[Senate Hearing 112-421]
[From the U.S. Government Publishing Office]
S. Hrg. 112-421
KEEPING OUR PROMISES TO WEST VIRGINIA'S SENIORS: STRENGTHENING THE
AGING NETWORK
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
CHARLESTON, WV
__________
FEBRUARY 13, 2012
__________
Serial No. 112-13
Printed for the use of the Special Committee on Aging
Available via the World Wide Web: http://www.fdsys.gov
SPECIAL COMMITTEE ON AGING
U.S. GOVERNMENT PRINTING OFFICE
73-971 WASHINGTON : 2012
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20402-0001
HERB KOHL, Wisconsin, Chairman
RON WYDEN, Oregon BOB CORKER, Tennessee
BILL NELSON, Florida SUSAN COLLINS, Maine
BOB CASEY, Pennsylvania ORRIN HATCH, Utah
CLAIRE McCASKILL, Missouri MARK KIRK III, Illnois
SHELDON WHITEHOUSE, Rhode Island DEAN HELLER, Nevada
MARK UDALL, Colorado JERRY MORAN, Kansas
MICHAEL BENNET, Colorado RONALD H. JOHNSON, Wisconsin
KRISTEN GILLIBRAND, New York RICHARD SHELBY, Alabama
JOE MANCHIN III, West Virginia LINDSEY GRAHAM, South Carolina
RICHARD BLUMENTHAL, Connecticut SAXBY CHAMBLISS, Georgia
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Debra Whitman, Majority Staff Director
Michael Bassett, Ranking Member Staff Director
CONTENTS
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Page
Opening Statement of Senator Joe Manchin III..................... 1
PANEL OF WITNESSES
Statement of Shelley Moore Capito, U.S. Representative, Second
Congressional District, WV..................................... 3
Statement of Kathy Greenlee, U.S. Assistant Secretary for Aging,
U.S. Department of Health and Human Services, Washington, DC... 4
Statement of Suzanne Messenger, State Long-Term Care Ombudsman,
West Virginia Bureau of Senior Services, Charleston, WV........ 15
Statement of Brenda Landers, Director, Metro Area Agency on
Aging, Dunbar, WV.............................................. 17
Statement of Janie Hamilton, Director, Kanawha Valley Senior
Services, Charleston, WV....................................... 19
Statement of Helen Matheny, Director, Alzheimer's Outreach and
Registry Program, Blanchette Rockefeller Neurosciences
Institute, Morgantown, WV...................................... 22
Statement of James Clagg Volunteer, Milton Senior Center, Milton,
WV............................................................. 24
APPENDIX
Witness Statements for the Record
Kathy Greenlee, Assistant Secretary for Aging, U.S. Department of
Health and Human Services, Washington, DC...................... 38
Suzanne Messenger, State Long-Term Care Ombudsman, West Virginia
Bureau of Seniors Services, Charleston, WV..................... 49
Brenda Landers, Director, Metro Area Agency on Aging, Dunbar, WV. 56
Janie Hamilton, Director, Kanawha Valley Senior Services,
Charleston, WV................................................. 64
Helen Matheny, Director, Alzheimer's Outreach and Registry
Program, Blanchette Rockefeller Neurosciences Institute,
Morgantown, WV................................................. 69
James and Ellen Clagg, Volunteer, Milton Senior Center, Milton,
WV............................................................. 75
KEEPING OUR PROMISES TO WEST VIRGINIA'S SENIORS: STRENGTHENING THE
AGING NETWORK
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MONDAY, FEBRUARY 13, 2012
U.S. Senate,
Special Committee on Aging,
Charleston, WV.
The Committee met, pursuant to notice, at 9:46 a.m. in the
1st Floor Ceremonial Courtroom, W. Kent Carper Justice and
Public Safety Complex, Hon. Joe Manchin presiding.
Senator Manchin [presiding].
Also present: Representative Capito.
OPENING STATEMENT OF SENATOR JOE MANCHIN III
Senator Manchin. Good morning. How are you all? Thank you
all for coming. We really appreciate it.
Miss, are you ready? I can see we can start.
First of all, let me welcome all of you. I want to thank
Congresswoman Capito for being with me. I want to thank Senator
Rockefeller's office. Rocky is here, and their representatives
are here, and my office is with me. I have Lauren Alfred with
us, our senior age consultant, if you will. She runs our aging,
our Medicaid and Medicare health care, and also education. So
Lauren does a great job. We appreciate her.
