Meals on Wheels

Meals on Wheels is a program that delivers meals to individuals at home who are unable to purchase or prepare their own meals. The name is often used generically to refer to home-delivered meals programs, not all of which are actually named "Meals on Wheels". Because they are housebound, many of the recipients are the elderly, and many of the volunteers are also elderly but able-bodied and able to drive automobiles.

Research shows that home-delivered meal programs significantly improve diet quality, increase nutrient intakes, reduce food insecurity and improve quality-of-life among the recipients.^[1][2] The programs also reduce government expenditures by reducing the need of recipients to use hospitals, nursing homes or other expensive community-based services.

History

Meals on Wheels originated in the United Kingdom during the Blitz, when many people lost their homes and therefore the ability to cook their own food. The Women's Volunteer Service for Civil Defence (WVS, later WRVS) provided food for these people. The name "Meals on Wheels" derived from the WVS's related activity of bringing meals to servicemen. The concept of delivering meals to those unable to prepare their own evolved into the modern programmes that deliver mostly to the housebound elderly, sometimes free, or at a small charge.^[3][4][5]

United Kingdom (1943)

The first home delivery of a meal on wheels following World War II was made by the WVS in Hemel Hempstead, Hertfordshire, England in 1943. Many early services used old prams to transport the meals, using straw bales, and even old felt hats, to keep the meals warm in transit.^[3]

This type of service requires many volunteers with an adequate knowledge of basic cooking to prepare the meals by a set time each day. The majority of local authorities in the United Kingdom have now moved away from freshly cooked food delivery, and towards the supply of frozen pre-cooked reheatable meals.^[6]

Australia (1953)

Doris Taylor MBE founded Meals on Wheels in South Australia in 1953, and in 1954 the first meal was served from the Port Adelaide kitchen.^[7] The first meals were delivered to eight elderly Port Adelaide residents on 9 August 1954.^[8][9]

In New South Wales, Meals on Wheels was started in March 1957 by the Sydney City Council. In the first week, 150 meals were served for inner city dwellers; these were cooked in the Town Hall kitchen.^[4]

Organised on a regional basis, in Australia Meals on Wheels is a well established, active and thriving group of organisations. The history of a small sample of some of the organisations includes: New South Wales,^[4][10] Queensland,^[11][12] South Australia,^[13][14][15] Western Australia^[16] and Victoria.^[17]

In 2012, the Queensland branch of Meals on Wheels was a recipient of the Queensland Greats Awards.^[18]

United States (1954)

National

Established in 1974,^[19] the oldest and largest national organization is Meals on Wheels America, which supports more than 5,000 community-based senior nutrition organizations across the country.^[20] By providing funding, leadership, education and advocacy support, Meals on Wheels America empowers its local member programmes to provide services to their communities.^[20] With local programmes, they galvanize the resources of local community organizations, businesses, donors, sponsors and more than two million volunteers – bolstered by supplemental funding from the Older Americans Act – into a national safety net for seniors.^[21]

Currently, they are located in Arlington, Virginia^[22] and headed by President and CEO Ellie Hollander.

Pennsylvania

The first home-delivered meal programme in the United States began in Philadelphia, Pennsylvania, in January 1954. At the request of the Philadelphia Health & Welfare Council, and funded by a grant from the Henrietta Tower Wurtz Foundation, Margaret Toy, a social worker in Philadelphia's Lighthouse Community Center, pioneered a programme to provide nourishment that met the dietary needs of homebound seniors and other "shut-ins" in the area who otherwise would have to go hungry. As is the case today, many participants were people who did not require hospitalization, but who simply needed a helping hand in order to maintain their independence. Most of the volunteers were high school students, who were dubbed "Platter Angels." The "Platter Angels" would prepare, package, and deliver food to the elderly and disabled through their community. The daily delivery consisted of one nutritionally balanced hot meal to eat at lunch time, and a dinner consisting of a cold sandwich and milk along with varying side dishes.

Ohio

Columbus, Ohio, was the second city in the U.S. to establish a community based meals programme. Building on the model set forth in Philadelphia, a federation of women's clubs went through the town to inform themselves of possible participants for a meal service. In Columbus, all of the meals were prepared by local restaurants and delivered by taxi cabs during the week. On weekends, high school students filled the posts.

