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At Last, Aid for Senior Nutrition That Offers More Than Crumbs

Long before the coronavirus hit, nutrition programs that served the nation’s older adults struggled to keep up with a growing demand. Often, they could not.

In Charlotte, N.C., and nine surrounding counties, for example, the waiting list for Meals on Wheels averaged about 1,200 people. But Linda Miller, director of the Centralina Area Agency on Aging, which coordinates the program, always assumed the actual need was higher.

She knew some clients skipped meals because they couldn’t travel to a senior center for a hot lunch every weekday; some divided a single home-delivered meal to serve as both lunch and dinner.

Some never applied for help. “Just like with food stamps, which are underused,” Ms. Miller said, “people are embarrassed: ‘I worked hard all my life; I don’t want charity.’”

5.4 million older recipients.

For years, advocates for older adults have lobbied Congress for more significant federal help. Although the Older Americans Act has enjoyed bipartisan support, small annual upticks in appropriations left 5,000 local organizations constantly lagging in their ability to feed seniors.

From 2001 to 2019, funding for the Older Americans Act rose an average of 1.1 percent annually — a 22 percent increase over almost two decades, according to an analysis by the AARP Public Policy Institute. But adjusted for inflation, the funding for nutrition services actually fell 8 percent. State and local matching funds, foundation grants and private donations helped keep kitchens open and drivers delivering, but many programs still could not bridge their budget gaps.

food insecure,” meaning they had limited or uncertain access to adequate food.

And that shortfall was before the pandemic. Once programs hastily closed congregant settings last spring, a Meals on Wheels America survey found that nearly 80 percent of the programs reported that new requests for home-delivered meals had at least doubled; waiting lists grew by 26 percent.

Along with money, the Covid relief legislation gave these local programs needed flexibility. Normally, to qualify for Meals on Wheels, homebound clients must require assistance with activities of daily living. The emergency appropriations allowed administrators to serve less frail seniors who were following stay-at-home orders, and to transfer money freely from congregant centers to home delivery.

Even so, the increased caseloads, with people who had never applied before seeking meals, left some administrators facing dire decisions.

In Northern Arizona, about 800 clients were receiving home-delivered meals in February 2020. By June, that number had ballooned to 1,265, including new applicants as well as those who had previously eaten at the program’s 18 now-shuttered senior centers. Clients were receiving 14 meals each week.

By summer, despite federal relief funds, “I was out of money,” Ms. Beals-Luedtka said. She faced the grim task of telling 342 seniors, who had been added to the rolls for three emergency months, that she had to remove them. “People were crying on the phone,” she recalled. “I literally had a man say he was going to commit suicide.” (She reinstated him.) Even those who remained started receiving five meals a week instead of 14.

diminish loneliness and help keep seniors out of expensive nursing homes. They also may help reduce falls, although those findings were based on a small sample and did not achieve statistical significance.

Interestingly, Dr. Thomas’s research found daily meal deliveries had greater effects than weekly or twice-monthly drop-offs of frozen meals, a practice many local organizations have adopted to save money.

Frail or forgetful clients may have trouble storing, preparing and remembering to eat frozen meals. But the primary reason daily deliveries pay off, her study shows, is the regular chats with drivers.

“They build relationships with their clients,” Dr. Thomas said. “They might come back later to fix a rickety handrail. If they’re worried about a client’s health, they let the program know. The drivers are often the only people they see all day, so these relationships are very important.”

a prepandemic evaluation found.

So while program administrators relish a rare opportunity to expand their reach, they worry that if Congress doesn’t sustain this higher level of appropriations, the relief money will be spent and waiting lists will reappear.

“There’s going to be a cliff,” Ms. Beals-Luedtka said. “What’s going to happen next time? I don’t want to have to call people and say, ‘We’re done with you now.’ These are our grandparents.”

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‘They Have No One’: At 88, a Transgender Icon Combats Loneliness Among Seniors

MEXICO CITY — The pink paint of her stairwell is peeling, the black metal banister chipped, but Samantha Flores is as sharp-witted as ever amid a profusion of climbing plants and bursting red flowers.

