Americans are getting older. With advances in healthcare and technology, the number of Americans above the age of 65 is projected to double in the next forty years. In New York alone there are currently 1.6 million seniors. Nearly 75 percent of these residents are facing frailty and over 21 percent are living in poverty, according to a 2017 report by the Department of the Aging (DTFA). Furthermore, one in ten New York seniors face food insecurity and more than a quarter of the population is nutritionally at-risk. Given these circumstances, social policies need to account for the unique needs of older adults in terms of housing, healthcare, social services, transportation, community engagement and of course, food.
As part our ongoing Food Policy for Breakfast series, we invited five specialists from both the public and non-profit sectors to join us for a discussion on Nutrition and Aging in New York City. Our guests, listed below, taught us about the unique challenges of food accessibility for NYC’s aging adults as well as innovative policies, nutrition programs, and technologies that are designed to support this growing population.
If you missed the event, you can watch the recording here.
Moderator: Charles Platkin, PhD, MPH; Executive Director, Hunter College NYC Food Policy
The Citymeals on Wheels program is one of many in NYC that help seniors access nutritious food. Why then do many seniors face food insecurity?
The NYC Department of the Aging (DTFA) provides food to seniors both at neighborhood senior centers and through the home delivery of more than 19,000 meals each day. The agency also connects seniors to the SNAP food stamp program, through ongoing outreach and enrollment clinics. Still, Caryn Resnick, Acting Deputy Commissioner at DTFA said that stigma, cultural competency, language barriers and fears around immigration prevent eligible recipients from enrolling in SNAP.
“Fear is a particularly significant barrier to enrollment,” said Ruth Finkelstein, Executive Director of Brookdale Center for Healthy Aging at Hunter College, “especially in New York City where more than half of older adults are foreign born…and at a time when national anti-immigration sentiments have intensified fears about enrolling in governmental programs… during the Clinton administration…when these anti-immigration measures were introduced, an HRA study proved that SNAP applications and the acceptance of WIC checks were noticeably low in communities with high immigrant populations.”
To overcome the stigma of social service use that prevents many older adults from accessing senior programs, Jessica Balboni, Director of the Center at Lenox Hill Neighborhood House, has increased the use of bilingual social workers and mental health services at her program, where 3 meals are served 7 days a week. Additionally, as part of a legal advocacy program at Lenox Hill, she established introduced bi-weekly SNAP clinics to facilitate enrollment among older adults.
Still, while many adults enjoy the hot, fresh meals served at senior centers and through delivery programs, others might prefer to receive culturally-specific foods or fresh produce that they can cook at home. Shulamit Warren, Director of Policy and Special Projects for the office of Manhattan Borough President, Gale Brewer, highlighted Westside Campaign Against Hunger’s mobile pantry project which serves 11,500 Northern Manhattan families annually. This program avoids common physical and cultural barriers to pantry usage by bringing food to communities, providing language services, and empowering customer agency through a dignified, grocery-store like experience with an emphasis on local produce. The Westside Campaign Against Hunger also utilizes Plentiful, and app that allows food pantries to track customer traffic and customers to locate and schedule their pantry visits.
How do food programs conduct outreach to seniors, many of whom are homebound?
For older adults, enrollment is only one barrier to food programs. With the aging population, there is a hidden need,” said David Nocenti, JD, Executive Director at Union Settlement Association, “…as people age, they don’t expect to need assistance. Then they become more physically and mentally disabled and we don’t necessarily learn about them.”
In this way, seniors face generation-specific barriers, such as social isolation and limited mobility, in addition to the socioeconomic and cultural barriers that affect all New Yorkers.
Isolation is a particularly relevant issue in New York, where, according to the AgeFriendlyNYC initiative report, there are nearly 425,000 seniors who live alone. Even for older adults who have SNAP benefits, if they live in walk up apartments or in NYCHA housing where elevators may be broken for several weeks, regular grocery shopping trips may not be possible. “Food is the incentive that brings people out to our senior programs at Union Settlement,” Nocenti shared, “then if someone is absent from a meal for three days, the community notices, we follow up and then we are able to address the cause.”
In recent years, food security programs have given special attention to the nutritional quality of their offerings. What is being done to improve seniors’ access to fresh fruits, vegetables and age-appropriate nutrition?
