Meals on Wheels only isn't 'showing any results' if you ignore all these results

WASHINGTON - At a news conference Thursday, Mick Mulvaney, President Donald Trump's budget chief, defended proposed cuts to the Meals on Wheels program, which provides food aid to needy senior citizens, by saying the program is one of many that is "just not showing any results."

Meals on Wheels is a nonprofit group that receives funding from the federal government, state and local governments and private donors. "We serve more than 2.4 million seniors from 60 to 100+ years old each year," the organization writes. "They are primarily older than 60 and because of physical limitations or financial reasons, have difficulty shopping for or preparing meals for themselves."

If that doesn't clear the bar for "results," as Mulvaney put it, there's also been a fair amount of peer-reviewed research on the efficacy of the program.

A 2013 review of studies, for instance, found that home-delivered meal programs for seniors "significantly improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Other beneficial outcomes include increased socialization opportunities, improvement in dietary adherence, and higher quality of life."

Not only that, the programs offer good bang-for-your-buck: "These programs are also aligned with the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services by helping older adults maintain independence and remain in their homes and communities as their health and functioning decline."

In other words, the programs help seniors stay at home and out of costly nursing facilities. If you're interested in keeping a lid on health-care costs, the importance of this finding can't be overstated.

"The average cost of a one-month nursing home stay is equivalent to providing home-delivered meals five days a week for approximately seven years," one of the studies in the analysis found. How's that for "results"?
Also on the cost-containment front, a 2013 study by researchers at Brown University found that in most states, increasing Meals on Wheels enrollment would result in a net savings from decreased Medicaid costs for nursing home care.

More recently, those same researchers conducted a random controlled trial of Meals on Wheels efficacy. The study, which was funded by AARP, enrolled hundreds of seniors on food waiting lists across the United States. Some received daily meal deliveries, others got weekly bulk frozen food deliveries, and some simply remained on waiting lists.

"What we found is that there were statistically significant differences in health benefits among the three groups," lead researcher Kali Thomas said, "with the highest gains recognized among participants living alone who had face-to-face contact via daily deliveries."

Those receiving daily meals also experienced fewer falls and hospitalizations, the study found.

"Meals on Wheels sounds great," Mulvaney said Thursday, but "to take that federal money and give it to the states and say, 'Look, we want to give you money for programs that don't work' - I can't defend that anymore."

Photo: Leah Millis, The Chronicle. Bernie, 90, who preferred to only give his first name, looks out through his window as his Meals on Wheels delivery sits on the table in front of him in his home Nov. 24, 2016 in San Francisco, Calif.


For the Record: WH budget director did not say Meals on Wheels did not show results

“We want to give you money for programs that don’t work. I can’t defend that anymore.”
–White House budget director Mick Mulvaney, press briefing, March 16, 2017

There has been a lot of media criticism of Mulvaney for suggesting that the popular Meals and Wheels program does not work or is “just not showing results.”

But, because of tweets and snippets posted on the Web, it appears his comments have been misinterpreted. He was not talking about Meals on Wheels, but about a program in Housing and Urban Development Department known as CDBG, or community development block grants.

There are some scattered municipalities which use some of their CDBG funds to help fund nutrition programs for the elderly. But most of the funding for Meals on Wheels comes from a separate program run out of the Health and Human Services Department, said Jenny Bertolette, vice president of communications at Meals on Wheels.

“The FY 2016 budget level for the Older Americans Act Nutrition Program (through HHS) was $834,753,000,” she said. “The 2017 ask (proposed by House) is $848,557,000.”

The Obama administration’s budget justification said that this funding would “allow states to provide a total of 205 million meals to over 2 million older Americans nationwide.”

The Trump administration has proposed a 17.9 percent cut in funding for HHS, but it has provided no detail on whether that would also impact the Administration for Community Living, which funds nutrition programs for the elderly. Bertolette said it was fair to assume there would be an impact.

As for the CDBG, Bertolette said “there’s no nationwide breakdown of how these block grants are allocated within each state. Some programs will be hit hard and some might not be affected. It really depends on the state.” She pointed to a provider in Ypsilanti, Mich., that she said it faced a 30 percent cut in funding.

But Alison Foreman, the director of Ypsilanti Meals on Wheels, said while government funding made up about 30 percent of its funds, almost all of that came from the HHS program. But “last year Washtenaw County Office of Community and Economic Development did issue pass thru [CDBG] dollars to YMOW for vehicle updates and staff support,” she said.

“We realize it is unclear what the President’s proposal means for nutrition and aging programs,” Foreman said in an email. “The overall proposed funding cut of 17.9% for HHS, which includes the Older Americans Act funding for aging programs, is concerning.”

Here is the full quote by Mulvaney at the press briefing.

As you know, or I think you know that Meals on Wheels is not a federal program. It’s part of that community — the CDBG — the block grants that we give to the states. And then many states make the decision to use that money on Meals on Wheels.

Here’s what I can tell you about CDBGs because that’s what we fund — right? — is that we spend $150 billion on those programs since the 1970s. The CDBGs have been identified as programs since I believe the first — actually, the second Bush administration as ones that were just not showing any results. We can’t do that anymore. We can’t spend money on programs just because they sound good. And Meals on Wheels sounds great — again, that’s a state decision to fund that particular portion to. But to take the federal money and give it to the states and say, look, we want to give you money for programs that don’t work — I can’t defend that anymore. We cannot defend that anymore. We’re $20 trillion in debt.
We’re going to spend money, we’re going to spend a lot of money, but we’re not going to spend it on programs that cannot show that they actually deliver the promises that we’ve made to people.