At 88, the Mexican transgender icon remains elegant, funny and at times flirtatious, sitting at a small round table on the landing outside her tiny Mexico City flat where she has received callers, at a safe distance, throughout the pandemic.

After nearly nine decades as a socialite, a manager of a gay bar, an L.G.B.T.Q. advocate, and much more, Ms. Flores has a large community of longtime friends and neighbors who come knocking.

“Without my friends, I wouldn’t be who I am,” she said.

But as Ms. Flores well knows, many seniors are not so lucky. And so there is one part of her world that she’s aching to get back — the drop-in center she founded and runs to help older L.G.B.T.Q. adults combat their isolation. It was the first organization of its kind in Mexico.

Vogue Mexico last June, and was later featured in a campaign for the fashion house Gucci.

But for Ms. Flores, the glamour and attention are just new platforms to talk about what’s most important to her — Vida Alegre, and the rampant discrimination still faced by Mexican trans women, which often makes sex work their only means of making a living.

“It’s society’s fault that trans women have to work on the streets,” she said. “They aren’t given any other option.”

When coupled with machismo attitudes and widespread gang violence, discrimination can also be deadly for trans women in Mexico, which regularly ranks among the most dangerous countries in the world for transgender people. Few are lucky enough to live as long as Ms. Flores has.

But luck, it seems, has often been on Ms. Flores’ side.

Born in the city of Orizaba in Veracruz state in 1932, Ms. Flores grew up in a house with a yard full of orange, guava, lemon and avocado trees. She described her childhood as idyllic. Her family was tacitly accepting even then of what she called her effeminate nature, she said.

“I couldn’t pass by unnoticed, ” Ms. Flores recalled.

But behind her back, there were always whispers from neighbors and schoolmates, Ms. Flores said, and after graduating from high school, she couldn’t wait to leave Orizaba.

“What I wanted was to get out of that damn town and away from those damn people,” she said. “I realized that I was criticized and singled out for being queer.”

Ms. Flores moved to Mexico City, where she began dipping into the capital’s nascent gay scene of the 1950s and ’60s.

“For me, it was freedom,” she said.

One night in 1964, Ms. Flores was invited to a costume party, and together with a few friends, decided to go in drag. She chose the name Samantha for her persona after Grace Kelly’s character in the film “High Society,” which featured music by Cole Porter, her favorite singer.

“I liked Samantha because of the double meaning,” Ms. Flores said. “Bing Crosby called her Sam, which can also be short for Samuel.”

The host of the party was a friend of Ms. Flores, Xóchitl, then one of the most famous trans women in Mexico, who Ms. Flores says, had connections to the rich and powerful that allowed her the freedom to hold extravagant parties for the L.G.B.T.Q. community.

“She was the one that opened the door for trans women,” Ms. Flores recalled.

Little by little, Ms. Flores appeared in public as Samantha until, eventually, she was Samantha.

“I became myself, I found my true personality,” she said.

Soon, Samantha Flores was a staple of the Mexico City club scene.

“She was always a very, very elegant woman,” recalled Alexandra Rodríguez de Ruíz, a transgender rights activist and writer who was a teenager when she started going to gay clubs and encountered Ms. Flores. “Always wearing beautiful dresses and always accompanied by handsome young men.”

Back then, Ms. Rodríguez said, being part of the L.G.B.T.Q. community in Mexico was even more dangerous; the police would regularly detain trans women on the street or raid gay bars and confiscate their belongings.

“There was a lot of persecution,” she said. “Sometimes, if they were bad cops, they would take you to someplace and rape you or beat you.”

But Ms. Flores said she managed to avoid trouble. Whether it was that she could easily pass as female or because of her friendship with the well-connected Xóchitl, she was never bothered by the police.

Still, Ms. Flores said she felt uneasy being a trans woman in Mexico, and decided to move to Los Angeles. For several years in the 1970s and early ’80s, she lived between Mexico and L.A., where she worked managing a gay bar, among other ventures.

By the time she came back to Mexico full-time in the mid-’80s, the AIDS crisis was in full swing.