I now call this Special Committee on Aging hearing to
order, and I want to thank all of you for coming. I'm pleased
to have the opportunity to bring the Aging Committee to West
Virginia to discuss commonsense ideas for the future of senior
services in this country, because in West Virginia we know how
to set our priorities around our values, and I think we've done
it well with the services we give.
As many of you know, when I was governor, we set a budget
that got our fiscal house in order, but we did so while
prioritizing our seniors and increasing resources for senior
services by 83 percent. I have Sandy Vanin with us. Sandy was
my senior director at that time, and we really put our money
where our mouth was. We placed food trucks in all 55 counties.
We targeted funding for Alzheimer's, respite care and elder
watch programs, provided seniors with the support they needed
to continue to live in the comfort of their own homes, and I am
proud of what we have done in West Virginia, and I am committed
to bringing these commonsense lessons to Washington so that we
can keep our promises to our greatest generation.
In recent years, the need of senior programs and services
has only increased as our seniors are living longer and facing
difficult economic times. Last year, the first of the 77
million Baby Boomers turned 65, and now every day for the next
18 years over 10,000 seniors will turn 65 and become eligible
for senior services and entitlements. I myself will turn 65,
and I tried to find out who in my staff put that in.
[Laughter.]
They have all denied it, but we think it was Lauren, making
these issues all the more salient to me. As my generation
ages--and I don't think that I am; I'm still in denial, and
we've talked about all this before, I'm having a hard time--
there's no doubt that we will place unprecedented demands on
the national budget and resources because of my age, not my
needs right now, thank goodness. Now more than ever, we need to
be ready to help seniors stay healthy and independent as they
age.
Today's hearing will focus on how we can strengthen our
system of Federal, state, and local senior service agencies
known as the Aging Network to meet the growing needs and
challenges of the Baby Boom generation and preserve these
critical services for future older Americans. If you can think
about how many times you hear us in government talk about one-
stop shopping, even in the retail private sector, one-stop
shopping, make it easy and convenient, we want one-stop
service. I want to make sure that as we grow older, we know
exactly that we can go one place and find out everything that
we have available to us, are entitled to, and what we can
access.
The Older Americans Act, which was signed into law in 1965,
funds the majority of programs and supports for our seniors,
including Meals on Wheels, caregiver help, health promotion,
elder abuse prevention. Every five years, Congress takes a
fresh look at programs in the Older Americans Act to assess
whether they're meeting the needs of the people they serve.
This year, Congress is due to reauthorize the Older Americans
Act, and I look forward to bringing many of the ideas and
comments that we receive today to Washington to improve the new
bill.
As Congress revisits this legislation and at the same time
works to tackle our rising deficit, I believe we must identify
inefficiencies and redundancies in the system because wasteful
spending should be the first to go. Our National Aging Network
is made up of 56 state units on aging, 629 Area Agencies on
Aging known as AAAs, 20,000 service providers and thousands of
volunteers. In a system this big, there are bound to be
inefficiencies and a great deal of room for improvement through
coordination, flexibility, and innovation. This is one of the
key issues that we'll address today.
I have asked stakeholders from across West Virginia's aging
network, from the state government to local volunteers on the
ground, to come together to discuss their ideas for bringing
services to more seniors more efficiently, and you have come,
and I appreciate that.
We're also fortunate to be joined by U.S. Assistant
Secretary for Aging, Kathy Greenlee. Kathy comes from the State
of Kansas, and the governor of the State of Kansas at the time
was Kathleen Sibelius, who is now Secretary of DHHS. I worked
with her as a governor. I know that Kansas has a lot of the
same concerns and demographics that we have, and I appreciate
you being here, Kathy.
I'd like to thank all the witnesses who have joined us here
this morning. I am eager to hear your thoughts and ideas for
improving the way we deliver services to seniors.
What we're going to do, I'm going to turn to my friend and
colleague, Congresswoman Capito, for her opening remarks now,
and we will continue with our first panel.
Congresswoman.
STATEMENT OF HON. SHELLEY MOORE CAPITO, U.S. REPRESENTATIVE,
SECOND CONGRESSIONAL DISTRICT, WV
Representative Capito. Thank you. I'd like to thank the
Senator for including me today. This is a great display of
bicameral bipartisanship.
