The Gerontologist
Vol. 48, No. 2, 235–244

Copyright 2008 by The Gerontological Society of America

Falling Through the Social Safety Net: Food
Stamp Use and Nonuse Among Older
Impoverished Americans
Esme Fuller-Thomson, PhD, MSW,1 and
Melissa Redmond, MSW1
Purpose: Older adults are less likely than any other
age group to use the federal Food Stamp Program.
The personal and social costs of elderly diet insufficiency include disease exacerbation, depression,
and increased hospitalization. In order to improve
targeting and outreach efforts, this study identifies the
characteristics of eligible older Americans who are
not receiving food stamps and assesses the validity of
the Andersen behavioral model for predicting impoverished older adults food stamp use. Design and
Methods: We conducted a secondary analysis of the
2003 American Community Survey, which is a nationally representative survey with a response rate of
96.7%. We restricted our study subsample to the
14,724 impoverished American citizens who were
aged 65 years and older. We used bivariate and
logistic regression analyses to compare the 2,796
food stamp recipients with the 11,928 nonrecipients. Results: One in five impoverished older
American citizens had received foods stamps in the
preceding year. Female respondents, renters, younger respondents, disabled individuals, and those
who received Supplemental Security Income or welfare were more likely to receive food stamps. The
pseudo-R-square value indicated that the Andersen
Behavioral Model explained 28% of the model’s
variability. Implications: Improved targeting is
needed to enhance older adults’ participation rates.
Mobile and satellite food stamp offices in lower
income neighborhoods and other innovative outreach programs that collaborate with community

We acknowledge the generous support of the Royal Bank of Canada
Graduate Research Fellowship in Applied Social Work and the assistance
of Leanne McCormack, MSW, with manuscript preparation.
Address correspondence to Esme Fuller-Thomson, Factor-Inwentash
Faculty of Social Work, University of Toronto, 246 Bloor Street W,
Toronto, Ontario M5S 1A1, Canada. E-mail: esme.fuller.thomson@
utoronto.ca
1
Faculty of Social Work, University of Toronto, Canada.

Vol. 48, No. 2, 2008

235

partners could also improve access. With the vast
majority of impoverished older adults not receiving
food stamps, strategies such as these are extremely
important to rectify this situation among the most
vulnerable group of older Americans.
Key Words: Access, Andersen Behavioral Model,
Food Stamp Programs, Poverty, Social Welfare
Programs

Providing more support to poor Americans than
any other public assistance plan, the federal Food
Stamp Program (FSP) is designed to increase the
food-purchasing power of impoverished households
(Wolkwitz, 2007). Despite the program’s $23.9
billion budget allocation, recent estimates suggest
that only 54% of eligible Americans actually receive
food stamp benefits (Castner & Schirm, 2005).
Concerned with this underutilization, the FSP is
striving to reach a participation rate of 68% by 2010
(Castner & Schirm).
Hunger in the United States is still a pressing
social issue. One in eight households below the
poverty line has at least one member who has
experienced involuntary hunger because of insufficient funds to buy food (Nord, Andrews, & Carlson,
2004). Although access to the FSP is ostensibly
offered to all eligible individuals living in poverty,
research literature points to differential participation
rates for diverse sectors of the American public. As
a result, specific age cohorts and ethnic or racial
groups require tailored outreach strategies to maximize their program participation. These strategies
must be informed by solid research focused on each
group’s needs and patterns of utilization. In this
article we study the characteristics of a particularly
vulnerable subgroup: impoverished older Americans
who are not receiving food stamps (The term
impoverished refers to individuals who have incomes that are less than 100% of the poverty level.)