“My best friends, my most beloved friends, they died of H.I.V.,” Ms. Flores recalled. “I lost count — if I said 300, I wouldn’t be exaggerating.”

Seeing the crisis facing her community inspired her to become more of an activist.

“I became a fighter,” she said.

At first, Ms. Flores volunteered at an AIDS charity, and later began raising money for children with H.I.V. and women facing violence in northern Mexico, collecting funds at theater performances, including “The Vagina Monologues,” which ran in Mexico for years.

Then, a few years ago, a friend of hers suggested that she create a shelter for older L.G.B.T.Q. adults.

“That’s when the spark was lit,” Ms. Flores said.

It took years of wading through the Mexican bureaucracy and finding the right venue, but eventually she was able to secure rent on a one-room building on a busy street in the Álamos neighborhood. Vida Alegre now stands there, the building painted bright blue with a rainbow flag out the front.

The community has grown to some 40 people, about half of whom are straight and go there only for the company.

“It’s empathy and being together,” that brings people in, Ms. Flores said. “Abandonment and loneliness have fled.”

Besides reopening Vida Alegre, Ms. Flores has one other wish.

“I’m waiting for Prince Charming on his white horse and silver armor to come and serenade me,” Ms. Flores said. “I’ve been living here for 35 years, with the windows open, waiting for him. But he still hasn’t come.”

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Turning Away From Nursing Homes, to What?

The PACE provider manages all of a person’s health care needs that are covered by Medicare or Medicaid. “It becomes your form of health care coverage,” said Peter Fitzgerald, executive vice president for policy and strategy at the National PACE Association, a membership and advocacy organization.

States decide whether to offer PACE programs; currently 30 have programs serving about 55,000 people, Mr. Fitzgerald said.

Some states and regions are moving to address the needs of their aging citizens.

In January, Gov. Gavin Newsom released a master plan for aging for California. It calls for creating, over the next decade, millions of housing units for older residents, one million high-quality caregiving jobs, and inclusion goals such as closing the digital divide and creating opportunities for work and volunteering. Colorado, Massachusetts, Minnesota and Texas have already established master plans, and a number of other states are working on them.

California’s plan also calls for a new state office focused on finding ways to innovate using Medicare funds, especially for low-income, chronically ill seniors who also participate in Medicaid.

“We think this can really help our state by bringing together medical and nonmedical services for people who want to live well in the place they call home,” said Gretchen E. Alkema, vice president of policy and communications at the SCAN Foundation, a nonprofit focused on elder care that has worked with California and other states on age-friendly models.

In the Atlanta metropolitan area, which began tackling these issues head-on in 2002, one in five residents will be 65 or older by 2050, according to the Atlanta Regional Commission, a planning organization. The group has responded by developing a “lifelong communities initiative” to raise awareness in local government of the need for housing that is affordable and convenient to sidewalks, shopping and transportation.

Atlanta and four suburbs have joined an AARP-sponsored network of age-friendly communities, and several city neighborhoods have created plans.

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Covid Was 3rd Leading U.S. Death Cause in 2020

Covid-19 was the third leading cause of death in the United States in 2020, displacing unintentional injuries and trailing only heart disease and cancer, federal health researchers reported on Wednesday.

The coronavirus was the cause of death for 345,323 Americans in a year that exacted a steep price in lives lost. In roughly 30,000 additional cases, death certificates cited Covid-19 but it was not deemed the cause of death, according to the National Center for Health Statistics.

Some 3,358,814 Americans died of all causes in 2020, a 15 percent increase in the age-adjusted death rate over that in 2019, when 2,854,838 Americans died. In addition to Covid-19, heart disease claimed higher numbers of lives than expected last year, as did Alzheimer’s and diabetes — a phenomenon statisticians refer to as excess deaths.

“There’s a substantial number of excess deaths, beyond what we would have expected in a normal year,” said Robert Anderson, chief of the mortality statistics branch at the N.C.H.S. and a senior author of two reports published by the Centers for Disease Control and Prevention.

the virus was in fact the underlying cause of death in the vast majority of the cases. “Since the beginning of the pandemic, people were claiming deaths were simply being attributed to Covid when people were dying of other causes,” Dr. Anderson said. “We show that’s not the case.”