Senator Manchin. The way it should be.
Representative Capito. Yes, the way it should be. But as
you know, West Virginians are all pretty close, and the Senator
and I have known each other for a very long time. So I
appreciate him including me in this.
I'm just going to briefly say that there is no more timely
issue for--even though I'm not turning 65 this year, I am in
that sandwich generation where I have my parents and then still
my children. They're almost out of the nest, but--well, they're
out of the nest, but they would like to think--but you know
what I'm saying here. There's a lot of pressures, and I think
it's important in terms of coordination of care, of the
financial resources, the legal issues that you touched on in
terms of senior financial abuse, the vulnerabilities of our
seniors, and the transitioning of our parents into a different
way of living and a different way of coping with their
situation.
And as you all probably know, I'm dealing with this very
personally in my own way with my brother and my sister, and
there is no single manual that says if you find A, then you do
B; and once B happens, then you turn to C.
It is difficult to move through the systems. It's difficult
to understand what's happening, not just as a daughter but for
them to understand what's happening. And so this has been an
educational experience for me, so I really take to heart what
everybody is going to tell us today and what you all as
advocates in the audience do every single day to make sure that
families have access to care.
If you had a family that didn't--I mean, if you had a
senior that didn't have a family, and the Senator alluded to
this, it would just be tragically difficult for that senior to
try to figure out on their own, or to even know where they are.
I noticed there's a registry for Alzheimer's patients and folks
that have been diagnosed. I'm guaranteeing you, it's way
underestimating what is really going on in this state and in
this nation, because I can guarantee you neither one of my
parents is probably on that registry. So we need to talk about
that.
But in any event, you can see it's a very personal thing
for me, so I'm very, very pleased to be here today. We have a
lot of great resources both at the Federal and state level. We
just need to make sure that we have the coordination, the
awareness, the education, because we have the dedication and
the love and the caring that we need to move forward in this
very difficult arena.
So with that, thank you again for including me, and I look
forward to hearing the witnesses.
Senator Manchin. Thank you, Congresswoman.
Before we start, I would like to reiterate what
Congresswoman Capito said. Her parents, as they are needing
some services, I can tell you my mother--I would like to know,
if my mother did not have the family support, if my sister and
my brother-in-law and my cousins and nephews weren't taking
care of her on a daily basis, what type of life would she have
right now? I think that's what I'm trying to find out, because
I know other people aren't as blessed as I am to have the
family support that we have.
And with that being said, that person still deserves that
love and care no matter whether they have a family or not that
can do it, and not everybody can do it. So that's really the
purpose of what we're doing here today.
So with that, our first witness today is Kathy Greenlee.
Kathy is Assistant Secretary for Aging at the United States
Department of Health and Human Services. Kathy Greenlee brings
over a decade of experience advancing the health and
independence of seniors and their families. Prior to becoming
Assistant Secretary, Ms. Greenlee served as Secretary of Aging
for the State of Kansas, as well as the Kansas State Long-Term
Care Ombudsman.
Ms. Greenlee, or better known as Kathy, thank you so much
for being here, and we look forward to your remarks.
STATEMENT OF KATHY GREENLEE, U.S. ASSISTANT SECRETARY FOR
AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES,
WASHINGTON, DC
Ms. Greenlee. Thank you, Senator.
Do I need to turn this on?
Senator Manchin. No. We have you loud and clear.
Ms. Greenlee. Very good.
Senator Manchin. This is the state of the art. Kent Carper
and the County Commissioner----
Ms. Greenlee. The light is red.
Senator Manchin. Oh, it stays red here. It stays red.
[Laughter.]
Ms. Greenlee. Thank you, Senator. It's a pleasure to be
with you today for a special hearing of the Senate Special
Committee on Aging; and thank you, Representative Capito, for
also being here to participate.
This has been a fabulous experience and tremendous honor to
serve as United States Assistant Secretary for Aging, and this
is the fourth time I've been able to attend a special committee
hearing outside of Washington. I also travel the country, visit
with seniors in all settings, from community services to long-
term care settings, and what you are discussing today is
happening all across the country, the number of seniors turning
65, the number of seniors who are now very old and very frail
who need services and supports.