Numerous studies have reported that less than a
third of eligible older Americans actually receive FSP
benefits (Cunnyham, 2004; Haider, Jacknowitz, &
Schoeni, 2003; Wilde & Dagata, 2002). These participation percentages are much lower than those for any
other age group (Cunnyham, 2004; Rosso, 2001). Surprisingly, little research has focused on the characteristics of elderly persons who are eligible for the FSP
but are not using the service. Even fewer studies
have used multivariate models and theoretically informed analyses while attempting to describe this
population.
Reasons for low program utilization rates among
American seniors include the following: (a) barriers
to information concerning eligibility, program benefits, and policies, which include confusion concerning changing eligibility standards; (b) enrollment
impediments, which include difficulty accessing local
welfare offices, misconceptions regarding application process complexity, and language issues; (c) concern about stigma, which may be more pronounced
among older adults; and (d) perceptions concerning
lack of need or inadequate benefits (Gabor, Williams,
Bellamy, & Hardison, 2002; McConnell & Ponza,
1999; Parker, Jog, & Kennedy, 2005; U.S. General
Accounting Office, 2000; Wilde & Dagata, 2002;
Zedlewski & Rader, 2005).
As increasing numbers of Americans live to older
ages, concern regarding their food security and the
adequacy of their nutritional intake takes on added
importance (Guthrie & Lin, 2002; Wellman & Kamp,
2004). The personal and social costs of elderly diet
insufficiency include disease and disability exacerbation, depression, individual and caregiver strain, increased hospitalization, and earlier mortality (Food
Security Institute, 2003; Lee & Frongillo, 2001).
There is a need for timely research that focuses on the
demographic characteristics of eligible elderly persons who do not use food stamps.
This research will generate a detailed profile of impoverished older Americans who, though eligible, are
not accessing the FSP. A better understanding of the
factors that distinguish participating and nonparticipating impoverished elderly Americans will address
many of the gaps in our theoretical and practical
understanding of elderly food stamp utilization and
inform much needed program outreach efforts.
We use Andersen’s (1995) behavioral model to
predict the use of food stamps among older adults
who are living in poverty. Andersen’s framework has
been one of the most influential models in the field of
health care utilization over the past three decades
(Calsyn & Winter, 2000; de Klerk, Huijsman, &
McDonnell, 1997; Jang, Kim, & Chiriboga, 2005;
Jheriot, Segal, & Cowser, 2003; Li, 2006). However,
it has not commonly been used to assess utilization
of social assistance programs. The model is a helpful
theoretical framework for understanding the demographic, social, and situational factors influencing
program-utilization patterns.
236

Andersen hypothesized that patterns of utilization
are affected by predisposing, enabling, and need
characteristics. In equitable services, need characteristics will be the strongest predictors of utilization. In
inequitable services, enabling factors will provide the
greatest explanatory power. We have modified these
three groups of factors to address food stamp use.
Predisposing characteristics include demographic
characteristics such as age, gender, and race or ethnicity. Greater food stamp use has been associated
with being female (Rosso & Faux, 2003), Hispanic
(Faux & Rosso, 2003), African American (Faux &
Rosso), and younger (Martin, Cook, Rogers, &
Joseph, 2003). Characteristics that enable utilization
of the FSP include skill in speaking English (Algert,
Reibel, & Renvall, 2006), higher educational attainment (Kirsch, Jungeblut, Jenkins, & Kolstad, 1993;
Rank & Hirschl, 2005; Zedlewski & Rader, 2005),
family composition, and use of other social assistance programs such as Supplemental Security
Income (SSI) and public assistance (U.S. General
Accounting Office, 2004; Zedlewski & Rader).
Haider and colleagues (2003) reported that utilization rates were much higher among those individuals
with children than among those without them. One
possibility is that knowledge about and access to
social assistance programs is increased through outreach programs in the schools, such as lunch programs or school social workers.
Need characteristics refer to health-related characteristics and financial status. In particular, we
include the association between food stamp use and
functional limitations, limitations in activities of
daily living, and blindness or deafness. Rosso and
Faux’s (2003) analysis found that food stamp use was
higher for individuals with disabilities than it was for
those without them. Further, Rank and Hirschl
(2005) found that duration of use was higher for
those individuals with disabilities. Although all
individuals studied were living below the poverty
line, we included a variable in our analyses indicating
household income as a percentage of the poverty line
in order to identify those persons living in the most
extreme poverty. The proposed analyses were to
validate the Andersen behavioral model for predicting impoverished older adults’ use of food stamps.
Methods
Participants
The 2003 American Community Survey (ACS) is
a nationally representative survey of 838,293 households with a response rate of 96.7% (U.S. Census
Bureau, n.d.). A random sample of the ACS 2003 is
available as a Public Use Microdata Set (PUMS).
Because there is variability in the eligibility of legal
immigrants, we subsequently excluded noncitizens
from our sample. Thus, the final unweighted ACS
PUMS sample used for this study was 14,724
The Gerontologist

respondents who were American citizens living in
poverty and were aged 65 years and older, of whom
2,796 had received food stamps at some point in the
12 months preceding the survey.