The researchers’ examination of accompanying conditions on death certificates, like pneumonia or respiratory failure, and contributing conditions, like high blood pressure and diabetes, were consistent with what doctors see in patients who die of Covid-19.

Covid-19 death rates were highest among men; elderly people aged 85 and over; and Native American, Alaska Native and Hispanic individuals. Over all, the highest age-adjusted death rates for all causes were seen among the elderly; Black, Native American or Alaska Native individuals; and men.

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Entitled to Vaccines, Undocumented Immigrants in U.K. Struggle for Access

LONDON — In early February, the government of Britain announced that every person living in the country would be eligible for a coronavirus vaccine, free of charge, regardless of their immigration status. Public health experts praised the decision, necessary to ensure the safety of everyone, while others raised alarms at the prospect of noncitizens jumping ahead of eligible Britons.

“No one will get their vaccination out of turn,” Edward Argar, a British health minister, said in an interview. The disease, he added, is “looking for victims, it’s not worried about immigration status.”

As in much of the world, the virus has ravaged immigrant communities in Britain, many of which supply the bulk of frontline workers in grocery stores and domestic care. Many immigrants also live in crowded, multigenerational housing that exposed older family members throughout the pandemic. The government’s so-called vaccine amnesty was designed to encourage even those without legal status to come forward and get vaccinated.

But more than a month after the announcement, many undocumented immigrants said they remained fearful that asking for a vaccine would risk arrest or deportation. Others said they had been denied registration at local doctors’ offices, which often ask for identification or proof of address — although neither is required to access primary care.

hostile environment” policy that aimed to force those without legal status to leave the country by blocking their access to jobs, bank accounts and free medical care.

“It’s all very well to say, ‘Anyone can get a vaccine,’” said Phil Murwill, the head of services at Doctors of the World U.K. “But for years there was a deliberate policy of creating a hostile environment for undocumented immigrants that has put people off from accessing any kind of care. And we’re seeing that play out now.”

Outside estimates put the number of undocumented immigrants in Britain somewhere between 800,000 and 1.2 million, or just under 2 percent of the population. (The British government has not estimated the size of this population since 2005, when it was said to be 430,000.) It is a significant group that includes many at-risk workers, and one that epidemiologists say the vaccination campaign — which has so far given nearly half the population at least one dose — must reach if Britain hopes to safely exit the pandemic.

This month, Ghie Ghie and Weng, two undocumented domestic workers from the Philippines, walked arm in arm to the Science Museum in London, one of more than the 1,500 vaccination sites across the country. (Like other undocumented people interviewed for this article, the women asked to be identified only by their first names for fear of arrest.) Ghie Ghie had gotten her first shot of the vaccine the previous weekend and was hoping Weng could get hers.

booked an appointment online under the category of health and social care workers, which the government defined as “doctors, nurses, midwives, paramedics, social workers, care workers, and other frontline health and social care staff.” (As of last week, those age 50 and older are now eligible in England.)

prioritize vaccinating those in jobs done primarily by undocumented immigrants, like farm work. But Britain did not extend the social care worker category to include domestic workers, a Department of Health and Social Care spokesperson confirmed in an email.

“We are caring for children and elderly and the disabled,” said Marissa Begonia, founder of the Voice of Domestic Workers. “It’s not a lie. By our definition, we are social care workers.”

Weng works part time for two families, traveling between the households each week. “I want to get my vaccine in case the government asks, so that I can show I am not putting anyone at risk,” she said as she waited in line at the vaccine center. She re-emerged about 30 minutes later, proudly clutching the card showing she’d received the first dose of the AstraZeneca vaccine.

In 2018, the Home Office, the government ministry in charge of immigration, officially withdrew a data-sharing agreement that used patient information from the National Health Service to track down people thought to be violating immigration rules. (Data sharing still exists for deportation cases involving serious crimes.) The Department of Health and Social Care has said that anyone undergoing vaccination, testing or treatment for the coronavirus would not be subject to immigration status checks.

two agencies share patient information, most commonly in cases of undocumented immigrants with an unpaid medical debt of 500 pounds (around $690) for more than two months. Primary care, including treatment by a family doctor, is free whereas secondary care — hospital visits, surgeries, maternal care — is not.