In December, I had the opportunity to participate in the
50th anniversary celebration of the Senate Special Committee on
Aging. In addition to talking about seniors that day, there was
something that became very, very clear, something that we all
know and that is reflected by the two of you joining us today.
This is not a partisan issue. Aging and aging services, and
certainly the Older Americans Act, has a history of bicameral,
bipartisan support. I think it's a non-partisan issue and
something that affects all of our families, all of our lives,
and eventually ourselves. And so I just wanted to thank you for
your leadership by being here to demonstrate that this is
really about all of us and our families.
As I work with the Older Americans Act and the aging
services network, there are a number of significant values that
I see that we share, helping older Americans and persons with
disabilities maintain their health and their well-being so they
are able to live independently with dignity for as long as
possible. We have developed and implemented person-centered
approaches. We've supported self-determination, respect,
empowerment, and inclusion.
The Older Americans Act helps protect the most vulnerable
among us, and it helps provide basic respite care and support
for families so that they are better able to help take care of
their loved ones, which is what all Americans overwhelmingly
prefer, that they have the support of their family and their
friends and their communities as they age in place at home.
Last year, the national aging services network served
nearly 11 million seniors and their caregivers, 11 million.
And, Senator, that network is the one that you described. I
oversee a very unusual Federal structure where we are very
small at the Federal level. We send our money directly to the
States, to the area agencies on aging, to tribal organizations,
and through that network there are 20,000 service providers who
provide direct care; in addition to that, thousands and
thousands of volunteers who do everything from deliver meals to
provide long-term care ombudsman support. These are the
backbone of the nation. These are the backbone services that
provide care.
Eighty percent of all long-term care in this country is
still provided by families, and this is how we support this
vital network. It's also important to note that the key
distinction of the Older Americans Act is that it complements
medical and health care assistance. It does not duplicate those
systems. And this assistance is critical in helping seniors
remain independent.
The flagship program that we have, the one that has always
been the largest through the Older Americans Act has been the
nutrition program. It's 40 percent of the support that we
provide to local communities and to States, whether it's home-
delivered meals or congregate meals. But often a meal is not
enough. The people need other kinds of supports, the kinds of
supports that you deliver here, transportation assistance and
rides, bath assistance, in-home supports, caregiver supports.
Seniors need a complex array of services.
The first time I testified at a field hearing for the
Senate Special Committee before Senator Kohl in Milwaukee, not
surprising since he is the committee chair, and he had someone
testify there who pointed out something that I had not really
realized until that hearing, hearing from a consumer who
pointed out that the Older Americans Act is the original home-
and community-based service system. It has been around for a
very long time and is the core strength that we have, often
supplemented by State dollars to help seniors stay independent.
Here in West Virginia, in fiscal year 2010, nearly 50,000
persons over the age of 60 received supports through this aging
services network. Of that 50,000, 30,000 lived in a rural part
of the State. This is not a surprise to you as elected
officials, that we must target the real parts of this State
because often people are isolated and vulnerable and live alone
in remote locations.
We provide rides, home-delivered meals, and support senior
centers. This assistance is well represented by the panel that
you have following me, the long-term care ombudsman, the people
who work for the financial exploitation task force, the people
who are providing direct services through the area agency on
aging. This is the core of our network, senior centers are
where the services are ultimately delivered.
I tremendously value the area agencies on aging, but I
think the best place to visit is the senior center, because
that's where the seniors come for services, supported, of
course, by the area agency on aging. This is important
community assistance but is challenged by the number that you
pointed out, Senator, the number of seniors turning 65 every
single day.
Fortunately, I believe we have some time to plan, not that
we have time to waste, but most people do not need services at
65, but they need them by the time they're in their late 70s or
80s, and this is a critical time that we support the services
that we have.
The Older Americans Act, which is the program that I'm
responsible for, helps in three main ways. The Older Americans
Act programs help Americans with severe disabilities remain
independent and in the community. We can measure the frailty
level of the people that we're serving, and we have put
together one of the measurements that's called a nursing home
predictor. Without these services, just as you said, Senator,
what would happen to this individual, and we can tell over the
course of the years that the people we serve through the Older
Americans Act are more and more frail, more and more likely to
need nursing home assistance without these vital community
supports.