At another point in the briefing, Mulvaney reiterated these points about CDBG, and whether some funds were used by Meals on Wheels.

My understanding of Meals on Wheels is that that is a state determination.  The federal government doesn’t directly fund that; it funds the central Community Development Block Grants, the CDBGs.  And some states choose to take the money and do Meals and Wheels.  Other states and localities might choose to do something else with them.  We look at the CDBGs.  And when we do that, we look at this as $150 billion spent over 40 years, without the appreciable benefits to show for that type of taxpayer expenditure.  And that’s why we have the reduction.

It’s clear from the context that Mulvaney is referring to CBDG. Reason, a libertarian magazine, has written a number of  reports that have criticized the program for waste and corruption.

Later in the briefing, Mulvaney was asked about after-school programs that might be cut. “They’re supposed to help kids who don’t get fed at home get fed so they do better in school,” he said. “Guess what? There’s no demonstrable evidence they’re actually doing that. There’s no demonstrable evidence of actually helping results, helping kids do better in school.”

That’s certainly debatable, but he was not talking about Wheels on Meals.


Trump budget: Meals on Wheels cutback prompts backlash

Donald Trump has published some budget proposals for the next fiscal year and, as expected, it's good news for defence and border security, bad news for the environment, arts, and certain welfare programmes.

One planned cutback has generated a particularly strong backlash: President Trump's intention to eliminate the entire Community Development Block Grant, which funds housing assistance and various community programmes.
Among them is Meals on Wheels, which provides food to the elderly and disabled, to veterans, and to others who are unable for some reason to leave their homes.

The planned cutback wouldn't eliminate Meals on Wheels, but it would limit a service which is already struggling to cope with increasing demand, according to the organisation behind it.

Last year, Meals on Wheels delivered food to 2.5 million Americans, including 500,000 veterans, according to its own figures. It also offers ancillary benefits, it says, such as reducing loneliness and preventing falls - which it says saves the taxpayer $34 billion per year in hospital bills.

And that is backed up by a 2015 study by Brown University, which found that elderly citizens who received home-delivered meals experienced fewer falls and needed fewer trips to hospitals.

"Meals on Wheels sounds great," said Mick Mulvaney, Mr Trump's White House budget director, but, he added, the programme is "just not showing any results".

Majority of the programme's funding comes from donations from individuals, corporations and foundations, but about 3% of the budget for Meals on Wheels' national association is through government grants.

The national chapter supports a network of 5,000 independently operated local agencies, which provides the actual food and services to senior citizens, according to Jenny Bertolette, a spokeswoman for Meals on Wheels,
Those local agencies primarily rely on federal funding through the Older Americans Act under the US Department of Health and Human Services (HHS), which could see a nearly 18% cut in the proposed budget.

The Older Americans Act covers about 35% of the cost of serving 2.5 million Americans through local chapters, Ms Bertolette said.

Should the health department see its funding decrease, those cuts would likely trickle down to programmes like those funding Meals on Wheels' local affiliates, she added.

These local agencies also depend on the Community Development Block Grant in which Mr Trump seeks to eliminate.
Though it is unclear how much the local chapters will be affected under the proposed budget cuts, Ms Bertolette said "we are certain that our programmes would suffer on some level", which means that means seniors would not receive the care they need.

For example, a local programme outside of Detroit could lose as much as 30% of its budget if the Community Development Block Grant ends.

That could mean turning seniors away or cutting services like two meals a day down to one, Ms Bertolette said.

Asked whether the planned cuts were "hard-hearted", Mr Mulvaney argued that it was just as compassionate not to ask American taxpayers to pay for welfare programmes that don't work.

"You're focusing on recipients of the money. We're focusing on recipients of the money and people who give us the money in the first place. I think it's fairly compassionate to go to them and say, look, we're not going to ask you for your hard-earned money anymore."

The planned funding cut, and Mr Mulvaney's remarks, prompted heavy criticism on Twitter.

Tweet: Meals On Wheels brings meals to the elderly. Sometimes that's the only meal they have for the day. Sometimes it's the only person they see.

Some drew comparisons with the costs incurred by Mr Trump's security demands, particularly his regular weekend trips to his Florida commercial club, Mar-a-Lago - one of which was estimated to cost more than $3 million.

Others pointed out that the cuts to a number of welfare programmes were being made to balance out a significant increase in defence spending, or to the estimated cost of Melania Trump's decision to stay in New York so son Barron did not have to change school - reported to be somewhere in the region of $300,000 per day.

Meals on Wheels providers told Market Watch that it costs about $2,500 per year to feed a single senior citizen.

A 2013 report on the effectiveness of Meals on Wheels found that the home-delivered meals "significantly improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants".

Other benefits included "increased socialisation opportunities, improvement in dietary adherence, and higher quality of life". The social aspect was highlighted by Elijah Cummings, representative for Maryland's 7th District, who also invited Mr Mulvaney to his district to see first hand the impact of the programme.

The draft budget proposals say the Community Development Block Grant, which encompasses Meals on Wheels, is "not well-targeted to the poorest populations and has not demonstrated results".

Others have pointed to the fact that the majority of funding for the programme comes through state-allocated funds and not federal grants, and would not be affected by this cutback.

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