Most days no one visits Carol Kotal.

A thin pink string hangs from the wall of her tidy apartment in Portland senior housing, ready for her to pull if she had an emergency. But based on past experience when her neighbors have sounded the alarm, Kotal figures no one would come.

So Kotal was glad to see Leonard Guralnick when he knocked on her door last Thursday, carrying a bright orange Meals on Wheels bag filled with her weekly delivery of frozen dinners and canned cat food for her shy gray tabby.

“He’s a friendly face,” Kotal said of Guralnick. “He’s always sweet.”

Kotal, 57, is one of 1,400 homebound older people in Greater Portland who receive Meals on Wheels through the Southern Maine Agency on Aging. A former data entry specialist, Kotal suffers from illnesses and past injuries that make it painful for her to walk or stand for any length of time. The Animal Refuge League of Greater Portland donated the cat food.

Regular check-ins by Meals on Wheels volunteers are a tandem benefit of the federally- and state-funded nutrition program that serves about 4,600 Mainers annually. But there’s a chronic waiting list of 400 to 1,500 people who qualify for the program but can’t get it because funding doesn’t go far enough.

Two bills before the Legislature would target the waiting list and make sure the program is available to seniors who need it, including those who would benefit from boosted nutrition after a hospital stay. The total annual cost for both would be just over $1.5 million.

“The isolation that some of our seniors face is one of the social determinants of health that Maine really must address,” said Sen. Linda Sanborn, D-Gorham, a retired physician. “Part of it is giving seniors a nutritious meal, but the personal contact is a very significant aspect.”

Leonard Guralnick delivers food to Michael Ray, 65, at his apartment in Portland on Thursday. Ray is one of Guralnick’s dozen or so regular clients. Staff photo by Derek Davis

HEALTHY FOOD & HUMAN CONNECTIONS

Social determinants of health are conditions of everyday living that affect a wide range of health outcomes, according to the U.S. Centers for Disease Control and Prevention. They include income and education level, access to healthy food, water and air, preventive health care, community and workplace safety, and the nature of social interactions and relationships.

Proponents of Meals on Wheels say it’s a practical and compassionate way to provide a basic form of health care that’s much cheaper than hospital stays and long-term care. And those costs are expected to increase exponentially as the number of older Mainers continues to grow.

“A majority of us want to be able to age at home rather than go into assisted living or a nursing home,” Sanborn said. “But if people can’t do their own shopping or make at least one nutritious meal a day, that becomes impossible.”

Maine’s population is now solidly the oldest in the nation, with the highest median age of 44.7 years – meaning the younger population is dwindling – and tied, with Florida and Montana, for the largest proportion of residents age 65 and older – 19 percent of the state’s 1.3 million people, according to the U.S. Census.

And Maine’s senior population is projected to grow 41 percent over the next decade, from 270,229 in 2017 to 381,870 in 2027, according to a 2018 report from the Muskie School of Public Service.

Meals on Wheels recipients must be 60 or older, primarily homebound and unable to prepare nutritious meals on a regular basis. Financial need isn’t a factor, though half of Mainers who receive federal food assistance are living in poverty. Fifty-two percent of recipients live alone.

Younger people may qualify for Meals on Wheels if they have physical or mental disabilities and receive Social Security benefits. An exact figure wasn’t immediately available, but senior advocates estimated that about 10 percent of Meals on Wheels recipients are under 60.

“They’re all good,” says Michael Giggey, a 55-year-old Portland client, in reference to the meals he gets delivered to his home. “They help me get my vegetables.” A Maine-based study showed that the Meals on Wheels program saves money and has clear health benefits for homebound seniors. Staff photo by Derek Davis

TARGETING THE WAITING LIST

L.D. 472, sponsored by Rep. Ann Matlack, D-St. George, would increase state spending for Meals on Wheels by $1.5 million in fiscal 2020 and 2021. During the latest contract year ending Sept. 30, the largely federally funded program cost $4.5 million, with $377,000 coming from the state’s General Fund.

Maine’s five area agencies on aging, which operate the delivery program by region, raised nearly $1.4 million for the program in fiscal 2018, including $381,000 donated by meal recipients who pay when they can, said Jess Maurer, executive director of the Maine Council on Aging.

Two years ago, Maurer testified before the Health and Human Services Committee for similar legislation that sought an additional $500,000 for Meals on Wheels. That bill made it out of committee but ultimately wasn’t funded.