Our programs are efficient. Our funding has stayed
primarily flat. But because the money is leveraged at the local
and community level, we have been able to serve more clients
with the same amount of dollars. And because of this
leveraging, the Older Americans Act services help build
capacity in the network. It was never designed to be the whole
show, but always an anchor around which you wrap State
supports, community supports, private support, faith-based
organizations. This is really, I see, the center beam around
which we provide a variety of community services. It's always
meant to be and it's always designed to be a grassroots system,
as you have reflected here with you today.
It is important that we continue to make advancements, that
we take advantage of technology, that we have enough
flexibility to try innovation. How can we use technology to
help reach the remote seniors that you have in this State, as
well as across the country? How can we be innovative in
providing all of the services that we support and fund?
As you know, the Older Americans Act is up for
reauthorization. It was actually up for reauthorization in 2011
and has not been reauthorized. Senator Sanders on the Senate
HELP, Pension and Aging Subcommittee, who is in charge of
reauthorization, is tremendously committed to reauthorizing the
Older Americans Act, and we continue to work with the Senate
very closely so that we can move this reauthorization.
There are some fundamentals that I would like to talk about
before I close about the Older Americans Act. When I first
started, I spent most of the first year as Assistant Secretary
traveling the country to get input from local providers, and
here's what I learned about the law. It's working. It's not
broken. And this is an opportunity to talk about the future as
we talk about the Older Americans Act. There's nothing wrong
with the law, and this is not a time when we need to go in and
fix something but go into the law and figure out how it can
continue to be improved.
It is the glue that holds the entire national system of
long-term support together. It is meeting the goals established
by Congress. It meets the goals of targeting the people who are
most vulnerable, people who are poor, people who have chronic
diseases, people who have high risk for nursing home placement,
people who are frail. It is meeting the objectives, and I
always look forward to opportunities to figure out how we can
do more, how we can find more partnerships.
I will give you an example of one that's not in my
testimony. We have reinvigorated our relationship with the
National Institute on Aging to find out what are the best
evidences that they have on how they can help develop evidence-
based programs that we can deliver through the aging network.
We are ready to have good science behind the social services
that we deliver, and the Older Americans Act and its network is
as strong as ever.
We are here to partner with you. We believe that the
pending reauthorization could be passed, needs to be passed,
and by doing so we can really look at the challenges of an
aging population that are increasing, help individuals maintain
their health and independence, and continue to be able to focus
on the person.
This is where I'd like to conclude, that the beauty of
having this particular law is that it's able to do as you
talked about, Representative Capito, come in and evaluate one
person at a time regardless of their race or income or
geographic location, regardless of their situation in life, to
determine what do they need, what are their frailties, how can
we provide assistance, and if those change next year, we'll
provide different additional ones.
This is the beauty of how this law has always been
developed, that it is person-centered, that it reflects the
very unique needs of each individual senior as they age in this
country. Thank you very much.
[The prepared statement of Kathy Greenlee appears in the
Appendix on page 38.]
Senator Manchin. Secretary Greenlee, thank you so much for
your remarks.
Let me preface. I have about three quick points to make,
and then I'd like to hear your response.
Before I do that, the most sobering moment I've had as a
senator was when I sat in the Armed Services Committee and I
asked at that time Admiral Mullen, who was then chairman of the
Joint Chiefs of Staff--this is the entire Department of
Defense, military, everything that protects us in who we are as
a country--and I asked him, I said what's the greatest threat
the United States of America has right today? This was maybe
three or four months ago.
Now, there's a lot of things I was expecting, an array of
answers. Was it Al Qaeda? Afghanistan? Iraq? Was it Iran? North
Africa? Or was it Russia? Or was it China building up their
military? I could have gotten an array of answers.
He didn't even flinch. You know what he said? The deficit
and debt of this nation is the greatest security risk we have
as a nation. He didn't think there was an army that would pose
that much of a threat. He didn't think that there was any
foreign element that would pose a threat to us as a nation.
But our debt and what we're carrying right now, the
financial burden--and we've talked about this--if we don't fix
it--we're now, our debt ceiling is able to go to $16.4
trillion. If we don't bring this under control--so I'm
prefacing it by saying what our challenges are and why we have
to be so much better and smarter.
We will be the first generation to turn over the keys to
our children in worse shape than our parents gave it to us.
We'll be the first. All of us will be guilty to be the first to
let that happen if we don't stand up.
