The following report on how the elderly eat touches upon but a few of the many meal and nutrition programs available to the elderly. We have included the homeless, participants in the government-funded nutrition programs available to all seniors and those fortunate enough to live independent lives at Leisure World in Laguna Hills.
It is suggested that those who wish information about federally funded nutrition and other programs for the elderly should call 485-4402 or the county's referral and information number, 857-6466. Also available for those who wish the nutritional services of a dietitian is the L.A. Dietitians Information and Referral hot-line number, 934-4741.
The Union Rescue Mission of Los Angeles: We are in the anteroom of the immaculate mess hall, where about 200 homeless men, women and children wait silently for the lunch announcement, as if they were in church. A man in a blue serge suit is playing background music on an old grand piano.
The doors of the mess hall open, and there is a scurry, first by the women and children who are then allowed to partake in the lunchtime fare at the mission, then by the very old and finally by the younger homeless.
One of the diners is Joe Bailey, who is 62 but looks to be in his 70s. His job as secretary and bookkeeper vanished, and he has been out of work and money for years. He takes three meals a day at the mission. He is one of the regulars.
Roy Swarthout, 77, also eats at the mission. He had been hospitalized for the last two years and is without a job.
The relief center is a nonprofit organization with no governmental support since 1891. Most of the contributions are from individuals, churches and other organizations. The mission is also one of the endorsed agencies of the Los Angeles Department of Social Services.
The walk-in as well as live-in clientele represents only a speck of the homeless in the city. The mission serves only about 1,500 meals daily, of which only 12% are consumed by the elderly from the street. About 90% are men and 10% are women, whose population is increasing day by day, according to Lee Holthaus, executive director.
There are 300 sleeping beds available, and as many as 500 persons sleep on chairs. Only men are allowed in the mission shelter. Temporary quarters are available to women at two homes operated by the mission's outreach program. No one is turned away for food.
Even if the quality of the food at the mission is not always ideal, quantity seems to be no problem, according to Holthaus. "There is plenty of food down here. The problem is distribution and manpower to handle it. We don't have control on the issue."
Donations make up about 20% to 25%, and government subsidy, another 30% to 40%.
"The remainder of food purchased depends on price bids on items from markets. There is donated food from private individuals and some from meat companies who are cleaning out inventory. Sometimes farmers donate produce they can't get rid of, and restaurant food in excellent condition is accepted," Holthaus said.
"We are fairly low on dairy products because they are highest in cost. Cheese from the (U.S. Department of Agriculture) will end up in cheese sandwiches or distributed as is. Dry milk is not enjoyed by the diners," said Mark Holthaus, Lee's son and the mission's public information officer.
For breakfast, which ideally is based on the Basic Four Food Group diet, scrambled eggs with country bacon, home fries, hot oatmeal with prunes, toast, coffee and juice are served.
Lunch might include a shepherd's pie, tossed salad, bread, canned peaches and fruit drink beverage. No milk is served at lunch.
At supper the participant might find spaghetti and meat sauce, garlic toast, green salad and lemon pudding. Again, grape drink and tea are served.
On the day this writer visited, the elderly who slipped into the long oilcloth-covered tables were served sloppy Joes, bread, cake and coffee. Missing was milk or some other dairy product and fruit or vegetable.
Federal Nutrition Programs: By far the most widespread nutrition program available to the elderly throughout Los Angeles and the nation is what is commonly called Meals on Wheels, provided by the U.S. Administration of Aging under the Older American Act established in 1965 to all persons older than 60, regardless of nationality or race.
In large part a misnomer, Meals on Wheels actually refers to a small portion of the program that provides meals to homebound individuals in Los Angeles County. The major portion of the program, in both city and county, provides so-called congregate meals at various public and private sites, including churches, recreation and park facilities, restaurants, social and community clubs and the like.
While there is the normal share of problems with funding and administration, the programs for the most part are better than anything else the government has yet to offer its elderly citizens, as far as nutritional services go.
However, the number of participants represents only 4.5% of the 1 million elderly people in Los Angeles city jurisdiction and 3.8% in county jurisdiction. Many elderly who can make use of the services are not doing so, and the trend is nationwide.
"Why? It's impossible to serve all even if the entire elderly population demands it. At the moment more money is needed from the state level to augment existing programs," said Gordon Messer, Los Angeles County planner.