Those working on behalf of undocumented immigrants say that this hybrid health care system only adds to the confusion about what benefits undocumented immigrants are entitled to. “The government needs to suspend all charging and data sharing operations if they want to prioritize the widest possible access to public health,” said Zoe Gardner, a policy adviser for the Joint Council for The Welfare of Immigrants.

When Huseyin, a 30-year-old undocumented chef, found out that he could see a family doctor for free — and eventually be called for a vaccine — he said he immediately tried to register. That was three months ago.

He said a family clinic in London had asked for a valid passport or ID before turning him away. A few weeks later, he moved to Brighton, England, for a full-time job at a restaurant. He tried again with a local doctor there but was told — incorrectly — that he needed an N.H.S. number to register with them.

“N.H.S. guidance says nothing about documentation, but nobody teaches you when you’re in medical school about a patient’s right to access a G.P.,” said Dr. Elizabeth Bates, an associate general practitioner in the West Midlands. “That the N.H.S. is for everybody is something many British people are very intrinsically proud of, but even some doctors don’t understand that their practice may have these policies that prevent people from registering.”

Huseyin is now getting registration help from Doctors of the World U.K., a nonprofit that works to ensure access to health care for those with unclear immigration status. He’s young, though, and is unlikely to be called for a vaccine for months.

“I want the vaccine to protect myself and my community,” he said. “We are everywhere — the corner shops, restaurants, factories, hotels. Undocumented people are everywhere.”

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A Nursing Home’s Mission to Vaccinate Its Hesitant Staff

For them, the half-hour Tyler Perry video that had been playing on repeat on a giant screen in the multipurpose room did not seemed to resonate.

Ms. Sandri, who is of Chinese descent, began to understand. “I’m Asian, but I’m not Japanese or Thai or Indian, and they are very different people,” she said. “Until we understand cultural sensitivities beyond the major skin color groups, we’re not going to be successful at reaching herd immunity levels with some of those subsets.”

She started planning to have her director of maintenance, an African immigrant who has been vaccinated, to talk to reluctant peers about his experience and their concerns, and to find leaders of local African churches who might be willing to do the same.

She also doubled down on what she believed was working best: listening to and addressing the concerns of her employees one by one — what she called a “time-intensive, conversation-intensive, case-by-case uphill climb.”

The key, she said, was to tailor her message to what would resonate most with each person.

“For analytical people, we provided data on number of cases, number of people in trials, percent of people who experience an immune response,” she said. “For relationship-based thinkers, we asked if they had any vulnerable friends or family members, and how having or not having the vaccine might impact the relationship.”

Still, as the date of the third vaccination event approached in early March, Ms. Proctor was tired — of the pandemic and the long loss of freedoms, but also of hearing every day at work about the importance of getting the shot. Ms. Sandri, whose office was just around the corner, stopped by frequently to chat and gently raise the benefits of being vaccinated.

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Florida’s Coronavirus Cases Rise, Especially Among the Young

Scientists view Florida as a bellwether for the nation, the state furthest along in lifting restrictions, reopening society and welcoming tourists.

If recent trends there are any indication, the rest of the country may be in trouble.

The number of confirmed coronavirus cases in Florida has been steadily rising, though hospitalizations and deaths are still down. Over the past week, the state has averaged nearly 5,000 cases per day, an increase of 8 percent from its average two weeks earlier.

B.1.1.7, the more-contagious variant first identified in Britain, is also rising exponentially in Florida, where it accounts for a greater proportion of total cases than in any other state, according to numbers collected by the Centers for Disease Control and Prevention.

“Wherever we have exponential growth, we have the expectation of a surge in cases, and a surge in cases will lead to hospitalizations and deaths,” said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

impose an 8 p.m. curfew, although many people still flouted the rules.

