Además, ha estado luchando por conseguir comida.

A principios de año, terminó en el hospital luego de quemarse mientras calentaba agua para prepararse cereal. Su larga internación causó que al veterano de Memphis lo sacaran de la lista de la organización caritativa , que reparte comida a domicilio. Por eso, tuvo que depender de otros, de su hijo, de una generosa enfermera en sus horarios libres, y de una iglesia local, para que le llevaran comida.

“Muchas veces siento que me estoy muriendo de hambre”, dijo. “Tengo vecinos que también necesitan alimentos. Hay personas en la diálisis que necesitan comida. Hay hambre en todas partes”.

Millones de adultos mayores en todo el país pasan hambre en silencio, mientras la red de seguridad diseñada para ayudarlos se desmembra. En 2017, cerca del 8% de los estadounidenses de 60 años y más vivían en una situación de “inseguridad alimentaria”, según un reciente estudio del grupo , que lucha contra el hambre. Esto significa 5.5 millones de seniors que no tienen un acceso consistente a suficientes alimentos para una vida saludable, una cifra que se ha más que duplicado desde 2001, y que se espera siga aumentando a medida que crece la población mayor.

Mientras la crítica situación de niños que pasan hambre genera apoyo y puede abordarse en las escuelas, la difícil realidad de los adultos mayores hambrientos está marcada por el aislamiento, y el orgullo de una generación.

Uno de los principales programas federales para ayudar a los adultos mayores está muriéndose por dinero. El Older Americans Act, aprobado hace más de medio siglo como parte de las reformas sociales promovidas por el presidente Lyndon Johnson fue enmendado en 1972 con la meta de que todos los adultos de 60 años y más recibieran comida a domicilio o en grupo. Pero sus fondos quedaron muy relegados ante una población mayor en crecimiento, y por la inflación económica.

Las comidas a domicilio y grupales han disminuido en casi 21 millones desde 2005, según un análisis de datos federales de Kaiser Health News. Solo una fracción de los que viven con inseguridad alimentaria recibe servicios de comidas bajo el acta; un informe de la que analizó datos de 2013 halló que el 83% no recibe nada.

Con el acta a punto de expirar el 30 de septiembre, el Congreso está ahora mismo considerando su reautorización y cuánto gastar de ahora en adelante.

Mientras tanto, según el Departamento de Agricultura, solo 45% de los adultos de 60 años y más que son elegibles se han inscripto para recibir otro tipo de ayuda federal, como SNAP, el programa de cupones de alimentos para los estadounidenses más pobres. Muchos piensan que no califican, consideran que el servicio es mínimo, o ya no pueden ir a una tienda para usar los cupones.

Incluso menos seniors podrían tener este beneficio en el futuro. Más del 13% de los hogares que usan SNAP con miembros mayores podrían perderlo bajo una propuesta reciente de la administración Trump.

Por ahora, millones de adultos mayores, especialmente los de bajos ingresos, no tienen nada. Alrededor del país, las esperas para recibir las comidas de Meals on Wheels, una red de 5,000 programas basados en la comunidad y un proveedor crucial de comidas para adultos mayores, son frecuentes. Por ejemplo, en Memphis, la espera para recibir comidas de Meals on Wheels regularmente es de más de un año.

“Es realmente triste porque una comida no es algo costoso”, dijo Sally Jones Heinz, presidenta y CEO de la , que provee comidas a domicilio en el área de Memphis. “Así no es como deberían ser las cosas en 2019”.

Esto deja a millones de adultos mayores sin una provisión de comida consistente y nutritiva, y muchos terminan en hospitales porque la malnutrición exacerba enfermedades y previene la sanación. Esto eleva los costos de , impactando en los que pagan impuestos con . Un análisis reciente del encontró que Medicare podría ahorrar $1.57 por cada dólar gastado en comidas entregadas a domicilio en adultos mayores con enfermedades crónicas después de una hospitalización.

La mayoría de los hospitales no refieren a los adultos mayores a Meals on Wheels, y defensores dicen que muy pocas aseguradoras se involucran para asegurar que los seniors tengan suficiente comida para mantenerse saludables.

Edwin Walker, secretario asistente adjunto de la U.S. Administration on Aging, reconoce que las largas esperas son un problema de larga data, pero dijo que 2.4 millones de adultos mayores al año se benefician de las comidas a domicilio o grupales del Older Americans Act, permitiéndoles mantenerse independientes y saludables.

Aun así, algunos se escapan por las grietas. Robert Mukes, viudo de 71 años, murió de hambre en un frío día de diciembre de 2016, solo, en su apartamento de Cincinnati.