Leonard Guralnick brings food to John Witham, right, at his apartment in Portland. Regular check-ins by Meals on Wheels volunteers are a side benefit of the nutrition program. Staff photo by Derek Davis

“At the time, the waitlist for this service was around 200, but was expected to grow to 300 by the end of 2017,” Maurer told the committee last month. “From October 2017 until September 2018, the waitlist for this program skyrocketed, with 1,500 people waiting for the service at some point during that period.”

Maurer said the cost to eliminate the current waiting list of 400 people would be $740,000 per year, and it would cost $3 million annually to prevent a waiting list of 1,500 people. However, a yearly increase of $1.5 million is enough to expand the program while state officials seek ways to forecast future demand and identify appropriate funding levels, she said.

“The annual per-person cost for this program is stunningly low – about $1,850 – and yields a correspondingly impressive return on investment,” Maurer told the committee. “This single intervention of home-delivered meals has been demonstrated to aid in wound healing, decrease loneliness, reduce avoidable hospital readmissions and delay entry into facility-based care for more than two years.”

In Maine, a one-day hospital stay averages $2,262 and 10 days in a nursing home costs about $3,100, according to the Southern Maine Agency on Aging.

BUILDING ON PAST SUCCESS

A Maine-based study recently showed that meal-delivery programs save money and have clear health benefits for homebound seniors.

From 2013 to 2014, Maine Medical Center and the Southern Maine Agency on Aging collaborated on a two-year meal-delivery program that was featured in the American Journal of Managed Care last June.

The grant-funded program provided daily meals to 622 Medicare patients for one month following hospital discharge. The hospital readmission rate dropped from 12.3 percent to 10.3 percent and saved $3.87 in medical costs for every dollar spent on meals.

To build on that study, L.D. 474 would establish a two-year pilot project to provide homebound seniors with two weeks of medically tailored home-delivered meals following a hospital stay. Sponsored by Sanborn, the bill would cost $20,365 in fiscal 2020 and $27,153 in fiscal 2021. Seniors would be provided balanced meals that were low in salt, sugar or fat, as prescribed by a physician.

“That first two-week period is when seniors are most likely to be readmitted,” Sanborn said. “We know these programs pay for themselves many times over.”

Last week both bills were voted out of committee with unanimous recommendations to be approved in the Democratic-led House and Senate.

Gov. Janet Mills, also a Democrat, has instructed the state Department of Health and Human Services to work closely with lawmakers on the bills and to explore all options to address the issue of hunger in Maine and the unmet needs of aging Mainers, Mills spokeswoman Lindsay Crete said.

“Gov. Mills is committed to working with the Legislature to reduce the waiting list for critical programs like Meals on Wheels,” Crete said.

Leonard Guralnick, 68, volunteers for the Meals on Wheels program that operates out of the Westbrook Community Center. He says he imagined one day delivering Meals on Wheels when he was a younger man running a busy industrial sales company. Staff photo by Derek Davis

VOLUNTEERS MAKE IT HAPPEN

A major cost-saving element of the Meals on Wheels program is the more than 1,000 Mainers who volunteered to deliver more than 589,000 meals in fiscal 2018. They donated more than 63,000 hours, which proponents valued conservatively at $640,000.

Just try to keep up with Leonard Guralnick. A retired business owner, Guralnick said he imagined one day delivering Meals on Wheels when he was a younger man running a busy industrial sales company.

“It was something I sort of aspired to,” said Guralnick, 68, who lives in Portland. “Now that I’m retired, I need to keep busy. I enjoy driving and I like schmoozing with people. And I think the clients appreciate it.”

Guralnick delivers meals to more than a dozen people each Thursday, driving through the snowy streets of Portland and jogging upstairs from one apartment to the next. He goes over the groceries with each client.

Nancy McKeil gets a quart of milk with her meals. John Witham opens the door with a hearty hello and grins as Guralnick puts his dinners in the freezer. Michael Giggey checks out the meals stacked on his kitchen table. Grilled chicken and vegetables is a new option among old favorites like lasagna.

“They’re all good,” said Giggey, 55, who started getting meals six months ago at his social worker’s suggestion. “They help me get my vegetables.”

Kelley Bouchard can be contacted at 791-6328 or at:

kbouchard@pressherald.com

Twitter: KelleyBouchard