Design and Procedure
We used SPSS 15.0 for Windows to conduct our
analyses. In order to validate the Andersen Behavioral Model, we conducted both bivariate and
multivariate tests. To assess whether groups (e.g.,
men and women) differed significantly in the percentage using food stamps, we conducted chi-square
analyses for each of the predisposing, enabling, and
need characteristics. A logistic regression analysis
with food stamp use as the dependent variable was
also necessary for two reasons. First, we were
interested in whether each of the variables discussed
here were independently associated with food stamp
use, once the other variables were also included in the
analysis. Second, Andersen’s model is based on an
investigation of groups of variables divided into
predisposing, enabling, and need characteristics. An
assessment of the change in the pseudo-R-squared
value associated with each group of characteristics is
an important way to ascertain whether service
provision is based primarily on need or other factors.
For the logistic regression of food stamp use, we
entered independent variables in three blocks: predisposing, enabling, and need characteristics. We
assessed the independent contribution of each block
of predictors, and we generated odds ratios (ORs)
and 95% confidence intervals. Theory-driven hierarchical entry of each of the blocks of variables
produced results that were more clearly interpretable
(Phillips, Morrison, Andersen, & Aday, 1998).
Our analyses utilized a weighting variable designed by the U.S. Census Bureau. This weight
variable represents the probability of selection,
including noninterview adjustments and controlling
for the 2000 Census housing units and population
level. To avoid falsely increasing the likelihood that
we would obtain a significant p value, we rescaled
the weight variable to have a mean value of 1 for
the subsample. We determined the receipt of food
stamps by the participants’ response to the following
question: At any time in the past 12 months, did
anyone in this household receive food stamps?
We based all variables on self-report, including
ethnicity and race. We based household income on
a summation of income for all household members
from the following sources: (a) SSI; (b) public assistance or welfare payments from the state or local
welfare office; (c) wages, salary, commissions, bonuses, or tips from all jobs; (d) self-employment
income; (e) interest, dividends, net rental income,
royalty income, or income from estates and trusts; (f)
social security or railroad retirement; (g) retirement,
survivor, or disability pensions; and (h) other sources
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237

of income received regularly such as veteran’s payments, unemployment compensation, child support,
or alimony. We dichotomized responses to the first
two questions (yes or no) to determine if the household received SSI or welfare. The census calculated
the household’s family poverty level by using household composition and household income data. The
sample was restricted to those below 100% of the
poverty line. In 2003, the poverty line was $8,825 for
an older adult living alone and $11,122 for an older
couple (DeNavas-Walt, Proctor, & Mills, 2004). We
then created a variable identifying four levels of
poverty under the poverty line: (a) 0% to 24%, (b)
25% to 49%, (c) 50% to 74%, and (d) 75% to 99%
of the poverty line.
Further, respondents were asked if they had either
or both of the following long-lasting conditions:
(a) blindness, deafness, or severe vision or hearing
impairment; or (b) a condition that substantially
limits physical activities such as walking, climbing
stairs, reaching, lifting, or carrying. The former we
labeled severe vision or hearing difficulty and the
latter we defined as functional limitations. Respondents were also asked if they had a physical,
mental, or emotional condition lasting 6 months or
more that made it difficult to do any of the following: (a) learning, remembering, or concentrating;
(b) dressing, bathing, or getting around inside the
home; (c) going outside the home alone to shop or
visit a doctor’s office; and (d) working at a job or
business. For the purposes of this study, we defined
these as difficulty remembering, limitations in
activities of daily living, difficulty going out, and
difficulty working, respectively.