Richard Lieboff, former senior planner for the City of Los Angeles Department of Aging, reported that on the national level, the number of minority participants has declined during the last three years to 18% from 20%.
Several things are responsible for the drop of minority use of the services. "People are proud. They don't see themselves as poverty-stricken or impoverished. Many of them are simply not aware of the program. Some are ambulatory or are supported by other sources, such as family, church or community," Lieboff said.
In Los Angeles, minority attendance is not reflective of the national picture. In fact, the minorities served in Los Angeles city represent 35% of the participating population (25% in the county), which means that minorities are using the services well, according to Lieboff. "The reason probably is because the programs are funded to the minority agencies and they have served the groups very well," he said.
In greater Los Angeles, both Los Angeles County and Los Angeles City share the burden of allocating the state funds derived from the federal government to their so-called nutrition providers who, in turn, allocate funds to the individual sites.
In Los Angeles County there are 27 such providers and 95 nutrition/social services sites, whereas the city has assigned 14 major contractors to administer and disseminate the nutrition funds to about 98 sites. Allocations by the federal government for each meal range from $3.50 to $5.50. Some sites ask for voluntary donations of $1 to $1.25 from the participants to help cover some of the costs. According to law, no one is turned away because of inability to contribute. Transportation to and from the congregate sites also may be available.
Under the city program, a total of 2,230 congregate meals were reported served daily in February. The county reported a total of 7,333 daily congregate meals and 1,619 homebound meals in February. However, the increase to 2,177 of the county's homebound meals projected for 1985-86 reflects the additional funds appropriated through state Senate Bill 1996 to meet the overflow of homebound persons not serviced so far.
The program is also mandated to seek and identify low-income frail elderly who wish to remain independent and live within their communities. The task is not always easy for some groups, such as the Chinese, who often are too proud to make use of government assistance or who are unfamiliar with the goals of the program. "Every week we go out and talk to these people in our area and may have to talk to them several times before we gain their trust," said Patty Liu of the Chinatown nutrition program.
The daily nutrition program is designed to meet one-third of the Recommended Daily Allowance requirement, as well as to meet the varied tastes of the city's diverse ethnic communities.
Here is a report on some sites selected at random.
The Little Tokyo Nutrition Center (Koreisha Chushoku Kai), where about 200 elderly participants of this program have lunch daily, is filled with the clatter of voices at 11:30 a.m. By noon, the seniors are digging their chopsticks into oyako domburi , sunomono , rice and fruits and sipping low-fat milk or tea.
The menu changes daily on a six-week cycle with offerings enjoyed by the mainly Japanese elderly living the Little Tokyo area. There is chicken sukiyaki, ginger beef, stir-fried chicken, pork with eggplant and always rice. Sometimes--at least once a week--the menu includes other dishes such as spaghetti, meat loaf and fried chicken. But the menu is always accompanied by a vegetable, such as cabbage, spinach, broccoli or eggplant; a fruit such as apricots, plums, oranges or apples, and a dairy food such as low-fat or nonfat milk. Tea is always on the table.
The Chinatown program has been in existence for 10 years and is growing. The Hong Kong Low restaurant has been donated as the lunchroom facility for 225 participants by owner Bill Hong. The participants consist of new immigrants from Hong Kong and older immigrants from the Canton province in China. There are some Latinos, Caucasians, Vietnamese, Filipinos and Japanese among them.
Some participants travel from Monterey Park and Alhambra to meet friends in Chinatown for lunch. Some bring spouses and children, who are allowed to dine for the cost of the meal. A station wagon service takes meals to those who cannot travel to the site.
Hong's restaurant chefs carefully prepare foods that meet Chinese standards of appreciation and cooking methods. There is fresh rock cod steamed with ginger and soy sauce, spinach and pork, beef and zucchini. "There is no salt added to the dishes, and we use only vegetable oil and no MSG," said Patty Liu, the program's bilingual consultant for the Watts Labor Commission Action Committee, which manages the site.
The food is served family-style, starting with a hot soup, a choice of at least four entrees--including some meat, vegetable and rice--and fruit dessert with low-fat milk and tea.
Three nutrition sites in Burbank (McCambridge/Joslyn/Tuttle) service a basically Caucasian-Latino-Black population with hot meals.
Transportation facilities are available for those unable to travel to the site, and Meals on Wheels serves almost as many homebound elderly as those who actually come to the site.
