make a case for more for hungry older people, or anything else.

“What this conference report does is mainly make adjustments in terms of the budget and of course add additional money for state employee raises and a few critical things that have come to everyone’s attention,” Rep. Nelson Dollar, a Cary Republican involved with the budget process, told reporters as he defended this year’s atypical budget process. “I believe that it will be a budget that will be widely appreciated in terms of what it does.”

Advocates want boost

The pot of money called the Home and Community Care Block Grant comes from federal, state and local funds that pay annually for many non-Medicaid programs designed to allow seniors to age at home instead of in long-term care facilities. With the aging population on track to increase by one million people in less than two decades, the need for services has grown steadily.

More than half of the state’s counties are already experiencing population aging – a demographic shift in which the median age of the population increases significantly due to improved life expectancy and a drastic decline in birth rate. Map progression shows the changing number of people over 65 in each county. Data: NC Office of State Budget and Management

Each county’s Board of Commissioners decides on services most needed by older people, usually with the advice of the local council on aging.

This year’s budget calls for only a scant increase of $150,000 over last year’s state contribution of $31 million, funding that has left many more than 10,000 older North Carolinians on waiting lists for programs such as Meals on Wheels, congregate meals, adult day care, transportation, in-home aides, home renovation and more.

“Governor Cooper pushed to restore funding to this crucial program cut by legislators and also proposed expanding it,” Noelle Talley, a Cooper spokeswoman, said in an email.

“The Governor’s budget proposed last year for FY 2017-2019 recommended $3 million in new appropriations for these services in addition to restoring a $969,549 cut made by the General Assembly in FY 14-15.

“The final budget as passed by the General Assembly during last year’s long session restored the cut but didn’t include the additional $3 million Gov. Cooper sought for Home and Community Care Block Grants,” Talley wrote.

Cooper’s 2018-2019 budget recommended other provisions that affect older people, including a new staffer for Adult Protective Services, paid for by an increase in a separate federal allocation. There’s also money for additional people to take complaints at the Division of Health Services Regulation, which oversees long-term care centers as well as hospitals and other facilities. Cooper also recommended other big-picture changes that could benefit older people, such as Medicaid expansion, that did not pass.

Meanwhile, grassroots and nonprofit organizations across the state are using remedies ranging from digging into board members’ pockets, to handing out lists of resources, to putting on bluegrass music concerts to confront the problem.

“When someone from Meals on Wheels comes by, that may be the only person that the older person sees that day,” musician Tony Williamson said at a recent appearance, promoting a June 24 fundraiser he’ll play for the agency in Chatham County.

“There’s an older couple in Siler City, both with health issues, their son lives out of town,” Chatham County advocates say in a flier for the show. “A cousin checks in some times. They are on a waiting list for home-delivered meals.”

Older people across Chatham County were continuing to add their names to a growing waiting list for services based in the community, according to the county’s Meals on Wheels agency.

In Wake County, 20 Meals on Wheels board members pitched in $400 each at a May meeting, coming up with $8,000 on the spot to let five more people receive daily meals, agency executive director Alan Winstead said. That left 182 people on Wake’s Meals on Wheels waiting list.

“We did it as a challenge,” Winstead said.

Extra money is elusive

Nationally, money for services such as home-delivered meals has sometimes gotten a bad rap as “feel-good” spending, rather than an effort with a measurable result. But several academic studies have shown otherwise.

Clarence (Gabby) Hayes, 93, a Marine veteran of World War II, often stops by the congregate meal site at Garner Senior Center. Along with Meals on Wheels and other services, congregate meals are paid for by Home and Community Care Block Grants. Photo credit: Thomas Goldsmith

“Compared to initial values, participants improved significantly in some variables for dietary patterns, nutrient intake, and nutrient density, and were less likely to be food insecure,” wrote the authors of a study 2013 in the Journal of Nutrition Health and Aging. “Furthermore, [home-delivered meals were] more likely to impact those living alone and those with poorer initial status.”

This year, new funding in areas of concern such as teacher salaries, school safety, prison security and water pollution near Wilmington has dominated budget talks.

The study that presented harsh findings for older state residents, called the “State of Senior Hunger Survey” was conducted by academics James P. Ziliak at the Center for Poverty Research at the University of Kentucky and Craig Gundersen at the University of Illinois’ agriculture and consumer economics department.

The survey produces state rankings based on the number of residents who gave positive responses to statements such as “We relied on only a few kinds of low-cost food to feed our children because we were running out of money to buy food.” An answer of “often” or “sometime” was viewed as a positive response.

Betsy Crites, also a co-coordinator at End Hunger Durham, said better solutions ought to emerge in the long term than the agency’s focus since its 2015 founding, supplying hungry people with information on how to make use of public and private resources.

“There’s a huge disparity of income between the people at the top and the rest of us and the poor,” Crites said. “How that plays out on the ground is in the line at the food bank.”

Rose Hoban contributed reporting to this story.

The rankings in the new study are based on responses to a food security section of the Current Population Survey conducted by the U.S. Census Bureau. Although rankings in some categories have improved in recent years, the study finds that older Americans face more food insecurity today than before the Great Recession.
The 2016 numbers used, the most recent available, reflect 21,948 sample observations. Based on the list of questions below, respondents are ranked as having marginal food insecurity if they answer one question positively, having food insecurity if they say yes to three or more, and living in very low food security when giving eight or more affirmative answers in households with children; and six or more in childless households.

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...