Podcast: How Meals on Wheels America Serves Up a Lifeline for Seniors (Chronicle of Philanthropy)

By Denver Frederick

Meals on Wheels America does more than serve nutritious meals. It also checks up on people who are otherwise isolated and saves many of them from being hospitalized or institutionalized. Here, volunteer Nancy Brennerman chats with Josephine Hayward while delivering a meal in Portland, Me.

Meals on Wheels America, established in 1954, serves nearly a million meals a day and has grown to 5,000 programs in the United States. But as the country’s senior population grows in both numbers and needs, the nonprofit known widely for its daily food deliveries to housebound people has evolved to offer “more than a meal,” to echo one of its research and awareness campaigns puts it.

In this episode of the Business of Giving, CEO Ellie Hollander talks about how the charity has developed into a lifeline and alert system, providing not just nutritious meals but companionship and safety checks for seniors who might otherwise spend days in isolation. That work spares many clients the need for hospitalization or institutionalization, reducing the country’s health-care tab by millions of dollars a year.

With America’s elderly population expected to double by 2050, small investments can further reduce those costs exponentially, Ms. Hollander says. She details Meals on Wheels’ research collaborations with AARP and Brown University to demonstrate both the social and economic effectiveness of its work, and its exploration of innovative funding models like a “pay for success” project with Johns Hopkins. 

Listen to the full interview below, and/or scroll down to read a transcript provided by the Business of Giving.


Denver: Most Americans are familiar with Meals on Wheels and hold it in very high regard, but not nearly as many understand all that they do and the vital role that they play in communities across America. We have with us this evening just the person to help us better appreciate how critically important they are to the health and well-being of so many. She is Ellie Hollander, the President and CEO of Meals on Wheels America. Good evening, Ellie, and welcome to The Business of Giving!

Ellie: Thank you so much, Denver! It’s a pleasure to be here.

Denver: Why don’t you start by giving us a bit of the history of Meals on Wheels and the mission of the organization?

Ellie: Meals on Wheels actually has existed for decades. The stories tell us that it started actually in Great Britain when nurses were putting meals to be delivered to people of service in baby carriages and were wheeling them across lines. So the concept existed a long time ago. But in the United States, our first history was about 1954 when a small group of Philadelphia citizens began to support their local senior neighbors… to extend their independence and health as they aged by providing meals.  

Denver: And what’s the mission of the organization?

Ellie: Well, today, we envision an America in which all seniors live more nourished lives with independence and dignity. At the end of the day, Denver, we all would probably love to have the choice of living out our lives in our own homes for as long as we choose. Meals on Wheels enables that to happen.

Denver: Well, in looking at seniors who are hungry and who are homebound…that’s a pretty big issue. How big is it? And how difficult is it for them to navigate this system of ours?

Ellie: Well, today, about one in six seniors struggles with hunger, which is a pretty daunting number, and we know that the senior population is slated to double by 2050. So, what we try to do is have community-based Meals on Wheels programs to be able to provide nutritious meals… and more than just a meal. We actually enter the home and have that important sense of companionship and socialization and a safety check while we’re in the home. And there are 5,000 Meals on Wheels programs across the country that are doing this on a daily basis.

Denver: Give us an idea of how that operation works, Ellie. What’s a typical meal? What’s the average cost? The number of meals you deliver every day?  And how they get delivered?

Ellie: We are a diverse grassroots organization, so there really is a variety of ways that meals are prepared and delivered. If you look in the aggregate, we deliver about one million meals a day. Yes, it’s very impressive, but it’s not enough;  we’ll talk about that in a minute – the need is greater than what we’re able to provide. But these meals are delivered in urban, suburban, and rural areas across the country. In many cases, it’s a hot, recently prepared meal that meets one-third of the daily nutrition requirements that we need as we get older.  And for many, it represents one-half of their entire food intake in a given day. So sometimes these meals are warmed and prepared, and sometimes they’re cold or frozen so that the seniors can decide themselves when they want to have the meal.

Denver: Well, we know the importance of a nutritious, high-impact meal that you serve every day, and I think the understanding of most people ends just about there. But as you touched upon before, you do so much more. Perhaps that case is best crystalized in your “More than a Meal” campaign. Speak a little bit more about what you do in addition to just providing a good, healthy meal.