Results
Of older American citizens living in poverty,
approximately one in five was receiving food stamps.
The majority of our chi-square analyses indicated
that, as we hypothesized, a wide range of predisposing, enabling, and need characteristics were associated with food stamp usage (see Table 1). All
bivariate analyses were below the .001 level of
significance. Food stamp utilization rates were higher
among female, Hispanic, and African American
respondents. Prevalence rates decreased with age.
Individuals with underage children in their homes
were twice as likely to use food stamps as those who
were not coresiding with children. Older adults who
received welfare or SSI had much higher rates of
food stamp use than those not receiving these social
services. With respect to need characteristics, older
adults who rented their accommodation had three
times the rates of food stamp use in comparison with
those who owned their accommodation and did not
have a mortgage. Having a disability was associated
with higher rates of food stamp utilization for each
of the six types of disabilities that we investigated.

Table 1. Analysis of Predisposing, Enabling, and Need Characteristics Associated With FSP Utilization
Among Poor Older Americans
Total (n)

FSP Use (%)

p

4,198
10,526

16.4
20.4

,.001

Ethnicity
Not Hispanic
Hispanic

13,665
1,059

17.9
31.0

,.001

Race
Not African American
African American

12,062
2,662

16.5
30.1

,.001

6,566
5,881
2,277

24.0
16.8
11.1

,.001

12,699
1,180
845

17.5
19.2
36.1

,.001

4,309
3,423
6,131
861

26.9
21.5
13.4
13.3

,.001

Citizenship
U.S. citizen by birth
Citizenship through naturalization

13,487
1,237

17.9
29.5

,.001

Children present in home
No children
1 or more children

13,747
977

17.8
37.2

,.001

Welfare
No welfare received
Welfare received

14,373
351

18.3
57.5

,.001

Supplemental Security Income
No
Yes

12,881
1,843

14.5
51.3

,.001

1,751
1,478
3,735
7,760

6.5
13.2
19.9
23.1

,.001

4,627
2,034
7,419
644

32.4
15.7
10.4
17.3

,.001

Limitations in Activities of daily living
Yes
No

2,156
12,568

27.2
17.8

,.001

Severe vision or hearing difficulty
Yes
No

3,351
11,373

24.3
17.8

,.001

Variable
Predisposing characteristics
Gender
Male
Female

Age (years)
65–74
75–84
85þ
Enabling characteristics
English-language skills
Speaks English at home
Speaks English as second language, very well
Speaks English not well or not at all
Education
Primary
Some high school (no diploma)
High school diploma
University degree

Need characteristics
Poverty quartiles
0% to 24%
25% to 49%
50% to 74%
75% to 99%
Housing tenure
Rented for cash rent
Owned with mortgage
Owned free and clear
Occupied without payment of cash rent

(Table continues on next page)

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The Gerontologist

Table 1. (Continued)
Total (n)

FSP Use (%)

p

3,926
10,798

25.8
16.8

,.001

Functional limitations
Yes
No

6,479
8,245

25.7
14.1

,.001

Difficulty remembering
Yes
No

2,596
12,128

27.7
17.4

,.001

6,585
8,139

26.2
13.8

,.001

Variable
Difficulty going out
Yes
No

Difficulty working
Yes
No

Note: The analysis is bivariate; poor older Americans are individuals aged 65 years or older who are living below the poverty
line (unweighted n = 14,724). The Total column is unweighted; the FSP Use column is weighted. The p-value column shows the
value of the chi-square tests. Information is from the American Community Survey 2003 Public Use Microdata Set. FSP = Food
Stamp Program.

However, three of the enabling characteristics and
one of the need characteristics reached statistical
significance but were in the opposite direction of
what we had anticipated: Those who did not speak
English well had twice the rates of food stamp use as
those who spoke English at home. Individuals with
less education were more likely to utilize food stamps.
Naturalized citizens were more likely to use food
stamps than were those born in the United States.
Older adults living below 25% of the poverty line had
less than one third the utilization rates as those living
between 75% and 99% of the poverty line.
The logistic regression (see Table 2) presents the
independent contribution of each of the characteristics, controlling for the other variables in the
analysis. All four of the predisposing characteristics
were significant. Women, Hispanics, and African
Americans had higher odds of food stamp use. In
comparison with those individuals aged 85 years and
older, those aged 65 to 74 had almost three times the
odds of using food stamps.
The Nagelkerke R-square statistic is a pseudo-R
square used in logistic regression to estimate the
percentage of variance in the outcome variable
explained by predictors in the model (Nagelkerke,
1991). The pseudo-R square indicated that the model
including only predisposing characteristics explained
7.4% of the variance in food stamp utilization for the
impoverished older adults in the sample. With the
addition of enabling characteristics, the change in
the pseudo-R square suggested that an additional
14% of the variance in food stamp utilization among
this sample was explained, of which 9.5% was
associated with just two variables (welfare use and
SSI). The majority of the enabling characteristics
were significant. Those individuals who did not
speak English well had 39% higher odds of using
food stamps than those who spoke English at home.
In comparison with college-educated respondents,
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239