New York

The city of Rochester, New York, began its home-delivered meal programme in 1958. It was originally a pilot project initiated by the New York Department of Health and administered by the Visiting Nurse Service. The Bureau of Chronic Diseases and Geriatrics of the New York Department of Health underwrote the costs.

California

Also in the late 1950s, a group of concerned women in San Diego, California recognised that isolated seniors were in need of regular meals and human contact. What was to become Meals-on-Wheels Greater San Diego, Inc. started in 1960, and has served area seniors for 50 years. When the national association, Meals on Wheels Association of America (MOWAA), sought guidance with the parameters to be used in the evaluation process for locally-run agencies, Meals-on-Wheels Greater San Diego was used as a model to help define the benchmark for successful operations, and "set the standard" for approval. The mission of Meals-on-Wheels Greater San Diego, Inc. is to support the independence and well-being of seniors. A private, not-for-profit corporation, Meals-on-Wheels San Diego strives to keep seniors independent in their own homes by delivering meals to those who are unable to adequately meet their own nutritional needs. Often, the availability of this service enables seniors to avoid seeking institutional alternatives. From modest beginnings, Meals-on-Wheels has grown into one of the largest senior service programmes in Southern California. Meals-on-Wheels is currently the only organization in the area home-delivering two meals a day, for seven days a week (including holidays), and providing modified diets to seniors, age 60 and older, throughout San Diego County. In 2009, agency-wide, 82 staff members supported over 2,200 volunteers who donated their time to home-deliver 450,000 meals to approximately 2,000 seniors throughout San Diego County. Debbie Case is the CEO and President of Meals-on-Wheels Greater San Diego.^[23]

Another California Meals On Wheels programme is Meals On Wheels West (MOWW), which has been delivering services to home-bound individuals in their homes since April 1974. The agency has since grown from an organization that served 8 clients in one city to one that provides meals and companionship to 396 individuals in 6 of Los Angeles County’s coastal communities by 2010. In 2010 alone, over 3,000 volunteers delivered more than 86,000 meals. Begun as a programme of the Westside Ecumenical Conference, MOWW attained its own non-profit status in 1994. The CEO since 1987, RoseMary Regalbuto’s, first challenge upon arrival at MOWW was to eliminate the waiting list by increasing the number of routes and clients served. Since then, no eligible clients have been made to wait for services. When Mrs. Regalbuto took the helm, MOWW was only serving Santa Monica. Due to her leadership, the agency now serves Santa Monica, Topanga, Pacific Palisades, Malibu and parts of Marina Del Rey. In 2010, 93% of MOWW clients stated that MOWW was a major factor in their ability to remain in their own homes. 88% of clients reported that the daily contact with Meals On Wheels West volunteers was important to them, and 50% stated the volunteers were the only visitors during the day. 70% of volunteers stay with the organization for more than 5 years, which allows for significant lasting connections with clients.^[24]

Oregon

Meals on Wheels People was founded in 1969 in Portland, Oregon and currently produces 5,000 hot, nutritious meals five days each week which are delivered to 34 senior centers throughout Multnomah County, Washington County and Clark County. The Meals are served at noon to seniors in center dining rooms or sent out as Meals on Wheels to frail, homebound elderly.^[25] Meals on Wheels People continues to expand to other locations, such as the Edwards Community Center in Aloha, Oregon where, in partnership with Edwards Center Inc. and Washington County Disabled, Aging and Veterans Services people over 60 years of age may receive hot lunches, alongside veterans and adults with developmental disabilities thereby providing new community connections for several groups that might otherwise become isolated.^[26]

Ypsilanti, Michigan

Ypsilanti Meals on Wheels was a programme idea that originated from the city of Ypsilanti’s Mayor’s Council on Aging. As a result of the Council’s recommendation in the spring of 1973, the City Council agreed to appropriate $8000 to a meal delivery programme to begin on July 1, 1973. Pastor William Bingham, pastor of the First Baptist Church of Ypsilanti and a member of the mayor’s Council on Aging, became the first Executive Director. Volunteers prepared meals in the kitchen of the First Baptist Church. Meal service began on January 14, 1974 to 16 homebound individuals. As time passed and the demand grew, Ypsilanti meals on Wheels purchased vans and equipped them with refrigerators and microwave ovens. Up until that time, volunteers had picked up cold meals, prepared at Eastern Michigan University, and heated them at each stop. Today, Ypsilanti meals on Wheels owns four vans and delivers approximately 200 hot meals each day, Monday through Friday. Drivers pick up the meals at Eastern Michigan University Hoyt Conference center and pack them into insulated containers that maintain the appropriate temperature until the delivery of the last meal.^[27]