With that being said, that's more to the point of what I'm
going to be asking. We brought all the different people who are
on the front lines in West Virginia, and you'll hear from them
in a second panel.
Can you tell me more, Secretary, about how you're building
collaborative partnerships with Federal and state community,
how you're looking for that efficiency, and basically the point
of service where it gets the most traction, if you will, the
most good to the people?
Ms. Greenlee. Let me answer your question in two parts and
first talk about the debt part, the financing part that you
prefaced.
What we know, those of us who provide services through the
Older Americans Act systems, the people behind me who provide
these services, is that if these services were not in place,
many, many people would then become reliant more quickly or
eventually on public programs; that it's very important that we
help--Older Americans Act services are cost effective, they're
fairly inexpensive, and they can help someone stay in their
community for as long as possible.
Once someone has to leave and go to a nursing home that
type of care in that setting is tremendously expensive, and
many people who get to the nursing home spend down within the
first year and become eligible for Medicaid. So from both good
people policy and good fiscal policy, community services are
much more cost effective, and I think that's the real value
that we have in providing Older Americans Act services.
But the world has become increasingly more complex for
seniors to navigate between the VA and Medicare and Medicaid
and these local services. The way the Administration on Aging
has been addressing this was first realized in the mid-2000s.
In the 2006 reauthorization of the Older Americans Act, we
implemented for the first time aging and disability resource
centers. All of your area agencies on aging here in West
Virginia participate as aging and disability resource centers.
And the best way for me to describe to you what that is,
it's a capability or a quality that the people in that resource
center can help someone access everything they need in the
community, whether its community supports from the government,
whether it's social service supports in the community. What we
have known in the aging services network for decades is that
our best asset is sometimes not the services we deliver but the
knowledge in our brains about how we put together services and
supports, formal services, informal services.
What the aging and disability resource centers do is the
piece that you're recommending. How do we have a one-stop shop,
someplace where there's one person who an individual can call
so you can say, oh my goodness, I don't know where to even
begin. Where there's someone who can do an assessment of the
loved one if they need it or help provide support for the
family caregiver, or help figure out if there are other
government services or other kinds of assistance that the
senior may need?
It is an extremely complicated system, and often people
will--I think people arrive at that system one of two ways, in
a crisis where mom falls and breaks a hip and the mom is at the
hospital, or with a family who has a senior who continues to
age and need more and more care at home. We can provide
assistance for all those scenarios.
Senator Manchin. Certainly with the budget crisis that
we're facing in Washington, we've been blessed in West Virginia
and we have our house in pretty good order, if you will, and
they're working on making it even better, but the challenges
are still there. But in Washington, knowing that we're going to
be facing some--every agency is going to be asked--every agency
is going to say, yes, but we're much more important, so we want
you to protect us; if anything, increase our funding. We're
going to have to make the hard realization that everybody can
work better and more efficiently.
Where do you see the efficiencies that you could, in your
crystal ball, looking at where you're seeing it from 40,000
feet now being in Washington, looking down at what every agency
is facing, how can we provide more services to more seniors
probably more efficiently, cut out the waste, fraud and abuse?
The GAO last year said $125--we knew that $125 billion was
misspent on most of our social services. When I say that, the
abuse, fraud, and waste that went into it. And when I went to
Washington, the first time I was there, they were going to cut
Head Start, the poorest of our children. They were going to cut
Social Security. They were going to cut Medicare and Medicaid.
I think who else is left to throw under the bus?
But if we could run it more effectively and more
efficiently, can we get better services and still have the
responsibility of our budget crisis that we're having? How
would you recommend and where do you see we can go?
Ms. Greenlee. Senator, I am a long-time public servant as
well, two decades in public service at the state level and the
Federal level. I agree with you but also would like to, point
out one key fact with regard to the programs that I run.
The Older Americans Act at the Federal level is a
relatively small investment. My budget on an annual basis will
sound big in West Virginia dollars, are real dollars, $1.6
billion. That's my annual budget. That's roughly what Medicare
pays each and every business day in this country every year. So
it is very small, and I always am concerned and responsive when
people talk about fraud and abuse.
We have program integrity measures. Every couple of years
there will be a provider in our network that runs off with some
money. But this is not a network that's replete with fraud and
abuse. It's not a network that drives significant enough
dollars to attract criminals. It's just really small.