those with only a primary school education had 64%
higher odds of using food stamps and those who had
some high school but had not graduated had 37%
higher odds. Naturalized citizens had 27% higher
odds of food stamp use than those born in the United
States. Older adults with children in their homes had
more than twice the odds of food stamp use than
their peers without coresident children. Receiving
welfare was associated with 3.7 times the odds of
using food stamps. Similarly, SSI receipt was
associated with three times the odds of food stamp
utilization.
The change in the pseudo-R-square value indicated that need characteristics explained a total of
6.6% of the model variance. In comparison with
those individuals living below 25% of the poverty
line, persons in each successive quintile had higher
odds of using food stamps (OR = 1.50, 2.21, and
2.79, respectively). In comparison with those persons
who owned their own home and had paid off their
mortgage, the odds of food stamp use was significantly higher among owners with a mortgage (OR =
1.25), those who lived with others without paying
rent (OR = 1.56), and highest among those who
rented their accommodation (OR = 2.64). Those
with vision or hearing difficulties, functional limitations, or disabilities that impacted their ability to
work had elevated odds of using food stamps.
Several of the need characteristics that had reached
the level of significance in the bivariate analyses were
no longer significant in the multivariate analyses
(i.e., limitations in activities of daily living, difficulties in going out, and difficulties remembering).

Discussion
This study has several limitations. Two factors
may result in the exclusion of some eligible older

Table 2. Logistic Analysis of FSP Utilization Among Poor Older Americans
Variable

OR

95% CI

p

Predisposing characteristics
Female
Male
Hispanic
Not Hispanic
African American

1.32
1.00
1.23
1.00
1.73

(1.19–1.47)
Referent
(1.03–1.47)
Referent
(1.55–1.94)

,.001

1.00

Referent

2.81
1.90
1.00

(2.38–3.31)
(1.61–2.23)
Referent

,.001
,.001

0.93
1.39
1.00

(0.76–1.14)
(1.12–1.74)
Referent

,.48
,.003

Education
Primary
Some high school (no diploma)
High school diploma
University Graduate

1.64
1.37
0.97
1.00

(1.31–2.07)
(1.08–1.73)
(0.77–1.22)
Referent

,.001
.009
.81

Citizenship
Through naturalization
U.S. citizen by birth

1.27
1.00

(1.06–1.51)
Referent

.009

Children present in home
1 or more
No children

2.51
1.00

(2.15–2.93)
Referent

,.001

Welfare recipient
Not a welfare recipient
SSI recipient
Not a SSI Recipient

3.74
1.00
2.97
1.00

(2.93–4.79)
Referent
(2.64–3.37)
Referent

,.001

1.00
1.50
2.21
2.79

Referent
(1.16–1.94)
(1.78–2.75)
(2.27–3.43)

1.00
1.25
2.64
1.56
1.05
1.00
1.18
1.00
0.99
1.00
1.38
1.00
1.08
1.00
1.35
1.00

Referent
(1.07–1.46)
(2.37–2.94)
(1.23–2.00)
(0.91–1.22)
Referent
(1.06–1.33)
Referent
(0.87–1.13)
Referent
(1.23–1.55)
Referent
(0.96–1.23)
Referent
(1.20–1.52)
Referent

Not African American
Age: years
65–74
75–84
85 and over
Enabling characteristics
English-language skills
Speaks as second language, very well
Speaks not well or not at all
Speaks English at home

