Constance Packard lives in a modest, tidy home in Massillon, Ohio. At 94, she's tired of cooking. Most of her meals are grab and go: something she can get out of the freezer.
So for a little over a year now, she's received meals from Vantage Aging's Meals on Wheels program five days a week. The day's delivery — sloppy joes, cheesy potatoes, vegetables, juice, applesauce and milk — is sitting on the counter.
"I don't always eat right, and they do have balanced meals. Nutritious. Something I need that I don't usually do myself," Packard said.
Not eating right is very common among older adults. Malnutrition — which the World Health Organization defines as "deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients" — affects millions of people. According to the Ohio Department of Health's Malnutrition Prevention Commission, 1 out of 2 older adults is malnourished or at risk of becoming malnourished.
Meals on Wheels of Northeast Ohio provides about 1,000 meals a day in Stark, Wayne, Summit and Portage counties. Last year, they served 315,000 meals to 2,800 clients at their homes and at congregate sites: hot meals, cold sack sandwich lunches and frozen meals.
The meals cost 7.75 each and customers pay a variety of ways. 39% of clients have federal funding through the Older Americans Act, 36% have funding through the Medicaid waiver program, about 10% pay privately and the rest pay via a variety of other funding sources.
More than a meal
Nora Logsdon, a dietician and program development manager at Vantage Aging, says that her mom, who's 88, gets their meals.
"It's peace of mind. We know somebody is going to be there daily to check on her," she said.
It's a sentiment echoed by a number of meals recipients. It's not just about the food.
"These Meals on Wheels, it's more than just a meal. It's the people that deliver them," said Dayton Walters, 88. "Thank the good Lord they all talk to me. They didn't just run up to the door and say, 'Here's your meal.' And that means a lot because if you're a shut-in like this, you never get to see anybody, hardly."
Jennifer Kanney-Beebe, Director of Home and Community-Based Services at Vantage Aging, said they provide wellness checks in addition to dropping meals off.
"Have they had a change in condition? [Are they] speaking differently or acting differently? So if the client doesn't answer their door for their meal delivery, the volunteer will reach out to their emergency contact. Or we will ask the local police or the sheriff's department to do a local safety check," she said.
Jennie Strubel, the program's Kitchen Operations Manager, has seen this first-hand.
"You'll walk to those people's doors, you're the only footprints there all winter. That was your track yesterday, and that'll be your track today. And a lot of them, that's all they have," she said. "We find people down. We've had people wait for us to show up because they knew we'd show up to call for help, because they couldn't get up. People don't have people anymore. Not like they used to."
Enough food, but not enough nutrition
Pam Lehman, who's retired, also receives meals from the program. She has COPD and congestive heart failure. She's on oxygen 24/7.
And if she couldn't get her meals anymore, she said, "I would probably have to go to TV dinners. But they're so high in sodium."
Packard, Walters and Lehman aren't alone. Older Americans often struggle to eat nutritious meals. But it’s vital that they do — otherwise they’re at an increased risk of frailty, disability and even death.
"They may get enough food. However, they don’t have enough nutrition. So they may eat some junk food, some not expensive food purchased from the convenience stores," said Lei Xu, a postdoctoral scholar at Ohio State University.
Xu conducted a study of people in southeast Ohio who participated in the Supplemental Nutrition Assistance Program, or SNAP. About 1 in 4 were over 65. She found that SNAP participants were 26% more likely to be food secure, but they weren't using their benefits to buy fruits and vegetables.
"They don’t have enough nutrition to support their health," Xu said. "So for policy-makers, they may need to think about how to encourage households to eat more healthy foods, like the fruit and vegetable intake."
Day by day, meal by meal
Xu found that people who went grocery shopping more often were more likely to eat fruits and vegetables. For many older adults, though, getting to the store is a barrier.
That's where people like Eileen Schonfeld, 81, come in. She makes sure to check in on members of her synagogue in Akron, like her friend Dee, who she visits at least every other week. Dee, a mother of three in her 80s, lives alone. Sometimes she has trouble taking care of herself.
"Dee wasn't that good a cook to begin with, by her own admission. Didn't like it. And she has been pretty much lost," Schonfeld said.
On one visit, Dee admitted she hadn't used her stove in over six months. She lost a lot of weight, dropping to 105 pounds. And though she's tried four meal delivery services, she's quit every single one.
The state offers some programs to help older adults get the nutrition they need. There are programs through the Ohio Department of Aging (meals provided under the Older Americans Act, PASSPORT, Senior Farmer’s Market Nutrition Program), the Ohio Department of Education and Workforce (the Child and Adult Care Food Program), the Ohio Department of Job and Family Services (SNAP, the Commodity Supplemental Food Program, and the Emergency Food Assistance Program) and the Ohio Department of Health (Creating Healthy Communities, nursing home dietary regulations).
There are also a few new programs, such as the Ohio Department of Aging's EXCEL Academy, which provides continuing education and support to nursing homes. The first cohort launched in 2024.
"The second cohort of 10 nursing homes receiving EXCEL training are being instructed on nutrition as their central topic, with modules focusing on healthful food, oral hygiene, hydration, and how they relate to resident quality of care and quality of life," said Ken Gordon, the Ohio Department of Health's press secretary.
Despite the number of programs, many older Ohioans aren't getting enough to eat, making volunteers like Schonfeld crucial.
She says, with Dee, they take it day by day. Meal by meal. Schonfeld tries to make sure Dee and the other congregants get enough protein.
"This is just learn on the job for me, to get them to eat, and to have the best quality of life they can have," she said.
This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The Silver Century Foundation.