I think the best way that we leverage the resources is to
partner with our bigger Federal partners. I believe there's a
relationship, or there needs to be improved relationships
between community services and medical services, for example,
that the doctors and the hospitals provide something as basic
as care transition to their home so people discharged from a
hospital know about these local services and the need to help
support the local services.
We have built silos of care, whether it's acute medical
care or long-term care or community services, and the most
holistic approach is to stitch them together so you've got one
person who needs a little bit of community services, who needs
a little bit of long-term care support, and they occasionally
need to see the doctor or go to the hospital.
The opportunities in the Affordable Care Act that I see are
for us to be innovative. I also think we have to look in other
directions. I spend a great deal of time talking to my
colleagues at the Health Resources Services Administration.
There are Federally-qualified health clinics all around this
country, and I have found since I came to Washington something
that concerns me, which is there are parts of the country where
the Federally-qualified health clinic doesn't know the area
agency on aging, and they're all providing services to seniors.
So we have to do an increasingly better job of outreach
both at the Federal level and at the community level to make
sure that we can help seniors navigate all of these systems,
because of the Federal budget and the strain on the State
budgets, our budgets are not growing. They're remaining
relatively flat, and we have more need.
Senator Manchin. A final one before I turn it over to my
colleague. As you know, West Virginia is a small state, and we
have about 15 percent of our population over 65 years of age,
which makes us the second most aged state in the nation on a
percentage basis.
With that, under the Older Americans Act, the funding is
done based on size and not specifically on need, mostly in the
nutrition. I'll tell you where I'm coming from. In nutritional
services, Florida receives 10 times more dollars than we do but
only serves four times more meals than we do, and that just
seems inherently unfair, and that's what we're seeing based on
need. And we're doing a heck of a job, but we have an awful lot
of people in a rural area that depends on us.
So we're out there working and going out and being able to
provide these services. So we're saying can fairness be brought
to that system? Funding solutions and what you're saying, the
story you just told us about efficiencies that you have, you
need to tell that story more. When you start saying that we
spend every day $1.6 billion in Medicare, and your total annual
budget to help all 50 states and the territories is only $1.6
billion, it pretty much sends a message.
With that, we all still have to look for our efficiencies
if we can do something better. But with what I just pointed out
to you, the inequity in the system, the way the monies are
spent, taking into consideration--I don't think they do--the
rural state, the Older Americans Act--the ruralness of our
state, the amount of people we're serving, and the dependency
that people have, how would you approach that?
Ms. Greenlee. Senator, the money that we have through the
nutrition program, both on the congregate side and in the home-
delivered program, is administered through an interstate
funding formula to every State based on the number of people in
the State over the age of 60. So it is a demographic
distribution based on the people over the age of 60.
But to respond to the point that you made, which is what if
we're serving more meals, we also have a smaller nutrition
program that's not as well known, which is the Nutrition
Services Incentive Program, which follows along afterward to
help provide incentives and reward people who do the most with
the money that they get, who serve more people with that money.
You are a particularly rural State. The Older Americans Act
requires that the State and the area agencies target certain
populations, and in West Virginia you would automatically
target rural. In Florida, they have larger numbers of people of
color and minorities. They're also listed as a high-profile
State. There are States that have people who are also remote. I
could talk to my friends in Alaska who also have tremendous
transportation challenges.
So we do a base funding, and then we follow along to reward
incentive because each State has kind of a slightly different
high-needs area that they're serving.
Senator Manchin. Thank you so much, Kathy.
And now for Congresswoman Capito's questions.
Representative Capito. Thank you. I'm just going to follow
briefly up on what the Senator said. With the $1.6 billion, if
you could just kind of walk me through, that's the Older
Americans Act appropriation for annual appropriation.
Ms. Greenlee. Yes.
Representative Capito. So then parts of that is nutrition?
How does that fold out, just really briefly? How does that fold
down to the state? Because you said mostly it is then just
pushed out to the states. So we're different pockets. Obviously
nutrition is, what, about 40 percent of your budget?
Ms. Greenlee. It's about 40 percent of our program dollars.
Most of the money that we have is distributed based on a
formula. So we have some competitive grants. We've done a lot,
for example, in the field of Alzheimer's and some other
evidence-based programs. Almost all of the money is sent to the
states based on the Census.