Canada (1963)

Brampton

Brampton, Ontario is the first city in Canada to deliver meals to seniors in need. In the spring of 1963, Ruby Cuthbert, a nurse, implemented the Meals on Wheels programme with the support of the local Soroptimist Club. Later, the Auxiliary group from Peel Memorial Hospital took over the responsibility and Brampton Meals on Wheels (BMOW) started with six meals a day.

Calgary

Meals on Wheels was formed in response to a plea from the Hospital Chaplaincy Committee of the Calgary Presbytery of the United Church. In 1965, a study was undertaken by the Presbyterian United Church Women into the needs of the elderly living alone and those being discharged from hospitals with no help available during their convalescence. On November 30, 1965 the Calgary Church Women's Community Care was incorporated and in 1976 the name was officially changed to "Calgary Meals on Wheels". In addition to the United Church, the Anglican, Baptist, Catholic and Presbyterian Churches supported the movement while interested volunteers and service clubs answered the call for help and proved to be the backbone of the fledgling organization. The United Way and the City of Calgary have also played a vital role in the success of this community service. On 15 November 1965 the first meal service started serving eight clients. By 1982 the number of clients had increased to in excess of 380 per day, requiring a move to a larger centre. In 2005, Calgary Meals on Wheels celebrated its 40th Anniversary, (having never missed a meal delivery in its 40-year history), and delivered to some 1,900 clients, plus services to several unique programmes. The organisation is governed by a Board of Directors, all of whom are volunteers. A pool of some 750 volunteers donate just under 75,000 hours of time a year to deliver meals five days a week within Calgary city limits.^[28]

Edmonton

The first meals were delivered on 21 April 1969 for $0.65 each. There was one route on the south side with a total of three meals.^[29]

Fredericton

Meals on Wheels of Fredericton, New Brunswick began in 1967. They currently serve over 40,000 meals per year to about 300 clients. The organization will be celebrating 50 years of service in 2017.^[30]

Halifax

Meals on Wheels began in Nova Scotia in 1969, with three volunteers delivering six meals in Halifax.^[31]

Vancouver

Since 1967, the Health and Home Care Society of BC has operated the Meals on Wheels programme in Vancouver and Richmond.^[32]

Winnipeg

Meals on Wheels was originally created as a side project of The Home Welfare Association. A 1961 study recommended the establishment of a Meals on Wheels delivery service for people who were unable to prepare meals for themselves, such as the elderly and infirm. A three-year pilot project was started and they delivered the first meals on 30 June 1965. In 1981 the Home Welfare Association chapter was officially closed when the name was changed to Meals on Wheels of Winnipeg, Inc.^[33]

Ireland (1971)

Longford

The first meals were delivered in Longford, a small county town in the Midlands. They were delivered by County Longford Social Services, organised by Sister Calasanctius of the local Convent of Mercy and the local hospital's medical officer Dr Gerard McDonagh. The meals were distributed from a mobile kitchen for which funds had been raised by the local children. The fundraising had been organised by the Longford News (local newspaper) editor Derek Cobbe.

Some of the first meals were delivered by a volunteer driver, the late Pat Hourican, with volunteer helper the late Sr. Bonaventure. The mobile kitchens were built by a local businessman, Noel Hanlon, at his ambulance factory in the town. The vans had specially fitted gas cookers provided by the ambulance factory to keep the dinners warm. Meals were delivered then to some 400 people around Longford, mostly elderly or disabled, and were free of charge, supported by small grants and locally collected funds.

Modern programmes

Today, Meals on Wheels programmes generally operate at the county level or smaller. Programmes vary widely in their size, service provided, organisation, and funding.

There are Meals on Wheels programmes in Australia,^[34] Canada,^[35][36] Ireland,^[37] the United Kingdom and the United States. The National Association of Care Catering^[38] are a great source of information on UK Meals on Wheels services. The Meals On Wheels Association of America (MOWAA)^[39] is a national association for senior nutrition programmes headquartered in Alexandria, Virginia, but each programme operates independently.