Miami-Dade County, which includes Miami Beach, has experienced one of the nation’s worst outbreaks, and continues to record high numbers. The county averaged more than 1,100 cases per day over the past week.

In Orange County, cases are on the rise among young people. People 45 and younger account for one in three hospitalizations for Covid, and the average age for new infections has dropped to 30.

Gov. Ron DeSantis has rejected stringent restrictions from the very start of the pandemic. Florida has never had a mask mandate, and in September Mr. DeSantis banned local governments from enforcing mandates of their own. Among his scientific advisers now are architects of the Great Barrington Declaration, which called for political leaders to allow the coronavirus to spread naturally among young people, while the elderly and those with underlying conditions sheltered in place.

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Why Supply Isn’t the Only Thing Stymying Europe’s Coronavirus Vaccine Rollout

On Wednesday, Mr. Draghi said that differing approaches by the regions to vaccinating people over the age of 80 was unacceptable, adding that some “neglect their elderly to favor groups who claim priority based probably on some contractual power.”

In Tuscany, a region usually admired for its health care system, only about 6 percent of people over the age of 80 have been fully vaccinated, prompting a public letter from leading citizens.

“Inefficiency,” they wrote, “produces deaths.”

Matteo Villa, a researcher at the Italian Institute for International Political Studies who has studied the coronavirus pandemic, said that Italy’s strategy of first vaccinating only health care workers had resulted in a bottleneck that made the virus more deadly.

“When the delays came,” he said, “we still had a lot of elderly people to vaccinate.”

Guido Bertolaso, the former head of Italy’s civil protection agency who is now in charge of the vaccine campaign in Lombardy, said the country had failed to act on emergency footing.

He blamed pharmaceutical companies not making good on their promised deliveries for Italy’s problems. “When you plan, you must know where you get the vaccine, at what time, which amount, on a weekly basis,” he said. In any case, he added, “In Italy with planning, we are not very good.”

Avoidable organizational and logistical problems have slowed the rollout and infuriated Italians. In Lombardy, a wealthy northern region at the center of Italy’s outbreak, intensive care wards are still packed with older and dying Italians, making it an emblem of Italy’s missteps.

“Every time the phone rings, I hope it’s them,” said Ester Bucco, 84, from Castiglione Olona, in the Lombardy region, who registered two months ago to get vaccinated but has yet to get an appointment. She walks around the house carrying her home phone and said she had started taking anti-anxiety pills to cope. “I really want to see my grandchildren.”

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Supply Isn’t the Only Thing Stymying Europe’s Vaccine Rollout

On Wednesday, Mr. Draghi said that differing approaches by the regions to vaccinating people over the age of 80 was unacceptable, adding that some “neglect their elderly to favor groups who claim priority based probably on some contractual power.”

In Tuscany, a region usually admired for its health care system, only about 6 percent of people over the age of 80 have been fully vaccinated, prompting a public letter from leading citizens.

“Inefficiency,” they wrote, “produces deaths.”

Matteo Villa, a researcher at the Italian Institute for International Political Studies who has studied the coronavirus pandemic, said that Italy’s strategy of first vaccinating only health care workers had resulted in a bottleneck that made the virus more deadly.

“When the delays came,” he said, “we still had a lot of elderly people to vaccinate.”

Guido Bertolaso, the former head of Italy’s civil protection agency who is now in charge of the vaccine campaign in Lombardy, said the country had failed to act on emergency footing.

He blamed pharmaceutical companies not making good on their promised deliveries for Italy’s problems. “When you plan, you must know where you get the vaccine, at what time, which amount, on a weekly basis,” he said. In any case, he added, “In Italy with planning, we are not very good.”

In Lombardy, a wealthy northern region at the center of Italy’s outbreak, intensive care wards are still packed with older and dying Italians, making it an emblem of Italy’s missteps.

“Every time the phone rings, I hope it’s them,” said Ester Bucco, 84, from Castiglione Olona, in the Lombardy region, who registered two months ago to get vaccinated but has yet to get an appointment. She walks around the house carrying her home phone and said she had started taking anti-anxiety pills to cope. “I really want to see my grandchildren.”

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