There are about 95 to 105 congregate and 85 to 90 homebound meals served daily out of the McCambridge site.
The meals at these sites are strictly American, according to Terrance (Terry) Shiz, the nutrition director. There is tuna casserole, chicken (baked or broiled in compliance with health recommendations for reducing fat in the diet), baked Swiss steak and sometimes chops. There are two hot entrees, with baked or mashed potatoes, a small salad, milk and bread (rolls are baked occasionally) and butter.
Leisure World, Laguna Hills: Gertrude Shapero has just finished her 30-minute walk around Leisure World's precisely manicured, well-maintained grounds. She will have some shredded wheat or other whole grain with some decaffeinated coffee for breakfast. In winter she prepares oatmeal or another hot cereal. "Breakfast is my best meal of the day because I enjoy it," she said.
Shapero is one of 21,000 elderly people living independent lives at Leisure World, a community of older citizens. And she is one of the fortunate few in terms of good health.
Good health, often influenced by environment and life style as much as diet, is exemplary among this vulnerable age group at Leisure World, where economic-social status is above average.
Diane Edwards, who conducts a weight-control class at Saddleback Community Center at Leisure World, praises the group of elderly for their consciousness about health and diet. "They are conscious about all things. They read and they are curious about product labels." Those who attend her class have learned that simply reducing fats, salt and sugar in the diet and exercising (walking one hour a day) can make a great difference in the quality of life and in their weight.
"I lost 10 pounds just by watching those ingredients, and I feel much better," said Mary Lou Gragson, who lives with her husband, Virgil, in one of the comfortable condominium-apartments.
Their diet is simple, yet nutritious. For breakfast Gragson will have dry cereal, and her husband, oatmeal and orange juice. Lunch is a slice of whole-wheat bread with some low-fat cheese melted on top. Virgil enjoys cottage cheese, fruit and toast.
The couple have a dinner consisting of a large green salad, a vegetable and baked fish or chicken. Fat is trimmed, and butter is avoided. Snacks are dried fruit and prunes.
Exxie Jones discovered that she had high cholesterol and triglyceride levels. And she was overweight. Since taking the weight control class offered at Leisure World, she has lost 10 pounds and changed her methods of eating. "When I play bridge, the others eat cupcakes; I don't," she said.
She also includes exercise in her daily health program. She walks two miles each morning and rides a bike for 30 minutes. She has also joined a one-hour weekend aerobic class. "I feel much better now," she said. Her breakfast consists of bran cereal, orange juice and coffee. For lunch, a low-calorie cottage cheese, fruit and toast with coffee and non-fat milk are about it. For dinner, she will broil or bake chicken without skin or prepare a stir-fry dish of chicken with vegetables.
All have greatly increased their chances of minimizing the aging process through diet and exercise, according to nutritionists.
"Excess weight, constipation, brittle bones are among the maladies associated with the aging process that can be minimized with a balanced diet," said Sharon Higgins, a registered dietitian and nutrition consultant in Los Angeles who treats older patients.
Higgins recommends a daily diet of 1,200 to 1,500 calories for women and about 2,000 calories for men older than 60. "These diets should include daily selections from each of the four food groups--dairy products, meat, vegetables and fruits, breads and cereals," she said.
To remain within these calorie limits, however, seniors may want to choose foods that are lower in fat when eating foods in the milk and meat group. They may also want to limit their consumption of sweets, salty snacks and alcohol because of their high-calorie and low-nutrient properties.
To avoid constipation, Higgins suggests consuming complex carbohydrates, which are foods rich in fiber, such as whole-grain breads, cereals and fresh fruits and vegetables.
Fluids also help ward off constipation, Higgins said. She recommends six to eight (8-ounce) glasses of water or other liquid, such as milk and fruit juices, each day.
Because the elderly must consume adequate nutrients yet keep calories low, careful selection of foods is important.
Learning the calorie and nutrient content of foods is the first step toward conscious dining.
Here are some recipes which are used by both the nutrition program facilities and other programs.
