Development and current status of home-delivered meals programs in the United States: are the right elderly served?

Federal home-delivered meals programs for the frail elderly began in the United States in the 1970s, and during the 1980s the provision of meals to the homebound elderly has been expanded through development of state-funded meals programs. The time has now come to pose two questions relative to coverage and program impacts. These questions are whether the program serves those who are currently most needy and whether the meals programs reduce the need for higher levels of care. Information available suggests that the elderly most served are those with socioeconomic problems that reduce their ability to obtain regular meals. Medical disability as a criterion for program eligibility or priority is less often used. The new finding that provision of home-delivered meals reduces hospitalization rates has to be re-examined, to ask the key question of whether the medically needy are actually kept out of the hospital by being provided with home-delivered meals.