Need characteristics
Poverty quartiles
Household income , 25% of poverty line
25% to 49%
50% to 74%
75% to 99%
Housing tenure
Accommodation owned mortgage free
Owned with mortgage
Rented for cash rent
Occupied without payment of cash rent
Limitations in activities of daily living (ADL)
No limitations in ADL
Severe vision or hearing difficulty
No severe vision or hearing difficulty
Difficulty going out
No difficulty going out
Functional limitations
No functional limitations
Difficulty remembering
No difficulty remembering
Difficulty working
No difficulty working

.02
,.001

,.001

.002
,.001
,.001

.006
,.001
,.001
.49
.003
.86
,.001
.21
,.001

Note: Poor older Americans are individuals aged 65 years or older who are living below the poverty line (unweighted n =
14,724). Information is from the American Community Survey 2003 Public Use Microdata Set. The Nagelkerke pseudo-R-square
value that is due to the complete model is 0.282. The change in this value per block is as follows: predisposing characteristics,
0.074; enabling characteristics, 0.142 (receipt of SSI and welfare explain 0.095); need characteristics, 0.066. FSP = Food Stamp Program; OR = odds ratio; CI = confidence interval; SSI = Supplemental Security Income.

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The Gerontologist

adults from our sample. Some legal immigrants are
eligible for food stamps whereas others are not. First,
because the ACS did not contain sufficient information to determine food stamp eligibility for
noncitizens, we excluded all noncitizens from the
analysis. Second, we restricted the sample to those
with gross household incomes under the poverty line.
Eleven percent of food stamp recipients have gross
incomes over 100% of the poverty line, although
their net incomes meet the eligibility criteria of being
below the poverty line (U.S. Department of Agriculture, Food and Nutrition Service, n.d.a). Thus, we
may have excluded a minority of eligible older
adults. We may also have erred in the opposite
direction. Unfortunately, the ACS does not include
information on financial or vehicle assets. Therefore,
some of the respondents in our analysis may not be
eligible for food stamps because their assets exceed
prescribed levels. Furthermore, the ACS does not
have information on whether American Indian and
Alaskan Native respondents, who make up 1% of
the sample, were participating in food distribution
programs on Indian reservations and were therefore
ineligible for food stamps.
Despite these limitations, the analyses do provide
some helpful insights into the characteristics of
impoverished older Americans who do not use
food stamps. Using 2003 data, we found an overall
prevalence rate of 19.2%. This percentage is
considerably lower than the 26.9% (Cunnyham,
2004) and 30% (Wilde & Dagata, 2002) previously
identified in studies of those individuals aged 60 and
older. In contrast, our sample included only those
aged 65 and older. We found that participation rates
were much higher among the younger cohorts, and
thus the different age minimum may partially
explain these disparities. Furthermore, as we already
discussed, we may have included in our sample some
older adults who were ineligible for food stamps as
a result of wealth, which we could not assess.

Predisposing Characteristics
Our results support the findings of the previous
literature indicating that food stamp rates are higher
among women, African Americans, and Hispanics
(Faux & Rosso, 2003; Rosso & Faux, 2003). However, even in these groups, utilization rates are still
abysmal. At least two thirds of those persons eligible
in each of these populations are not receiving food
stamps.
This study’s finding that the younger cohort (age
65–74) had almost three times the odds of food
stamp use as compared with the oldest respondents
(age 85 and older) is provocative. Rogers-Dillon
(1995) suggests that welfare stigma is produced
through an interaction between an individual’s life
history, situation, and social audience. An earlier
incarnation of the FSP was inaugurated in 1939 to
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241

provide support to the neediest among the poor. One
explanation for the reticence of the oldest respondents is the possibility of greater concern over
‘‘welfare stigma’’ among those who lived through
the Depression era during their adolescence and
young adulthood. In addition, although food stamps
should not be synonymous with welfare, it is
important to note that many states require that
applicants visit the same location in order to enroll in
either assistance program. Florida, Kansas, New
Jersey, and West Virginia are among a handful of
states that permit online applications.
Furthermore, the historic practice in which
individuals physically hand over the food stamps to
their local store when they pay for their groceries
may be associated with public shame. Most states
are now using electronic benefit transfer cards.
Similar to debit cards, electronic benefit transfer
cards were ostensibly introduced to counteract fraud
but may also serve to minimize stigma (Food Stamp
Program: Frequently Asked Questions, n.d.). This
being said, the imposition of new technology may
still serve to alienate the oldest eligible Americans.
With nine out of ten of the oldest cohort not
receiving food stamps, it is clear that focused
outreach and public education to destigmatize the
FSP are necessary.