Ellie: We consider the meal as the “entrée” into the home, if you will—no pun intended. We talked about one in six seniors struggles with hunger today, but one in four seniors live alone in isolation, and that number is also going to grow. So having that individual – whether it’s a Meals on Wheels staff, person, or a volunteer – knocking at the door, entering, having permission to cross the threshold into the home is very important to a number of seniors who may only see that  one individual in a given day. So it’s really about that socialization and knowing that there’s someone that cares about you… that’s coming in to check on you.

Often, our Meals on Wheels programs can do additional things while they’re in the home. So they can do a safety check. They may come back with the ability to do some home repairs; could be minor, could be major home repairs. We also can talk a little bit about the fact that many of our clients have pets. So there’s an additional added benefit to Meals on Wheels– coming in to not only provide this nutritious meal and companionship and that safety check.  But we also can do other things for that client while we’re there.

Denver: Oh, that’s very sweet. And you’ve really become the eyes and ears of the health care system in so many different ways. You’re a big believer in evidence-based results and are always building the business case. And to that end, you’ve worked with the AARP Foundation and Brown University. Give us an idea of the evidence and of some of the cost savings that result from this program.

Ellie: We actually believe that we are part of the health care solution, and that this is not new. We have this existing infrastructure that I mentioned – 5,000 programs– in virtually many, if not all, communities across America. And what we’re able to do is: by just providing a simple meal,  companionship, a safety check, we’re able to help seniors stay out of much more expensive health care settings. Many seniors can avoid unnecessary visits to the emergency room, hospitalizations. They can more rapidly recover from surgery or illness when they are discharged from the hospital. And also, we can avoid premature placement in a nursing home—all of which, as you know, Denver, are very expensive—and help reduce taxpayer dollars, Medicare and Medicaid expenses. So we view ourselves as a critical partner to health care to help improve health outcomes, quality of life, and reduce health care costs.

Denver: That’s just great. I think I’ve heard you say that $7 a day — the cost of a meal– is a lot cheaper than $1,300 a day, which would be the cost of hospitalization. I noticed that Brown University, in their study, they said if each state increases the number of older people receiving these meals by just 1%, we would save $100 million. That’s fantastic!

Ellie: It is amazing! That study was a great study that Brown University did. And I think it was for every $25 more invested in Meals on Wheels per senior, the long-term care nursing home population, as you pointed out, could be reduced by 1%, which is annually millions of dollars. In fact, two quick factoids that I always like to share—The first is: we can feed the senior Meals on Wheels for an entire year for the equivalent cost of the senior being in a hospital on average for one day… or a nursing home for 10 days. That’s very, very compelling. And the other is that seniors are at greater fall risk, particularly when they are malnourished or dehydrated. And so we know that falls cost this country $31 billion a year, and we know from our study with the AARP Foundation and Brown University that those receiving Meals on Wheels on daily delivery report fewer falls and less fear of falling.

Denver: Well, let’s take this evidence-based, data-driven approach that you have pioneered, Ellie, one step further. What you’ve done, you’ve piloted this “Pay for Success” project. I know you’ve done one in Central Maryland.  First, tell us what a Pay for Success project is, and how this approach is working for Meals on Wheels.

Ellie: One of the challenges with funding for Meals on Wheels is that there are just not enough resources available. We can talk a little bit later about where the funding comes from. But the idea of a social impact bond…or the flipside of that coin is: they’re often known as “pay for success” instrument, is that there is an outside investor, a social investor, who wants to do good and get a return on doing good.

And we have an intervention that we know works, which is Meals on Wheels. We’ve talked about it. It saves money, reduces health care expenditures, and improves health outcomes. So, a social investor invests in this intervention. Who benefits from that? Well, there are two beneficiaries. One is obviously the seniors that we serve. But where the cost savings comes from, in this case, for example, is a health plan or a hospital system because they’re seeing fewer hospitalizations, fewer readmissions to hospitals– which today causes a penalty for hospitals if it’s within 30 days for certain conditions. So the idea  of this social impact bond “Pay for Success” model is to look for an alternative financing mechanism to support an intervention that we know works. And then what we want to do is prove it with our work in Central Maryland, with Johns Hopkins Bayview Hospital, and then scale this across the country.

