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Mar 27, 2017

Today, Meals on Wheels America President and CEO Ellie Hollander sent the following letter to Mick Mulvaney, Director of the Office of Management and Budget regarding the nationwide Meals on Wheels network, the public-private partnership it embodies and the positive impact it is having on millions of seniors. It is our hope that this letter will serve as the basis for a discussion with Director Mulvaney and/or his staff about the effectiveness of Meals on Wheels and how programs across the country are supporting the dignity and independence of our most vulnerable seniors, while at the same time helping to reduce federal healthcare spending by keeping them out of hospitals or nursing homes.

The Honorable Mick Mulvaney
Director, Office of Management and Budget
725 17th Street, NW
Washington, DC 20503 

Re:  Meals on Wheels: Saving Lives and Taxpayer Dollars

Dear Director Mulvaney: 

Since the Budget Blueprint was released, Meals on Wheels America and local senior nutrition programs across the country have witnessed an incredible public outcry to proposed budget cuts for meal services. This has been driven in large part because Meals on Wheels is, in fact, a cost-effective public-private partnership comprised of federal, state and local governments, businesses, and neighbors helping neighbors that delivers on the promises made to America’s seniors and their families every day. I am writing today to share with you how Meals on Wheels programs are dramatically improving health outcomes, reducing healthcare expenditures and saving taxpayer dollars.  

First, let me start by saying that Meals on Wheels America has proactively sought to clarify erroneous facts about Meals on Wheels programs and their sources of funding in all of our public communications since the “skinny budget” was publically shared. We have also been cautious and careful in stating that we do not yet know whether there will be cuts proposed for the nutrition programs authorized under the Older Americans Act (OAA), administered by the U.S. Department of Health and Human Services (HHS). However, because OAA funding represents on average about 35% of a Meals on Wheels program’s budget, we remain deeply concerned about the potential for further reductions in order to achieve the 17.9% proposed cuts to HHS’ budget. This threat, on top of the elimination of both the Community Development and Community Services Block Grants, as well as senior volunteer and employment programs, will substantially undermine Meals on Wheels programs’ ability to effectively serve those seniors who are highly vulnerable and at-risk. 

We also believe this debate, and the misinformation surrounding it, presents an opportunity for us to foster a better understanding of the evidence and data that supports the effectiveness and financial return that Meals on Wheels delivers. In fact, we have confidence that a greater investment in Meals on Wheels will actually bring about savings on the mandatory side of the federal government. Ensuring that our seniors today and in the future receive the proper nutrition needed to maintain health and improve quality of life is not only an investment in our nation’s fiscal future, but it is also a preventative prescription for significantly reducing Medicare and Medicaid expenditures. As a nation, we can either invest in senior nutrition now, or face the consequences of much more healthcare spending later. 

Meals on Wheels America, a 501(c)(3) nonprofit, is the voice of a network representing 5,000 local, community-based senior nutrition programs. For more than 45 years in communities large and small, urban and rural, these programs have worked tirelessly under the radar, stretching consistently inadequate funds far enough, and relying on an army of two million volunteers to support those older adults in the greatest social and economic need. All programs share the same mission:  to enable the seniors they serve to live out their lives healthier and more safely and independently in their own homes, where they want to be. As it turns out, Meals on Wheels clients are far more vulnerable than comparably-aged Americans. The majority live alone, have limited to no mobility, suffer from multiple chronic conditions, are reliant on numerous daily medications, and are in desperate need of nutritious meals and companionship.


The evidence clearly shows the positive impact Meals on Wheels has on improving health outcomes and reducing healthcare costs. Whether meeting a long-term nutritional need or just providing a short-term intervention of meals to help through a care transition, Meals on Wheels is part of the healthcare solution for an aging America. It works, and it saves money.

Five pilots we sponsored between Meals and Wheels programs and hospitals resulted in readmission rates over a 30 day period of 6-7%, as compared to the national average of 15%-33%. Even before readmission rate penalties were on the radar, we conducted a five year Transition Care program with a large insurance company spanning 36 states and eventually growing to over 135,000 Medicare Advantage beneficiaries. A pilot study indicated that the post-discharge savings for the first month were substantial with an average savings of approximately $1,000 per patient per month. That translated to about a 33% savings per patient served compared to those who did not participate.  

The economic case for Meals on Wheels continues. Brown University, as reported in the Health Services Research Journal, found that for every additional $25 a state spends on home-delivered meals per person, it can expect a 1% decrease in the low care nursing home population. That translates to millions of dollars in Medicaid savings annually. Another Brown University study published in 2015 found that high-risk seniors receiving Meals on Wheels showed greater improvements in both mental and physical health, fewer hospitalizations and were less likely to fall. Falls alone, according to the Centers for Disease Control and Prevention, cost our nation more than $31 billion in annual Medicare expenses.

Research consistently shows that seniors receiving Meals on Wheels are able to better remain living at home and out of far more costly healthcare settings—such as hospitals and nursing homes. Based on an annual survey conducted by the Administration for Community Living, 83% and 92% of seniors who receive Meals on Wheels say that it makes them healthier and enables them to remain at home, respectively. According to the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services, Medicaid pays for up to 62% of the beds for the approximately 1.4 million people currently in nursing homes. Long-term care costs for the estimated 50% of the people turning 65 today, whether in the home or in a nursing home, will be an average of about $90,000 for men and nearly $180,000 for women, because women live longer. Meals on Wheels programs saves millions of taxpayer dollars because they can care for a senior – providing meals to improve health, socialization to reduce isolation, and safety checks to eliminate risks – for an entire year for the cost of just one day in a hospital or 10 days in a nursing home.


With 10,000 Americans turning 65 every day and the size of the senior population projected to more than double to 98 million in 2060, the need to enable seniors to remain at home will become much more acute. About half (52%) of Americans turning 65 today will develop a disability serious enough to require long-term services and supports (LTSS). An investment in Meals on Wheels offers the high social and economic return on investment that the public should expect – should actually demand – from the government. Budget cuts to Meals on Wheels are economically counterproductive. In fact, greater federal investment in a program that works well would make sense.

We know and understand that the Administration and Members of Congress alike are tasked with making tough choices as it relates to the federal budget. However, programs like Meals on Wheels are working and demonstrating proven results. With a relatively small investment, Meals on Wheels programs contribute substantially by reducing other federal expenditures, which is the ultimate form of compassion to taxpayers. And, there is nothing wrong with simultaneously providing a lot more compassion for those seniors who gave so much to this country as our former soldiers, firefighters, police officers and teachers. 

As you know, Meals on Wheels has strong bipartisan support all across the political spectrum, from the left to the right and everywhere in-between. The OAA Nutrition Program, which originally became law under a Republican President, celebrates its 45th anniversary this month. The Act in its entirety was reauthorized in 2016 for three years without a dissenting vote, specifically by voice vote in the House and unanimous consent in the Senate.  

We invite you to learn more about how Meals on Wheels can help the federal government save money, reduce the debt and better serve its citizens and communities. I am enclosing several documents to provide further context and information about Meals on Wheels programs. Please consider us a resource to you and your staff. 

We also invite you to deliver meals with a local Meals on Wheels program so you can see the full impact we are having on frail and often forgotten seniors who see no one else all day except for their Meals on Wheels volunteer. We would be pleased to make arrangements for that to occur. 


Ellie Hollander

President and CEO
Meals on Wheels America

cc: John Czwartacki, OMB Director of Communications