This is just a tiny sampling of the challenges faced by the 25 million seniors in the U.S. who struggle to make ends meet. They were collected for a 2020 report conducted by Social Policy Research Associates and Mathematica on behalf of the U.S. Department Agriculture’s (USDA) Food and Nutrition Service (FNS) to better understand how to improve access to SNAP benefits, also known as food stamps, among this extremely vulnerable population.

Not all seniors living below the poverty level officially qualify as “food insecure.” But many older Americans struggle to procure affordable, nutritious, and ample enough food. And those challenges are often invisible in a society that has outmoded ideas of grandparents surrounded by supportive family members or happily ensconced in assisted living facilities, all needs attended to.

Annelies Goger, an economic geographer now at the Brookings Institute who worked on the 2020 report while employed by Social Policy Research Associates, said that misconceptions about seniors persist “because Medicare and Social Security are seen as a pretty big safety net to protect older Americans against economic instability.” But for those without a cushion, she added, “it’s striking how insecure they are and how inadequate” the supplemental programs are that are meant to fill the gaps.

In 2018, 4.7 million men and women over the age of 60 received SNAP benefits, a number experts estimate represents only about one-third of eligible seniors. And some, like the game hunter mentioned above, receive benefits far below their need, an outcome that Eve Anthony, CEO of the Athens Community Council on Aging in Georgia, calls “incredibly insulting to seniors.”

The pandemic has dramatically increased demand for food assistance for seniors and other marginalized groups, even beyond SNAP. For example, Meals on Wheels, which normally provides food for 2.4 million in-need seniors, reports that 79 percent of its regional programs saw demand for meals increase—by 900 percent, in some cases. Requests for assistance in Anthony’s county in Georgia, which has a 26 percent poverty rate among its population of 126,000, almost doubled among seniors, from 215 to 385—although “I know there are more,” she said.

Identifying vulnerability among seniors, let alone figuring out ways to effectively and consistently feed them, remains elusive. For starters, “being able to tease out food insecurity among older adults, for whom there is not a lot of heterogeneity, is tied to measurements that were not developed for these,” but rather for younger populations, like college students, said Cindy Leung, assistant professor in the Department of Nutritional Sciences at the University of Michigan School of Public Health. “It shows there’s a lot of work that needs to be done.”

Still, a growing body of research by Leung and others seeks to home in on the challenges to better understand possible solutions.

A Complex Web of Challenges

They also have their own unique problems, explained Uche Akobundu, senior director of nutrition strategy and impact for Meals on Wheels America. “Seniors’ access to food is really a multidimensional challenge beyond financial constraints,” she said. “If they’re physically impaired, that makes it a challenge to acquire, prepare, and consume food. They have to be transported to the store, which is more difficult as you get older, and have complex health challenges and limited mobility and functionality. Can we reach, grab, or navigate around the grocery store? Can we move around our home? Are we dining alone, or compelled to feed the cat or [a grandchild] more than ourselves?”

Leung of the University of Michigan published a study in January that found food insecurity among older adults rose from 5.5 percent to 12.4 percent over a 10-year period—with a corresponding decrease in diet quality. To Akobundu’s already extensive list of challenges Leung adds the complexity of trying to find critically important nutritious ingredients on a limited budget.

“For older adults having to manage chronic conditions, it’s more challenging if you’re food insecure to access special foods that are consistent with what your doctor recommends,” she said. “Your caloric needs are also less than for a younger adult population, so that means you have to be mindful of fitting a high-quality diet into fewer calories.”

Her paper makes multiple links between diet quality, food insecurity, age-related physical and mental limitations, chronic disease, and poorer health. As Harvard Medical School assistant professor Seth Berkowitz put it in testimony to the U.S. Senate Special Committee on Aging in July 2017, “[H]ealth conditions are often caused or exacerbated by an inadequate diet . . . [and] while there is no evidence that food insecurity causes breast cancer, adequate nutrition is vital when undergoing cancer treatments, such as chemotherapy.”

All of this is exacerbated by secondary factors elucidated by the USDA report: some seniors’ permanent inability to work, their age-related cognitive decline, and major health crises that can sap their savings—especially if they are between 60 and 65 and lost health care benefits but don’t yet quality for Medicare.