El forense calificó la causa principal de muerte como “inanición de etiología desconocida”; los registros de defunción muestran que el hombre de 5 pies 7 pulgadas pesaba solo 100.5 libras.

Un asesino lento

, investigador sobre pobreza de la Universidad de Kentucky, quien lideró el estudio de Feeding America, dijo que la inseguridad alimentaria comenzó a aumentar con la gran recesión de 2000, tuvo su pico en 2014, y no muestra señales de volver a los niveles previos a la recesión.

Mientras que adultos mayores de todos los niveles de ingresos pueden caer en el hambre, las tasas son más altas entre los adultos mayores pobres. Y más del 17% de los mayores de raza negra y el 16% de los hispanos (de todas las razas) viven con inseguridad alimentaria, comparado con menos de 7% de los adultos mayores de raza blanca.

Una serie de problemas se combinan para poner a esas personas mayores en una espiral descendente, dijo , nutricionista certificada, quien preside el Departamento de Nutrición y Dietética de la Universidad del Norte de Florida. Las visitas a los mercados se vuelven más difíciles si no pueden conducir. Los medicamentos caros dejan menos dinero para la comida. Los problemas crónicos de salud física y mental debilitan la resistencia y dificultan cocinar. Pulgada a pulgada, las personas mayores hambrientas se van deteriorando.

E, incluso si no mata directamente, el hambre puede complicar una enfermedad y matar despacio.

La desnutrición debilita la inmunidad, que tiende a debilitarse naturalmente a medida que las personas envejecen. Una vez que comienzan a perder peso, es más probable que se vuelvan más frágiles y mueran en un año, dijo el doctor John Morley, director de medicina geriátrica de la Universidad de Saint Louis.

En junio, la Cámara Baja aprobó un aumento de $93 millones para los programas de nutrición del Older American’s Act, aumentando el financiamiento total en aproximadamente un 10% a $1,000 millones en el próximo año fiscal. En dólares ajustados a la inflación, eso es menos que en 2009. Además, todavía tiene que votarse en el Senado controlado por los republicanos, donde el aumento propuesto enfrenta barreras.

La representante Suzanne Bonamici (demócrata de Oregon), quien preside el Subcomité de Derechos Civiles y Servicios Humanos, espera que el panel aborde la legislación para la reautorización de la ley pronto.

“Estoy segura que la Cámara aprobará pronto un proyecto de ley sólido”, dijo, “y espero que el Senado también se mueva rápidamente para que podamos satisfacer mejor las necesidades de nuestros mayores”.

Mientras tanto, la necesidad de comidas a domicilio sigue aumentando cada año, aseguró Lorena Fernández, quien dirige en Yakima, Washington.

Para Kim Daugherty, directora ejecutiva de la , una llamada que recibió ejemplifica lo devastador del problema. La mujer en la línea le dijo a Daugherty que había estado en la lista de espera para recibir comida por más de un año.

“Señora, hay varios cientos de personas delante de usted”, le explicó Daugherty.

“Solo necesito que todos lo recuerden”, fue la respuesta inquietante de la mujer: “tengo hambre y necesito comer”.

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And he has struggled to get enough to eat.

Earlier this year, he ended up in the hospital after burning himself while boiling water for oatmeal. The long stay caused the Memphis vet to fall off a charity’s rolls for home-delivered , so he had to rely on others, such as his son, a generous off-duty nurse and a local church to bring him food.

“Many times, I’ve felt like I was starving,” he said. “There’s neighbors that need food too. There’s people at dialysis that need food. There’s hunger everywhere.”

Indeed, millions of seniors across the country quietly go hungry as the safety net designed to catch them frays. Nearly 8% of Americans 60 and older were “food insecure” in 2017, according to a Feeding America. That’s 5.5 million seniors who don’t have consistent access to enough food for a healthy life, a number that has more than doubled since 2001 and is only expected to grow as America grays.

While the plight of hungry children elicits support and can be tackled in schools, the plight of hungry older Americans is shrouded by isolation and a generation’s pride. The problem is most acute in parts of the South and Southwest. Louisiana has the highest rate among states, with 12% of seniors facing food insecurity. Memphis fares worst among major metropolitan areas, with 17% of seniors like Milligan unsure of their next meal.

And government relief falls short. One of the main federal programs helping seniors is starved for money. The Older Americans Act — passed more than half a century ago as part of President Lyndon Johnson’s Great Society reforms — was amended in 1972 to provide for home-delivered and group meals, along with other services, for anyone 60 and older. But its funding has lagged far behind senior population growth, as well as economic inflation.