Denver: And how has that been working? Are you getting the results that you’ve been looking for?  And what are your plans in terms of trying to scale this up?

Ellie: Well, this is the first of its kind, as you mentioned, in a space where we’re working with health care and seniors. We have just initiated this project. We plan to begin it. It takes a long time to set it up to make sure that we’re understanding the needs of our health care partner, making sure that we define the interventions that we want to use, and finding an outside party who will independently evaluate whether or not we accomplish the outcomes. Accomplishing the agreed-upon outcomes is what determines who gets paid and when. So, we plan to roll this out this summer, but we’re doing all that upfront work now that’s required to make this successful.

Denver: I know the scaffolding and the infrastructure in the social impact bond space is just really being built as we’re speaking. Let’s pick up on your last point about your funding model. How much of it, Ellie, comes from private sources? How much of it is from government? What are you anticipating in a Trump administration?

Ellie: Let’s talk first about the sources of funding. About one-third of the seed money for Meals on Wheels programs comes from the Older Americans Act. So that represents about a third, and this is a great example of a public-private partnership, in that for every dollar that we get from the federal government, our programs are able to match in the aggregate with individual donations, families, corporations, foundations, state and local government. So it’s been a very successful model, but as I’ve said earlier, one in six today struggles with hunger, and we are today serving 23 million fewer meals than we were in 2005 because the funding– the seed that comes from the federal government– has not kept pace with need or inflation. So we’re having to try to fill that gap through other means; thus, our pursuit of this social impact bond.

The uncertainty today with the political environment… I think nobody really knows what direction we’re going… which was the driver years ago for us to begin to invest in evidence-based work. To say that not only is there a great social and moral need that Meals on Wheels fills, but there is an economic return on investment. And we’ve been making that case, as you alluded to earlier, to help make decisions easier.  If we invest more in this existing intervention, we will see at the back end significant savings going forward.

Denver: I know. It’s so frustrating. We’re so short term in the way we look at these problems about the money today and not really taking that long view in terms of what it’s going to cost our society over the long term.

You know, as you become the eyes and ears of the health care system, are there pots of federal money you might possibly be able to tap, like the Centers for Medicare & Medicaid Services?

Ellie: We’re hoping so. We were called out in a recommendation by a pretty prestigious National Commission on Hunger that had been set up a couple of years ago by the leadership in the Senate and House. And they had a series of recommendations, two of which were consistent with our hope.  We envision that doctors should be able to write prescriptions for seniors or people with disabilities who meet certain criteria that should be able to just get a meal that’s covered through Medicare and/or through Medicaid. And what we need to do now, which is a little challenging given the distraction on Capitol Hill– understandably with all the changes that are going on– we’d like to carry that football across into the end zone to make sure that that happens. And I think right now, it’s going to be challenging to get people’s attention until things settle out in Washington.

Denver: Fair enough. That seems to make some sense. Well, you have forged some great partnerships, Ellie, and I wanted to ask you about a couple of them. We recently had Aria Finger – she’s the CEO of DoSomething.org – on the program.  And what they do is they engage young people to make positive change, whether it’s online or offline. What have you done together with them?

Ellie: Well, we’re very proud of our relationship with DoSomething.org. This is a partnership that we say “pays in love.” Since 2014, nearly one million handmade Valentine’s Day cards have been crafted by the DoSomething.org’s network. They have about 5.5 million youth volunteers. And what we do is we engage them through our partnership with DoSomething.org to craft these wonderful, personalized Valentine’s Day cards.  And then we match them with Meals on Wheels programs. We have those Valentine’s Day cards delivered with their meals. And as I mentioned earlier, one in four seniors are living alone in isolation. It’s so neat and so uplifting for them to be able to get a personalized card that reminds them that someone’s thinking about them. So we really covet that relationship that we have with them, which started with Nancy Lublin when she was running DoSomething.org a few years ago.

Denver: What a great touch that is! One of your major, long-standing corporate partnerships has been with Subaru of America. What’s that partnership about?