Most Meals on Wheels programmes deliver meals hot and ready-to-eat, but some deliver cold meals in containers ready to microwave. Others supply deep-frozen meals. Some warm-meal programmes provide an additional frozen meal during the days prior to a weekend or holiday, when there would be no delivery. Depending on the programme, meals may be delivered by paid drivers or by volunteers. In addition to providing nutrition to sustain the health of a client, a meal delivery by a Meals on Wheels driver or volunteer also serves as a safety check and a source of companionship for the client.

Most clients of Meals on Wheels programmes are elderly, but others who are unable to shop or cook for themselves (as well as their pets) are generally eligible for assistance. In the United States, programmes receiving federal funding may not serve people less than 60 years old. US Federally funded programmes may only request voluntary contributions from clients, while other programmes often charge a moderate fee for service. Regardless of their sources of funding, eligibility for most programmes is determined solely by medical need, with financial need and actual ability to pay not making a difference either way.

United Kingdom

In the county of Suffolk, the programme is referred to as "Community Meals".^[40] "Meals on Wheels" services are provided for those who have been assessed to have difficulty cooking for themselves. Community Meals services can comprise daily hot meals, chilled meals or a weekly or fortnightly delivery of frozen meals. Traditional hot deliveries are cooked in a central kitchen then transported to the service user.

Support to the elderly is also provided by WRVS (formerly named Women’s Royal Voluntary Service).

National Association of Care Catering Community Meals Week is a national event aiming to increase visibility of Community Meals Services.^[41] In October 2008, Camilla, The Duchess of Cornwall assisted in Meals on Wheels Week activities.^[42]

Increasingly in the UK, commercial rather than voluntary or local authorities organisations are providing the meals. For example, some Local Authorities have stopped providing hot meals and are instead delivering frozen pre-cooked meals.^[43] Other variations include using Apetito, who operate a "Chefmobil"^[44] service which regenerates meals en route,^[45] and Apetito subsidiary Wiltshire Farm Foods, which operates a Meals on Wheels alternative service for those who do not meet assessment criteria.^[46]

October 2011 saw a Hairy Bikers series, Meals on Wheels, air on BBC Two. The series fronted a campaign with BBC Learning to save local 'meals on wheels' services around the UK.^[47]

Canada

Halifax Meals on Wheels in Nova Scotia currently operate 68 programmes across the province; more than 600 volunteers serve an estimated 3400 meals a week. In Halifax, the service is partially funded by the municipality. The United Way also provides funding, depending on how much the programmes need. Organizations such as nursing homes and hospitals provide many of the meals; others come from restaurants and private homes. The programme isn't just for the elderly; people of any age who live alone often call when they're recovering after a recent hospital stay and are unable to cook for themselves. Other users of Meals on Wheels are people with disabilities such as multiple sclerosis who use the programme to help them through a rough time when cooking becomes too difficult. In 1996, 56.7% of clients in Halifax used the service for less than three months.^[31]

There are dozens of independent meals on wheels in Montreal, one of the largest and most innovative is the unique intergenerational Santropol Roulant, an organisation operated mainly by young volunteers in central Montreal neighbourhoods. Deliveries are done on foot, by bicycle and by hybrid car in some outlying routes.^[48]

Ireland

Longford

Currently (2016) vans are still used to deliver meals around Longford by County Longford Social Services, a registered charity - 4 vans deliver to all areas of County Longford, but the meals are now hot soup and chilled main course and dessert - recipients have microwave ovens for reheating the dinners. Meals are provided 7 days per week, 365 days per year. Unfortunately there is now a small charge (€4 per meal) due to reduction in grant aid, but there is still local support with fundraising and over 25 volunteer drivers and helpers. There are 4 employees (2 full-time and 2 part-time) with more people on various employment schemes, and the Social Services Council also provides a subsidised chiropody service and a patient transport service to help people maintain their mobility and independence. This is supported by a pre-owned fashion shop in Longford, "Change of A Dress", mainly run by volunteers.