The biggest chunk of the act’s budget, nutrition services, dropped by 8% over the past 18 years when adjusted for inflation, an found in February. Home-delivered and group meals have decreased by nearly 21 million since 2005. Only a fraction of those facing food insecurity get any meal services under the act; a found 83% got none.

With the act set to expire Sept. 30, Congress is now considering its reauthorization and how much to spend going forward.

Meanwhile, according to the U.S. Department of Agriculture, only 45% of eligible adults 60 and older have signed up for another source of federal aid: SNAP, the food stamp program for America’s poorest. Those who don’t are typically either unaware they could qualify, believe their benefits would be tiny or can no longer get to a grocery store to use them.

Even fewer seniors may have SNAP in the future. More than 13% of SNAP households with elderly members would lose benefits under a recent Trump administration proposal.

For now, millions of seniors — especially low-income ones — go without. Across the nation, waits are common to receive home-delivered meals from a crucial provider, Meals on Wheels, a network of 5,000 community-based programs. In Memphis, for example, the wait to get on the Meals on Wheels schedule is more than a year long.

“It’s really sad because a meal is not an expensive thing,” said Sally Jones Heinz, president and CEO of the , which provides home-delivered meals in Memphis. ”This shouldn’t be the way things are in 2019.”

Since malnutrition exacerbates diseases and prevents healing, seniors without steady, nutritious food can wind up in hospitals, which drives up costs, . Sometimes seniors relapse quickly after discharge — or worse.

Widower Robert Mukes, 71, starved to death on a cold December day in 2016, alone in his Cincinnati apartment.

The Hamilton County Coroner listed the primary cause of death as “starvation of unknown etiology” and noted “possible hypothermia,” pointing out that his apartment had no electricity or running water. show the 5-foot-7-inch man weighed just 100.5 pounds.

A Clear Need

On a hot May morning in Memphis, seniors trickled into a food bank at the Riverside Missionary Baptist Church, 3 miles from the opulent tourist mecca of Graceland. They picked up boxes packed with canned goods, rice, vegetables and meat.

Marion Thomas, 63, placed her box in the trunk of a friend’s car. She lives with chronic back pain and high blood pressure and started coming to the pantry three years ago. She’s disabled, relies on Social Security and gets $42 a month from SNAP based on her income, household size and other factors. That’s much less than the average $125-a-month benefit for households with seniors, but more than the $16 minimum that one in five such households get. Still, Thomas said, “I can’t buy very much.”

A day later, the Mid-South Food Bank brought a “mobile pantry” to Latham Terrace, a senior housing complex, where a long line of people waited. Some inched forward in wheelchairs; others leaned on canes. One by one, they collected their allotments.

The need is just as real elsewhere. In Dallas, Texas, 69-year-old China Anderson squirrels away milk, cookies and other parts of her home-delivered lunches for dinner because she can no longer stand and cook due to scoliosis and eight deteriorating vertebral discs.

As seniors ration food, programs ration services.

Although more than a third of the Meals on Wheels money comes from the Older Americans Act, even with additional public and private dollars, funds are still so limited that some programs have no choice but to triage people using score sheets that assign points based on who needs food the most. Seniors coming from the hospital and those without family usually top waiting lists.

More than 1,000 were waiting on the Memphis area’s list recently. And in Dallas, $4.1 million in donations wiped out a 1,000-person waiting list in December, but within months it had crept back up to 100.

Nationally, “there are tens of thousands of seniors who are waiting,” said , chief membership and advocacy officer for Meals on Wheels America. “While they’re waiting, their health deteriorates and, in some cases, we know seniors have died.”

Edwin Walker, a deputy assistant secretary for the federal Administration on Aging, acknowledged waits are a long-standing problem, but said 2.4 million people a year benefit from the Older Americans Act’s group or home-delivered meals, allowing them to stay independent and healthy.

Seniors get human connection, as well as food, from these services. Aner Lee Murphy, a 102-year-old Meals on Wheels client in Memphis, counts on the visits with volunteers Libby and Bob Anderson almost as much as the food. She calls them “my children,” hugging them close and offering a prayer each time they leave.

But others miss out on such physical and psychological nourishment. A devastating phone call brought that home for Kim Daugherty, executive director of the , which connects seniors to service providers in the region. The woman on the line told Daugherty she’d been on the waiting list for more than a year.

“Ma’am, there are several hundred people ahead of you,” Daugherty reluctantly explained.

“I just need you all to remember,” came the caller’s haunting reply, “I’m hungry and I need food.”

A Slow Killer

, a poverty researcher at the University of Kentucky who worked on the Feeding America study, said food insecurity shot up with the Great Recession, starting in the late 2000s, and peaked in 2014. He said it shows no signs of dropping to pre-recession levels.