Ellie: That’s been a long-standing partnership since 2008, and we are one of four national charities partners.  We’ve been there since day one when Subaru launched the “Share the Love” campaign. And at a particular time of year– around November through the very beginning of January– folks that either purchase or lease a Subaru have the opportunity to donate to a couple of different important causes, or to all of them. And this has been a very successful campaign, not only for Subaru that’s driven very successful sales numbers for them, but also shows their philanthropic bent.  And we’ve been able to deliver about 1.4 million meals as a result of the contributions that have come through that Share the Love campaign.

Denver: That’s great. I know a couple of years ago, it seems that the organization thought  that the brand had grown a little tired, and it was time to “freshen” it with a new look– which you did.  And that effort was further energized with a public service campaign with the Ad Council. Tell us about that and the results you’ve seen from it.

Ellie: We’re very excited about the work that we’re doing with the Ad Council.  But let’s back up to the rebrand. We realized that we wanted to better understand how the public perceives Meals on Wheels. So we did some public research… some pretty intensive research, and we found that 9 in 10 people know of Meals on Wheels.  9 in 10 people think favorably about Meals on Wheels. But when we asked the question: “What do you think of? What is it that we do?”, many people just felt like we were a meal delivery service. Didn’t realize that we were still around, thought we were sort of “your grandmother’s meals on wheels.” So we recognized that it was time to refresh and to contemporize not only our look, but to reframe our brand as  something that is more than just a meal.

And we found that when people understood that this was more than just a meal, it was about socialization and friendly visits, and really about ensuring the safety, well-being, and health of the seniors that we serve so that they could remain at home independently, people were so motivated. They said, “Wow! I didn’t know that’s what you did!” Well, then we realized we had to get the word out. So we began to investigate:  what would it take to have an Ad Council campaign?  And that took a fair amount of work and research. We were really honored to have been selected as one of three that the Ad Council selects every year through a pretty thorough vetting process. I think you’ve heard about that from Lisa Sherman.

Denver: Oh, yes I have.

Ellie: We went through that process, and we were really honored to have been selected to do that. And it takes a while to work, to gear up to a campaign, but we launched that campaign with a vengeance in July of 2016. It’s a multi-year campaign.  And as you know, it’s based on donated media across all channels to really raise awareness, help transform what people think about when they think about Meals on Wheels, but ultimately, to engage people in wanting to donate their lunch break. It’s called “America, Let’s do Lunch.”

Denver: I love it! I looked at the spots. They’re fantastic.

Ellie: I think what’s so great about them, and you may feel the same way, is these are real-life clients. These are Meals on Wheels clients.  And what you realize is the characters and the personalities of the people that you never know you’re going to run across that are on the other side of the door!  And the personal fulfillment and reward that comes from volunteering! When we did the research, we asked folks that had volunteered: “What is it that once you volunteer once with Meals on Wheels, you’re hooked for life? What is it?” And people said, “It’s like a drug. I never realized how personally rewarding this could be!” Because many of us volunteer, but we don’t really necessarily see the end result of the work that we’re doing. But when you knock on that door and say “Meals on Wheels!” and someone’s opening that door, and their eyes are bright because they are lonely and looking so forward to seeing you, it makes a huge difference!

Denver: Yes. You don’t get many volunteer opportunities like that that allow you to make that kind of connection. And it speak so highly of the organization that people trust you to let them cross the threshold into their home… and particularly older people. That really says a lot about the organization.

Ellie: It does!  And I think this is one of the differentiators that we offer to our health care system. We say, “Look. We’re trusted to enter the home, and we can help let you know if there’s an issue.” Oftentimes, our volunteers, they deliver on a Friday and come back on a Monday and find that someone has fallen over the weekend, and there was no one there to check on that person. So, we can really notify of a red flag or a change in a condition that might eliminate the need for an emergency.

Denver: For sure. Well, a big initiative that is coming up any day now is your “March for Meals” campaign. This year, I think, marks your 15th annual one. What goes on with that?