Depression, especially after the loss of a spouse, is also common, and this has only worsened during the pandemic as access to social and religious groups eroded. Pre-pandemic, Meals on Wheels programs often supplied lunches to congregate sites where seniors could socialize over a plate of chicken and dumplings. Dining with company is a recognized contributor to mental well-being in older adults, but the organization had to switch to delivery models that kept seniors solitary in order to keep them safe.

“[While] all the seniors are grateful,” Akobundu said, “a [solitary] frozen meal is a different dining experience than a [shared] hot meal, and some don’t even have equipment to reheat it.”

Goger called senior depression and its attendant isolation concerning, both pre-pandemic and now. “When you’re depressed, you have less energy to cook or problem solve, which affects basic functions that put you at greater risk of malnutrition,” she said.

Also concerning is the stigma that keeps many seniors from asking for help. Some become newly poor once they’re on fixed incomes or run out of money after caring for a spouse with a chronic illness, Leung said. They may be unaccustomed to feeling “needy.”

Many seniors are also confused about how to file for SNAP, especially online. “The people most likely to receive SNAP are those that have family members that helped them. Few are getting through without any assistance at all, based on our data,” Goger said. And there is confusion over what groups of programs seniors are eligible for “across utility assistance, food assistance, housing assistance, because things like Medicaid affect your eligibility for other programs,” she noted. Low-income seniors may be eligible for both Medicare (intended for people over 65) and Medicaid (intended for people with very low incomes). “It’s hard for a Ph.D to figure out, let alone someone whose ability to navigate the system is extremely reduced.”

Add rurality to any one of these equations and the challenges compound.

Possible Solutions

This does not mean there’s no hope for figuring out how to meet the complicated and increasingly urgent food needs of seniors, now and into the future. For starters, some states, including California, were able to keep restaurants afloat by temporarily paying them to make meals for seniors. (That program is authorized to run through April 7.) Cities have a role to play too. In Athens, Anthony tapped a local caterer for food preparation help. And New York City mobilized a Food Czar to coordinate multiple senior-serving agencies, including those focused on providing calorically, nutritionally, and culturally relevant meals.

Akobundu said the pandemic had an optimistic, unifying effect. “[It] gave us a shared sense of vulnerability that we all felt equally that made it easier to communicate need to our funders and donors and stakeholders.”

The FNS study identified clear solutions to eliminate barriers to SNAP enrollment among seniors; whether or not FNS will permanently implement them is another matter. One is a trial program called Combined Application Projects, which make it easier for seniors to apply for Social Security and SNAP at the same time, a standard policy across all states. Another, recommended by seniors themselves, is to increase outreach at senior centers, food pantries, public housing complexes, and through door-to-door visits. Anthony said she’ll be using this latter strategy herself moving forward by partnering with hyperlocal grassroots organizations that can identify seniors in need, sign them up for Meals on Wheels, and make food deliveries to them.

For her part, Goger would like to see more attention paid to building up infrastructure around feeding seniors. “More could be done to coordinate fresh produce for food pantries, and to make sure it’s publicized that seniors can go to X place to get it,” she said. When someone is discharged from the hospital, “there could be a healthy frozen meal program paid for with Medicare funds as preventive care, that would include options for special diabetic or low-sodium diets.”

Leung, too, sees clinical response as an important component of addressing senior need; her study recommends screening for food insecurity in clinical settings such as hospitals and doctors’ offices, where referrals to congregate meal programs and SNAP enrollment assistance could also be offered.

“Doctors play such an important role in older adults’ ability to manage their health. They’re a trusted source of information, and we’re definitely shifting toward doctors writing prescriptions for fruits and vegetables and making connections to special services,” Leung said. “There are [also] barriers to affording healthy food; if you’re diagnosed with diabetes you have to pay for a glucometer and testing strips. Doctors need to know that patients are not choosing to eat poorly or disregard medical advice.”

A slew of new research should also help in assessing the groups at highest risk, drivers of food insecurity, and programs most likely to increase their access to healthy meals.

“Factors that promote resilience deserve more research,” Leung said. “And we need to understand how seniors are managing food insecurity. Otherwise, they’re just relying on piecemeal programs to scrape by day to day.”