1 pound lean ground beef, chicken or turkey
1 (24-ounce) can low sodium red kidney beans
1 (1-pound) can salt-free tomatoes, chopped
1 (8 1/4-ounce) can pineapple chunks in pineapple juice, drained
1 cup salt-free chicken broth
1 cup cooked brown rice
1 cup all-bran
2 cups cooked sliced carrots
2 tablespoons brown sugar
Saute onion in large pot or flameproof casserole until tender. Add beef. Saute until lightly browned. Add beans, tomatoes with liquid, pineapple chunks, cooked brown rice, all-bran, carrots and brown sugar. Stir gently to mix. Cover and bake at 350 degrees 40 minutes or until heated through and bubbly. Makes 8 to 10 servings.
ORIENTAL CHICKEN WINGS
1 3/4 pounds chicken wings
4 1/2 cups water
3 Japanese mushrooms (shiitake), quartered
1 cup diced bamboo shoots
20 green beans, halved
1 tablespoon ginger, thinly sliced
5 tablespoons sake
1 1/2 teaspoons sugar
4 tablespoon soy sauce
Cut chicken wings at joints in 3 sections. Place wings and water in pot and bring to boil. Reduce heat and simmer 30 minutes. Set aside.
Remove wing pieces from broth, reserving 4 cups broth. Saute wing pieces in lightly greased skillet until lightly browned. Add mushrooms, bamboo shoots, green beans and ginger. Combine sake, reserved broth, sugar and soy sauce. Pour over chicken wings and vegetables. Cook until chicken is tender, about 20 minutes. Makes 4 servings.
CHINESE SPINACH SOUP
6 cups water
1/4 pound thinly sliced lean beef
1 bunch spinach, cut into 1-inch slices
1 (1-pound) carton tofu, cut into 1/2-inch cubes
4 drops oil
1/2 teaspoon soy sauce
Dash black pepper
1 egg, beaten
Bring water in saucepan to boil over high heat and add beef. Cook 1 minute. Add spinach and cook 1/2 minute or until water starts to boil again. Add tofu, oil, soy sauce, salt and pepper. Cook 1 minute or until mixture returns to boil. Remove from heat and add egg, stirring constantly to curdle egg. Makes about 4 servings.
2 medium carrots
1 cup dashi
2 (9-ounce) blocks devil's tongue jelly (konnyaku)
12 green beans
1 teaspoon mirin or sweet cooking wine
1/2 teaspoon salt
1 (1-pound) block tofu
2 tablespoons sesame seed
2 tablespoons white miso
1 teaspoon sugar
Cut carrots into strips. Slice jelly in thin strips. Cut greens into 3 sections. Cook carrots and jelly in dashi 2 minutes. Add green beans, mirin and salt. Cook 2 minutes longer. Drain and cool. Cook tofu in boiling water to cover, 2 minutes. Drain and let cool. Grind sesame seeds and add tofu. Mix, then add miso and sugar. Mix well. Add vegetables and jelly to tofu mixture. Makes 6 servings.
Note: Devil's tongue jelly, known as konnyaku in Japanese is a nutritious jelly-like alimentary paste containing no calories, which becomes firm when cooked. The product can be purchased at Japanese grocery stores.
MACKEREL IN SOY BEAN SAUCE
2 (4-ounce) mackerel fillets
1 cup dashi
2 tablespoons sugar
1 tablespoon mirin (sweet cooking wine)
3 tablespoons sake (rice wine)
1/4 cup sliced ginger
1/4 cup white bean paste (shiro-miso)
Thaw fish in refrigerator overnight, if frozen. Cut into 1-serving pieces. Combine broth, sugar, mirin, sake and ginger in skillet. Bring to boil. Place fish pieces in broth mixture. Cook 4 to 5 minutes, covered, over medium heat. Dilute bean paste with some of boiling liquid. Pour over fish. Cook 15 minutes over low heat. Makes 4 servings.
CHINESE STEAMED FISH
1 (1-pound) whole rock cod
4 slices ginger
1/4 cup soy sauce
1 tablespoon sugar
1 tablespoon mirin (sweet cooking wine)
1 tablespoon oil
Dash black pepper
2 green onions, sliced
Using steamer, steam fish, bring water in bottom of steamer to boil. Transfer fish carefully into steamer rack. Place ginger slices on top of fish. Cover steamer and steam 15 minutes. If fish is thicker and larger, add 5 minutes for every 1/2-inch thickness.
Mix soy sauce, sugar, wine and oil and pour over cooked fish. Sprinkle with pepper and green onions. Makes 4 servings.