Often times, programs neglect the complex experiences and identities that older adults carry beyond being senior. “Wiping out layers of humanity is the name of the game right now… which permeates our thinking” Finklestein reflected. “One of the ways this often happens is through the poor quality of food offerings through meal programs,” Resnick added, “we wonder why Alzheimers, now called Type 3 Diabetes, is the biggest explosion. For both the elderly and children.”
As part of a larger wellness initiative, the Lenox Hill Neighborhood House transitioned their food program to focus on plant-based meals with whole grains and local produce over the past few years. Although they received push back from members at first, eventually the community embraced the new menu, the staff enjoyed serving good food and everyone could see that it matters what you put in your body. “If you are four or eighty four,” said Balboni, “it affects your cognitive, emotional and social well being.” Balboni was also excited to share that “because having a plant-based diet of 90% fruits and vegetables is actually cheaper,” the organization, which serves nearly 400,000 meals a year, has lowered their costs.
Beyond whole foods, programs also need to consider restrictive diets and food preferences by finding ways to offer a variety of options to seniors. In order to meet this need, the DFTA developed Simple Servings as a guide for senior programs and food programs throughout the city. Simple Servings is an online database of more than 1,000 recipes that meet city and state nutrition standards and offer cultural variety to diners. As part of the AgeFriendNYC initiative, DFTA is enhancing the menu options to include medically-tailored meals for older adults with health conditions such as diabetes and hypertension.
The AgeFriendlyNYC report does not specifically mention food and nutrition as a priority. Where does this fit in to the current initiatives, and why is it not highlighted as a priority?
In explaining the AgeFriendlyNYC initiative, Resnick reminded us that solutions need to be comprehensive: “while nutrition and hunger are a priority, food is not an isolated issue in terms of aging,” she said. SNAP and meal programs are fantastic for people who enroll, and delivery programs are the theoretical answer to serving homebound seniors, “but,” added Finklestein, “there is currently no systematic way to identify isolated people.” Instead, she suggested a bottom-up approach that involves community accountability systems which, she said, “is what we counsel during times of disaster, but some people are living in times of disaster all the time.” DTFA is currently looking into a “see something say, something campaign” to encourage social responsibility for elderly neighbors, but has struggled to identify a reporting system that will be comfortable for New Yorkers.
For solutions to be sustainable, we need to look beyond the scope of New York City. “The way we are as older adults,” Finklestein notes, “is the product of our whole life experience: health threats, environmental threats, trauma and all the positive and negative life experiences across the life course.” Knowing this, we might consider the way our organizations invest in food systems and our policies that support small farms and influence the food that we ultimately feed to our children, our aging adults and our communities.
Another important consideration in food security planning is scale. While large organizations like Lenox Hill have the capacity to launch farm-to-table food programs, smaller programs may not be able to order produce at a large enough scale to qualify for wholesale pricing. Warren suggested that “a possible solution would be to build coalitions of programs that order together, like many smaller food pantries do throughout the city.” As the city’s senior population increases, collaboration will be necessary if smaller organizations are to be part of the solution.
For inspiration, we might look to Lenox Hill’s Teaching Kitchen program, which helps other food programs transition to plant-based, farm-to-table meals beginning with small, achievable goals such as house-made dressings and granola. To date, the Teaching Kitchen has helped over 64 nonprofit organizations that serve fresh fruits, vegetables and whole grains to 5.5 million people collectively.
How does New York compare to other cities when it comes to caring and nourishing aging adults?
All said, the task of preparing for an aging population seemed overwhelming until Finklestein reminded us that we have always accommodated the changing needs of older generations. The new phenomenon is that because life expectancy has increased by 40 years, “we now have multiple generations of ‘old’ living concurrently,” she said, “This new challenge is fun, if you think about it. It is not a problem, it is an opportunity.”
Ultimately, the panel on Nutrition and Aging reminded us that food is intimately tied to every part of our identity and community. To prepare for an aging population, NYC food security policies and programs will need to account for the range of social, cultural and health issues that older adults experience. Considering what we learned about initiatives throughout the city, we couldn’t help but notice- New York seems like a pretty incredible place to grow old.
You can listen to the full conversation here: Food Policy for Breakfast: Nutrition and Aging in NYC