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When an unprecedented bore down on Portland, Oregon, in June 2021, Jonna Papaefthimiou, the city鈥檚 chief resilience officer, immediately thought of the city鈥檚 most vulnerable populations: older people sweltering, often alone, in their homes.

She called Suzanne Washington, who runs the . 鈥淭hat overlap of their demographic and the demographic that faces great risk from heat is almost identical,鈥� Papaefthimiou says.

Over the next couple of days, Washington and a group of staff identified their most vulnerable clients, recruited volunteers, and started making calls. 鈥淲e were asking, 鈥楧o you have a fan? Do you know this heat is coming? Are you prepared? Could you get to a cooling center? Do you know where [the nearest one] is?鈥� Washington says. 

She and her team at Meals on Wheels collected donated fans and air conditioners, which the organization鈥檚 drivers brought with them on their food-delivery routes. The team conducted wellness checks by phone and helped clients find rides to cooling centers. 

Washington remembers calling a woman in her 80s who said she had just fainted, had a headache, and didn鈥檛 feel well. 鈥淲e sent out help,鈥� Washington says. 鈥淭hat person was in the heat-exhaustion phase and heading toward the next phase鈥濃�攈eatstroke, a life-threatening condition. The quick actions and persistent outreach of Portland鈥檚 local Meals on Wheels chapter most certainly saved lives.

Meals on Wheels, which originated in the United Kingdom during the Second World War, is not a climate organization鈥攐r even an emergency-response organization in the traditional sense. Rather, the program is best known for delivering hot meals to lower-income seniors. 

Researchers have found that nonprofit meal-delivery programs can reduce loneliness, risk of falls, and the need for institutional care.

But in recent years, as climate disasters increase in frequency and intensity, the broader mission鈥攖o 鈥溾�� of the seniors Meals on Wheels programs serve鈥攈as taken on new urgency.

Climate-related disasters, like extreme heat, hurricanes, and wildfires do not affect all populations equally. If you鈥檙e Black, or poor, you鈥檙e more likely to live in an that can get dangerously hot during a heatwave. You鈥檙e also to live in a low-lying area prone to hurricane damage and flooding.

People who are older, who have limited mobility, and who are isolated are among the during climate emergencies. In Multnomah County, which encompasses Portland, 56 of the 69 people whose deaths were were over 60 years old. Forty-eight of the dead had lived alone. 

There are more than 5,000 Meals on Wheels programs across the country serving more than 2.4 million people, according to , the leadership organization that supports local branches. These programs, which often have , have been shown to improve older Americans鈥� diets and nutritional intake, but their benefits go beyond food security.

Heat kills about 12,000 Americans each year, and around 80% of those deaths are in . When Hurricane Ian last year, most of those who died were over 60. When the Camp Fire engulfed the California town of Paradise, killing 85, the of the dead was 72 years, according to a Cal Matters analysis.

鈥淎nytime you鈥檙e dealing with a natural disaster or climate change-related event, you鈥檙e dealing with events that cause morbidity and mortality and ultimately lead to people succumbing to their chronic medical illnesses,鈥� says David Dosa, a geriatrician and researcher at Brown University. 

Older people are more likely to struggle with mobility, making it more difficult to evacuate an area that is flooding or in the path of a wildfire. They are also more likely to have health issues that require electrical devices, such as oxygen tanks or refrigerators for medicine, making power outages potentially deadly. And they are more likely to suffer from chronic conditions exacerbated by stress.

鈥淲hen 鈥楳rs. Smith鈥� dies in her apartment a week after a heat wave, she鈥檚 dying of COPD [chronic obstructive pulmonary disease] or heart failure. She鈥檚 not necessarily 鈥榙ying of the heatwave,鈥� even though chances are good that she was destabilized by the heat,鈥� Dosa says. 鈥淭he real body count ends up being much higher [than the official count],鈥� he adds.

Residents of assisted living facilities don鈥檛 necessarily fare better during emergencies. According to a released in February of this year, extreme weather events in 17 states have forced evacuations or led to injuries and deaths in long-term care facilities. In Florida, nine residents of a single nursing home after Hurricane Irma knocked out the facility鈥檚 air conditioning.

What does keep people safe is contact with others and contingency plans鈥攕uch as having a list of emergency contacts on the refrigerator and enough food, water, and medication on hand to last several days鈥攕ays Dosa.