Enabling Characteristics
Several of our findings on enabling characteristics
were in opposition to our hypotheses and the previous research on the topic. For instance, although
we were not able to assess differential access rates
among various linguistic groups, we anticipated that,
because they would have more difficulties learning
about and accessing the service, those persons with
low English proficiency would have lower rates of
FSP participation. Although our expectations were in
keeping with the research by Algert and colleagues
(2006), this did not prove to be the case.
Perhaps our finding of higher use among nonanglophones may be due to the fact that a lack of
English skills is highly correlated with duration of
poverty (Urban Institute, 2002, 2006). Greater duration of poverty, in turn, is associated with a higher
likelihood of accessing social services. Another potential explanation is that the FSP has made a substantial effort to provide Spanish material and
bilingual staff. The greater rates of utilization among
non-English-speaking older adults may reflect the
success of this outreach. This might also explain
our surprising finding that, among impoverished
Americans, those who were citizens through naturalization rather than through birth were more likely
to use food stamps.
We had anticipated that education would facilitate access to services, as is the case in medical care
(U.S. Department of Health and Human Services,

1998). However, our findings indicate that there is
a higher likelihood of food stamp utilization among
the poorly educated. Typically, lower levels of
educational attainment are associated with lower
wages and less job security, and thus a greater need
over the years to use food stamps. Furthermore,
well-educated older adults are more likely to have
accrued wealth and thus be ineligible for services. As
we already mentioned, our inability to determine
wealth may have resulted in the improper inclusion
of some individuals in our subsample.
Three of our enabling characteristics did support
our original hypotheses: Children present in the
home, receipt of welfare, and receipt of SSI were
each associated with higher food stamp utilization.
The pseudo-R-squared statistics indicate that almost
10% of the variability in the logistic regression was
explained by the latter two variables. Although it
appears that many welfare workers are connecting
clients to the FSP, there are still more than 40% of
welfare recipients who are not getting food stamps.
Many states may benefit from adopting a strategy
such as the one used in Maine.
Maine has provided leadership in the linking of
social welfare benefits through an integrated computer system. When an individual applies for one
benefit program (e.g., Medicaid or welfare), eligibility for the FSP is concurrently assessed. Eligible
individuals are then immediately invited to apply
for food stamps and other appropriate programs
(Wallack, 2006). This outreach project contributed
to a 49% increase in food stamp participation between 2002 and 2005 (Acheson, 2006). Initiatives
such as this hold great promise for improving access
to food stamps for impoverished older Americans.

Need Characteristics
Andersen’s framework proposes that those individuals with greater need are more likely to use
services. In the bivariate analyses, all six types of
disabilities were associated with greater utilization of
food stamps. This was in keeping with earlier research (Rosso & Faux, 2003). Those persons with
disabilities may have both a greater need for food
stamps and a longer duration of need (Rank &
Hirschl, 2005). However, in the logistic regression
analyses, only three of the six variables remained
statistically significant.
It is not surprising that we found that those individuals who owned their accommodation mortgage
free had much lower food stamp utilization rates.
Low-income older adults who are renters and, to
a lesser extent, those who continue to have mortgage
payments devote a higher proportion of their income
to housing and related costs. This results in less
disposable income for purchasing food and other
necessities, thus contributing to a greater need for
social service support such as the FSP. Although
242