Other areas

A study by Trinity College Dublin^[49] published in 2008 on behalf of the National Council on Ageing and Older People found most of Ireland served by Meals on Wheels services (or centre-based alternatives) since the 1980s, over half being registered charities. Half of the services are noted to be parish-only, with many more serving a slightly larger area: the report notes only 5% of providers serve "a significant proportion of their county" (but they do not mention the longest-running service in Longford, which serves the whole county).

United States

The Meals on Wheels Association of America (MOWAA) is headquartered in Alexandria, Virginia. MOWAA is the oldest and largest organization in the United States representing those who provide meal services to seniors in need, specifically those at risk of or experiencing hunger. MOWAA is a non-profit organization working toward the social, physical, nutritional and economic betterment of vulnerable Americans by providing the tools and information its programmes need to make a difference in the lives of others.^[39] In 2016, Meals on Wheels provided approximately 218 million meals to 2.5 million Americans.^[50][51] Approximately 500,000 of the recipients are veterans.^[50] The annual meal cost is $2,765.^[52]

Citymeals-on-Wheels serves the New York City area.^[53] In 2008, Citymeals delivered over 2.1 million meals to 17,713 frail aged in every borough of New York City. In addition, over 1,500 volunteers collectively spent 62,000 hours visiting and delivering meals to New York’s frail aged. Gael Greene and James Beard founded Citymeals-on-Wheels in 1981 after reading a newspaper article about homebound elderly New Yorkers with nothing to eat on weekends and holidays. They rallied their friends in the restaurant community, raising private funds as a supplement to the government-funded weekday meal delivery programme. Twenty five years ago their first efforts brought a Christmas meal to 6,000 frail aged.

In 2007, the MOWAA Foundation commissioned a study on hunger (see next section). In 2009, MOWAA partnered with The Mission Continues,^[54] an organization which addresses the needs of veterans who have served the United States.

Specialty Meals on Wheels programmes, such as "Kosher Meals on Wheels", also exist to service niche clientele.

MOWAAF study on hunger

The Meals On Wheels Association of America Foundation (MOWAAF),^[55] recognizing that hunger is a serious threat facing millions of seniors in the United States, determined that understanding of the problem is a critical first step to developing remedies.^[56] In 2007, MOWAAF, underwritten by the Harrah's Foundation, commissioned a research study entitled The Causes, Consequences and Future of Senior Hunger in America.^[57] The report was released at a hearing of the U.S. Senate Special Committee on Aging in March 2008 in Washington, D.C.

The study found that in the United States, over 5 million seniors, (11.4% of all seniors), experience some form of food insecurity, i.e. were marginally food insecure. Of these, about 2.5 million are at-risk of hunger, and about 750,000 suffer from hunger due to financial constraints. Some groups of seniors are more likely to be at-risk of hunger. Relative to their representation in the overall senior population, those with limited incomes, under age 70, African-Americans, Hispanics, never-married individuals, renters, and persons living in the southern United States are all more likely to be at-risk of hunger. While certain groups of seniors are at greater-risk of hunger, hunger cuts across the income spectrum. For example, over 50% of all seniors who are at-risk of hunger have incomes above the poverty threshold. Likewise, it is present in all demographic groups. For example, over two-thirds of seniors at-risk of hunger are caucasian. There are marked differences in the risk of hunger across family structure, especially for those seniors living alone, or those living with a grandchild. Those living alone are twice as likely to experience hunger compared to married seniors. One in five senior households with a grandchild, but no adult child, present is at risk of hunger, compared to about one in twenty households without a grandchild present. Seniors living in non-metropolitan areas are as likely to experience food insecurity as those living in metropolitan areas, suggesting that food insecurity cuts across the urban-rural continuum.^[58]

2017 proposed budget cuts

In March 2017, President Donald Trump's proposed budget would make cuts to block grants that go towards spending on Meals on Wheels.^[51] Defending these cuts, director of the Office of Management and Budget Mick Mulvaney said that "Meals on Wheels sounds great" but that the program is one of many that is “just not showing any results.”^[2][51]

Impact

A 2013 review study on the impact of home-delivered meal programs found that "all but two studies found home-delivered meal programs to 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."^[1][2] The study concluded, "Home-delivered meal programs improve diet quality and increase nutrient intakes among participants. 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."^[1][2]

See also

Wikimedia Commons has media related to Meals on Wheels.

• Food preferences in older adults and seniors
• Meals on Wheels Association of America

References