As Hurricane Ian approached South Florida last year, Stefanie Ink Edwards, CEO of and head of Fort Myers鈥� Meals on Wheels, raced to distribute hundreds of hurricane kits with water, nonperishable food, flashlights, and batteries. Staff and volunteers offered rides to shelters and made sure clients had those emergency numbers on the fridge. 

The storm hit Fort Myers on Wednesday, September 28, 2022. That night Ink Edwards could barely sleep. 鈥淚 was so worried about all of our homebound seniors, some of whom lived in really low-lying areas,鈥� she says. 鈥淭hat鈥檚 the really scary part for us, not so much the preparation for the storm but鈥攚hat鈥檚 it going to look like during the storm and then after? Are we going to be able to get to them?鈥� 

The following morning, Ink Edwards inspected the organization鈥檚 kitchen and was relieved to discover it had sustained minimal damage. 鈥淏y Friday, we were delivering meals and supplies again,鈥� she says.

The roads were littered with debris, and clients had a litany of requests: bottled water, a generator for an oxygen tank, help to remove a branch that had crashed through a roof. 鈥淲e do whatever we can,鈥� says Ink Edwards. 鈥淲e鈥檒l end up finding a roofer, but in the interim, to put the Band-Aid on it, my volunteers and staff are the ones tarping roofs.鈥�

Researchers have found that nonprofit meal-delivery programs can , , and the . One economic analysis of the model found that a in the number of people using the service was associated with a $109 million reduction in Medicaid spending.

鈥淲hat sets these programs apart is the daily interaction鈥攖he informal wellness check-in and the socialization that recipients receive by nature of these meals showing up at lunchtime, every day [or] multiple days a week,鈥� says Kali Thomas, a researcher at Brown University who has authored several studies on meal-delivery programs. 

In New York, the COVID-19 pandemic exacerbated one of the most dangerous hazards of old age: isolation. 鈥淭here are still so many who are afraid to go out, afraid to shop,鈥� says Beth Shapiro, the executive director of . 鈥淭he meal and the check-in coming to their door are really a lifeline.鈥� 

Jackie, a 73-year-old Queens resident and Citymeals client who asked that her last name be withheld, says she looks forward to her six-days-a-week deliveries. Two volunteers鈥擯ablo and Veronica鈥攖ake turns dropping meals off at her home. 鈥淚t鈥檚 like having a niece and nephew visit every day,鈥� she says. 

Jackie, who struggles with shortness of breath, heart palpitations, and poor vision, has lived alone since her mother died several years ago. 鈥淚 hibernate when it鈥檚 hot out because of my breathing problems,鈥� she says. During the summer, she relies on a single air conditioner in her living room and deliveries from her local pharmacy and deli to stay out of the heat. 鈥淚鈥檓 fortunate to have people like that because when you鈥檙e alone鈥攏o family, no siblings鈥攜ou have to be independent,鈥� she says. 

Jackie says that Citymeals has the phone number of one of her friends, who lives down the street. 鈥淚f for some reason I don鈥檛 answer the phone, they鈥檒l call her to make sure that she [knows I鈥檓] OK. If they can鈥檛 get ahold [of me or] her, they鈥檒l call 911 to make sure that I鈥檓 not dead or unconscious on the floor.鈥� (Cities, including New York, have adopted similar to keep vulnerable residents safe during heatwaves.)

During the first two years of the pandemic, Citymeals on Wheels more than doubled its annual deliveries and started substituting in-person visits with wellness calls. Volunteers have largely gone back to making in-person visits, but Shapiro says her organization is investing in expanding its check-in call program. 

Citymeals is also training volunteers to identify signs of heat-related illness. 鈥淭he people we鈥檙e feeding are living on extremely fixed incomes,鈥� says Shapiro. 鈥淭hey鈥檙e making the decision to鈥攊f they have an air conditioner鈥攖o turn it on or not. So we have to be very aware of what鈥檚 going on and check in.鈥�

For Shapiro, the climate crisis hasn鈥檛 changed Citymeals鈥� mission so much as focused it. After Hurricane Sandy, the organization bought a 25,000-square-foot building in the Bronx to use as its operations hub. Shapiro never thought they鈥檇 use the entire building: 鈥淎nd then came COVID, and we were filled to the gills.鈥�

She adds, 鈥淪o much of our planning is now around emergencies.鈥�

This story originally appeared in , an editorially independent, nonprofit news service covering climate change. Follow .