While older adults of all income levels can face difficulty accessing and preparing healthy food, rates are highest among seniors in poverty. They are also high among minorities. More than 17% of black seniors and 16% of Hispanic seniors are food insecure, compared with fewer than 7% of white seniors.

A host of issues combine to set those seniors on a downward spiral, said registered dietitian , who chairs the Department of Nutrition and Dietetics at the University of North Florida. Going to the grocery store gets a lot harder if they can’t drive. Expensive medications leave less money for food. Chronic physical and mental health problems sap stamina and make it tough to cook. Inch by inch, hungry seniors decline.

And, even if it rarely kills directly, hunger can complicate illness and kill slowly.

Malnutrition blunts immunity, which already tends to weaken as people age. Once they start losing weight, they’re more likely to grow frail and are more likely to die within a year, said Dr. John Morley, director of the division of geriatric medicine at Saint Louis University.

Seniors just out of the hospital are particularly vulnerable. Many wind up getting readmitted, pushing up taxpayers’ costs for Medicare and Medicaid. Afound that Medicare could save $1.57 for every dollar spent on home-delivered meals for chronically ill seniors after a hospitalization.

Most hospitals don’t refer senior outpatients to Meals on Wheels, and advocates say too few insurance companies get involved in making sure seniors have enough to eat to keep them healthy.

When Milligan, the Memphis veteran, burned himself with boiling water last winter and had to be hospitalized for 65 days, he fell off the Metropolitan Inter-Faith Association’s radar. The meals he’d been getting for about a decade stopped.

Heinz, Metropolitan’s CEO, said the association is usually able to start and stop meals for short hospital stays. But, Heinz said, the association didn’t hear from Milligan and kept trying to deliver meals for a time while he was in the hospital, then notified the Aging Commission of the Mid-South he wasn’t home. As is standard procedure, Metropolitan officials said, a staff member from the commission made three attempts to contact him and left a card at the blind man’s home.

But nothing happened when he got out of the hospital this spring. In mid-May, a nurse referred him for meal delivery. Still, he didn’t get meals because he faced a waitlist already more than 1,000 names long.

After questions from Kaiser Health News, Heinz looked into Milligan’s case and realized that, as a former client, Milligan could get back on the delivery schedule faster.

But even then the process still has hurdles: The aging commission would need to conduct a new home assessment for meals to resume. That has yet to happen because, amid the wait, Milligan’s health deteriorated.

A Murky Future

As the Older Americans Act awaits reauthorization this fall, many senior advocates worry about its funding.

In June, the U.S. House passed a $93 million increase to the Older Americans Act‘s nutrition programs, raising total funding by about 10% to $1 billion in the next fiscal year. In inflation-adjusted dollars, that’s still less than in 2009. And it still has to pass in the Republican-controlled Senate, where the proposed increase faces long odds.

U.S. Rep. Suzanne Bonamici, an Oregon Democrat who chairs the Civil Rights and Human Services Subcommittee, expects the panel to tackle legislation for reauthorization of the act soon after members return from the August recess. She’s now working with colleagues “to craft a strong, bipartisan update,” she said, that increases investments in nutrition programs as well as other services.

“I’m confident the House will soon pass a robust bill,” she said, “and I am hopeful that the Senate will also move quickly so we can better meet the needs of our seniors.”

In the meantime, “the need for home-delivered meals keeps increasing every year,” said Lorena Fernandez, who runs a in Yakima, Wash. Activists are pressing state and local governments to ensure seniors don’t starve, with mixed results. In Louisiana, for example, anti-hunger advocates stood on the state Capitol steps in May and unsuccessfully called on the state to invest $1 million to buy food from Louisiana farmers to distribute to hungry residents. Elsewhere, senior activists across the nation have participated each March in “March for Meals” events such as walks, fundraisers and rallies designed to focus attention on the problem.

Private fundraising hasn’t been easy everywhere, especially rural communities without much wealth. Philanthropy has instead tended to flow to hungry kids, who outnumber hungry seniors more than 2-to-1, according to Feeding America.

“Ten years ago, organizations had a goal of ending child hunger and a lot of innovation and resources went into what could be done,” said Jeremy Everett, executive director of Baylor University’s Texas Hunger Initiative. “The same thing has not happened in the senior adult population.” And that has left people struggling for enough food to eat.

As for Milligan, he didn’t get back on Meals on Wheels before suffering complications related to his dialysis in June. He ended up back in the hospital. Ironically, it was there that he finally had a steady, if temporary, source of food.

It’s impossible to know if his time without steady, nutritious food made a difference. What is almost certain is that feeding him at home would have been far cheaper.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).