BEEF AND ITALIAN SQUASH
1 tablespoon oil
1/4 pound thinly sliced beef
2 zucchini, sliced
Dash black pepper
1/2 cup water
1 tablespoon soy sauce
1 teaspoon cornstarch
Heat oil in skillet over medium heat until oil is very hot. Add beef and stir fry 2 minutes, turing meat to brown evenly. Add zucchini, salt, pepper and half the water. Cover and cook 10 minutes. Mix soy sauce, cornstarch and water in small bowl until smooth. Pour over zucchini mixture. Stir well over medium heat until liquid is translucent. Makes 4 servings.
JAPANESE CHICKEN SAUTE
1/2 large chicken
2 tablespoons oil
2 medium carrots, cut in small pieces
4 medium red potatoes, diced
1/2 pound green beans, cut into 2-inch pieces
4 shiitake (dry Japanese mushrooms), reconstituted and sliced
1 (8 1/2-ounce) block devil's tongue jelly (block alimentary paste), drained and cubed
1 (9 3/4-ounce) can bamboo shoots, drained
1/2 cup water
1/2 cup sake
1/3 cup soy sauce
1/4 cup sugar
1/2 teaspoon salt or to taste
Remove chicken flesh from bone and cut into bite-size pieces. Heat oil in large skillet. Add chicken and saute until browned on all sides. Remove chicken from pan and add carrots, potatoes, green beans, mushrooms, jelly and bamboo shoots. Saute 5 minutes. Add water, cover and cook 15 minutes longer or until vegetables are tender. Add cooked chicken, sake, soy sauce, sugar and salt. Simmer until chicken is tender. Makes 4 servings.
Note: Devil's tongue jelly can be purchased at Japanese grocery stores.
CHICKEN AND RICE LEMON SOUP DINNER
1 whole chicken, any size
2 stalks celery
1 bay leaf
3 sprigs Italian parsley
1 sprig dill, optional
1/2 teaspoon black pepper
1/2 cup rice
2 egg yolks
Juice of 1 large lemon
Place chicken in water to cover in large pot. Add carrots, celery, turnip, parsnip, potatoes, bay leaf, parsley and dill. Bring to boil. Reduce heat, cover and simmer 40 minutes or until chicken and vegetables are done. Remove chicken.
Drain broth in clean saucepan, discarding bay leaf, parsley and dill, but reserving all other vegetables. When chicken and vegetables are cool enough to handle cut chicken legs, thighs and breasts and set aside for other meals. Remove meat from backbone and wings. Add to broth.
Slice reserved carrots, celery, turnip, parsley and potatoes. (No need to remove skin from vegetables.) Set aside.
Bring broth to boil. Add pepper and rice. Partially cover pot and simmer over medium heat until rice is tender. Add served vegetables. Heat through. Beat egg yolks with lemon juice. Stir small amount of soup into yolk mixture, then return to pan, stirring constantly to prevent curdling. Remove from heat at once. Makes 6 to 8 servings.
1/2 chicken breast, boned and skinned or 1 (4-ounce) fish fillet, cubed
1 tablespoon oil
1 onion, chopped
1 clove garlic, minced
1 (10-ounce) can tomato soup
1 can mushroom soup
1 zucchini, sliced
1/2 teaspoon crushed dried oregano
Heat oil. Add chicken or fish fillet and saute until browned. Remove chicken or fish.
Set aside. Heat oil in skillet. Add onion and garlic. Saute until onion is tender. Stir in chicken, tomato soup, mushroom soup, zucchini, oregano and pepper. Bring to boil. Reduce heat and simmer 10 to 15 minutes for chicken, or 5 to 7 minutes for fish. Makes 1 or 2 servings.
QUICK CHICKEN DIVAN
2 toasted slices whole wheat bread
Sliced, cooked chicken or turkey
Cooked broccoli spears
1 (3-ounce) package cream cheese
2 tablespoons milk
2 teaspoons lemon juice
Dash cayenne pepper
1/4 cup shredded Swiss cheese
Place toasted bread on plates. Arrange chicken and broccoli on top. Cover and keep warm. Melt cream cheese with small amount of milk in small saucepan over low heat, stirring constantly. Stir in remaining milk, lemon juice and cayenne pepper. Cook until smooth and thoroughly heated, stirring constantly. Pour evenly over broccoli, chicken and toast. Sprinkle with cheese and paprika. Makes 2 servings.