subsidized housing is one way of increasing the
disposable incomes of older renters living in poverty,
applicants often face overly long waitlists. In one
tenth of the Section 202 sites, waitlists have been
closed because demand has vastly outstripped supply
(Kochera, 2006).
In contrast to our expectations, we found that
those who were in the poorest quartile of the poverty
index (0% to 24% of the poverty line) had the lowest
levels of food stamp utilization. In 2003, this level of
poverty indicated an annual income of $2,206 or less
for an older adult living alone and $2,781 or less for
an older couple. Only 1 in 15 older adults living in
this level of extreme poverty was receiving food
stamps. We hypothesize two reasons for this. First, if
people in this economic situation applied for food
stamps, it is probable that they would also be referred to welfare or SSI for assistance. Once welfare
or SSI was received, their income would be considerably above the 25% of the poverty-line cutoff
we have specified here. Second, the strongest association we found in our analyses was between
welfare, SSI, and food stamp use. We anticipate
that much of this association is related to the situation in which welfare recipients are referred to or
screened for the FSP program by their welfare or SSI
worker. It is probable that those in the lowest
poverty quartile are not receiving any government
subsidies such as welfare, a program designed to
move families well above 25% of the poverty line.
Thus, those in this lowest income category are
probably not in contact with welfare workers who
could inform them about the FSP. Although only
12% of older adults living under the poverty line are
in this lowest income category, it is imperative that
future outreach targets this particularly needy and
underserved group.
Although the pseudo-R-square value indicates
that Andersen’s framework explained a substantial
proportion (i.e., 28%) of the variability in food
stamp utilization in older adults living below the
poverty line, the model definitely requires further
refining. The fact that the direction of the association
between several key determinants and utilization was
the reverse of what we had anticipated indicates the
pressing need for further research. Qualitative
research might help researchers understand how
impoverished older adults learn about their eligibility for the FSP and what factors motivate or dissuade
them from program participation.
A comparison of pseudo-R-square values suggest
that enabling characteristics explained twice the
variability associated with either predisposing or
need characteristics. This is indicative of an inequitable pattern of service utilization. In an equitable
system, need should be the predominant factor
associated with utilization. Our findings may have
been influenced by the narrow subsample we
selected: All older adults in our sample were living
below the poverty line and therefore, by definition,
The Gerontologist

had need. However, additional need-related factors
such as degree of poverty within this subsample,
housing tenure, and disability levels were associated
with a change in the pseudo-R-square value of
only 7%.
The gap in service delivery to older adults living in
poverty is stark. Even among those persons receiving
welfare or SSI, fewer than 60% were concurrently
receiving food stamps. In no other examined subgroup did we find more than 40% accessing the
program. Nine out of ten impoverished Americans
aged 85 and older were not receiving food stamps.
Clearly targeted outreach to this population is
essential. It would be beneficial for the FSP to set
older adult participation rate targets for 2010 and
2020 in order to keep this population’s needs in the
forefront of program planning. Concomitantly, the
FSP will have to annually assess the participation of
older adults.
Several promising strategies have been proposed
to improve food stamp utilization rates. Community
education could address erroneous perceptions regarding low program benefits. Creating mobile and
satellite food stamp offices in lower income neighborhoods would improve access, as would offering
online application forms in all states (Martin et al.,
2003). Furthermore, having these sites be distinct
from welfare offices may decrease the perceived
stigma attached to food stamp use.
Although there is a general online prescreen tool
available (U.S. Department of Agriculture, Food and
Nutrition Service, n.d.b), the application process
itself could be improved. For example, in the state of
Maine, employees determine eligibility before individuals begin the social service application process
(Wallack, 2006). Reducing the length of the application form would also facilitate greater utilization
(Martin et al., 2003). Innovative outreach programs
that collaborate with community partners, such as
faith-based organizations, health organizations, and
school programming, could positively influence participation rates (Food Research and Action Center,
2006). These strategies could easily be adapted to
focus specifically on older adults. More extensive
multilingual service provision, and more assistance
for the illiterate and those with visual or hearing
impairments could also be of value. Home visits by
FSP workers to the functionally impaired could also
improve access.
Further education of SSI, welfare, public housing,
and senior community center workers on the importance of referral to the FSP could also improve access
for those older adults who are using other services.
Mailed brochures on the FSP, eligibility criteria, and
local contact information could be sent to all older
adults receiving SSI, welfare, public housing, and
Medicaid, as well as to those whose Social Security
payments are below the poverty line. With the vast
majority of impoverished older adults not receiving
food stamps, strategies such as these are extremely
Vol. 48, No. 2, 2008

243

important to rectify this situation among the most
vulnerable group of older Americans.
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Received March 14, 2007
Accepted July 5, 2007
Decision Editor: William J. McAuley, PhD

The Gerontologist