Ellie: The March for Meals we celebrate is a nationwide and a community-by-community celebration of the fact that it was in March where initially, the Older Americans Act senior nutrition programs were introduced. So it’s a month-long campaign. We kick it off on Capitol Hill on March 1, and it’s a way to really raise awareness and enlist community champions to step up. This could be folks like yourself, Denver—who are key influencers. It could be celebrities. It could be members of Congress, local dignitaries, anybody…local businesses, that really want to give back during the month of March. And we shine a light on it, as you indicated.  And we hope that people will be motivated to volunteer, to donate resources. We obviously want to do this year round, but March, of course, is the opportunity to really shine a light on that.

Denver: March for Meals. Let me ask you a question, too, about the organization itself. You were among the very first, Ellie, in the nonprofit sector to realize the importance of a healthy corporate culture – how it motivates and engages and makes the employees far more productive and wanting to stay with the organization. And I guess, probably, you got a little bit of that from your previous job, where you were the Chief People Officer over at AARP. Tell us about the corporate culture at Meals on Wheels and some of the things you’ve done to create such a great workplace.

Ellie: Never underestimate the power of culture. I’ve heard this said so many times– and I’ve lived it, so I know it’s true– is that you can have the absolute best strategy developed, but if you don’t nurture and care for the culture, it will eat strategy for lunch. And this is very true.

An engaged workforce starts with, really I think, a passion about the mission of the organization. We’re blessed with a wonderful mission– to create a platform for seniors to live out their lives as independently and healthfully as possible. So already, our employees are coming to work with that sort of mission focus. But if we don’t provide a work environment that enables them to perform at their personal best, then they’re never going to achieve their full potential.

So, we spend a lot of time on creating a very open and transparent culture. We have a number of staff activities. We do have folks that are not located in the office– that work in remote locations– so we want to be sure that we are including them in meetings and so forth. So, we do a lot in terms of promoting work-life balance. It’s very important with technology today that there’s now a blending and a blurring between work and life.  But we want to respect the fact that people need to disengage and to rejuvenate so that they’re energized to come back with a full force.

So we invest a lot in that, and I’m hoping that you’re going to actually come visit our office so that you can see that the actual space itself is conducive to that kind of open, transparent, and collaborative work environment.

Denver: Well, we look forward to sharing that with our audience. Let me close by asking you about the challenges you see in the years ahead for this country with this rapidly aging population—I think it’s 10,000 or so Americans who turn 65 every single day—and your vision for the increased role that Meals on Wheels actually needs to play to help the nation address this issue.

Ellie: With the senior population exploding, with all of us living longer but with more chronic conditions, we have an existing infrastructure called Meals on Wheels that exists in virtually every community in America. We need to invest in existing infrastructure that we know is there to serve the unique needs of our own communities. So, it’s a grassroots solution to a nationwide problem. It’s not going to happen on its own.

We’re continuing to reinvent our models to the extent we can, but nothing is going to replace that human-to-human personal touch that happens when you cross the threshold into the home. I’m hoping that we will recognize not only the social and moral benefits, but we’ll recognize the economic benefits by investing in this solution that exists and is successful today.

I have some concerns about getting lost in the fray, given that we’re in the midst of an appropriations process when we have an intervention that actually saves money.  But I’m hoping that with all of the members of Congress that deliver meals, and that many more that understand evidence-based work– which we’re heavily invested in– that we’ll be able to continue to make the economic case why this is an important intervention to be resourced properly and invested in.

Denver: Well, you certainly have a strong business case. Well, Ellie Hollander, the President and CEO of Meals on Wheels America, I want to thank you for being on the show this evening. Now, if people want to learn more about Meals on Wheels, make a contribution or become a volunteer, or maybe find out about that March For Meals in their local community, what do they need to do?

Ellie: If folks could just go to mealsonwheelsamerica.org, you can easily navigate to any of those topics to either find a meal for a loved one; you can type in a zip code to find a local Meals on Wheels program. There’s a whole section on March for Meals.

If you’re interested just in volunteering, you can go directly to americaletsdolunch.org, which is the website we specifically set up as part of our “America, Let’s do Lunch Ad Council campaign.”

Denver: Well, thanks so much, Ellie. It was a real pleasure to have you on the program.

Ellie: Denver, my pleasure. Thank you so much for the opportunity!