Representative Capito. So there's nutrition. And then what
would your other pockets be?
Ms. Greenlee. Then we have in-home supports.
Representative Capito. Okay.
Ms. Greenlee. We have nutrition. We have the family
caregiver program. We have some smaller parts. It's probably
the smallest one we have, for health promotion, where we're
doing a lot of chronic disease management, preventive services,
as well as in Title VII, the Elder Rights Program, where we
have some targeted efforts for elder abuse, long-term care
ombudsman, and legal services. Those are divided out per State,
per capita, based on the population of 60 or older, which is
the age of eligibility.
We also have some smaller programs that are directed
specifically to Native American programs, Alaska Natives,
Hawaiian Natives. There's a nutrition program, a family
caregiver program, and, of course, we have a direct government-
to-government relationship with the tribal organizations.
Representative Capito. One of the questions when we were
speaking with the media before we began was do you just need
more money? I mean, we're talking about the constraints that we
have. You mentioned them, too, and where we are for our future.
So we know that that's the big conversation in Washington now.
And certainly if you had your wish list of everything you could
have, more money would probably be at the top of everybody,
whether it's education, military, whatever the government is
involved in.
But it seems like you've accomplished a lot of efficiencies
with the money that you have. So I guess the message I'm
receiving is while certainly more money would be great, you can
still achieve great efficiencies with the $1.6 billion that is
then granted down to the states. Is that a fair statement?
Ms. Greenlee. May I address the money first and just point
out that I was very pleased in FY 2011, Federal fiscal years
2011 and 2012. The President recommended that the Older
Americans Act receive an additional $100 million in funding,
and that was packaged together as a caregiver initiative.
Roughly half of that money would have gone to provide support
to family caregivers and half that money to the care recipient.
Those historic increases, we've not seen that sort of a
recommendation for a decade for the Administration on Aging.
Those increases were not realized, that our budgets have been
flat funded.
Representative Capito. Do you know what he's doing in--he's
putting his budget out today, I guess.
Ms. Greenlee. Yes, but one rule is I don't want to get
ahead of him. He's announcing his budget in a couple of hours.
But I will say that these are tough times, and we have seen
support from both the Secretary and the President regarding the
value of these particular programs. They don't duplicate other
programs. They're critical infrastructure. They complement
other community services.
Yes, I think there's tremendous unmet need, and we do the
most that we can to spend these dollars wisely and to partner
with local communities as well.
Representative Capito. The other thing I just would
reinforce, and we talked about this earlier too, is
particularly in terms of the VA. Just in the brief comments
that we had before when we were talking earlier and from my own
personal experience, there's a disconnect between trying to
figure out how to weave the VA and the Medicare and all the
other services, whether you have your own private-pay personal
care situation or hospice or all the different pockets of
Federal.
I would encourage you, and you've said this in your
remarks, that you're coordinating with the VA, because the VA
has sort of opened up this area as an area of emphasis for
them. When you look at--I mean, we're losing our World War II
veterans, but we're going to have our Vietnam veterans, and
then certainly we want to plan for the folks who are coming out
now so that when in 40 or 50 years, or 30 and 40 years from
now, when they are trying to access these systems, the VA has--
and I know the VA is not your bailiwick, but the VA has morphed
into an area that--and I think they are trying to change where
they can meet those areas. So I would just encourage that.
And the other thing is I see Chuck back there from Roane
County, and another thing I'd like to reinforce, because he
does this at his senior center, is I like the way he has
coordinated not just seniors in a building, but he has young
people in the building, he has small businesses that are--he
has a rather large building, but he has entrepreneurs who are
coming in and trying to do building start-ups. He has after-
school care in the building. So it really does reflect more for
the senior who is getting the care more a community, because
seniors don't live in a--I don't live in a community of 56--I'm
going on 58.
[Laughter.]
of 58-year-olds.
Senator Manchin. I didn't want to remind you.
[Laughter.]
Representative Capito. Yes. Well, I am younger than you.
[Laughter.]
And, you know, seniors don't--the joy that I see, that most
seniors see when they see a baby or a young child, or even an
animal, a dog or a cat or a pet or something like that, I just
think that those kinds of coordinations outside of the umbrella
of senior care is something that we really ought to look at,
and I know you all are looking at it, but it's something that
maybe we ought to put more emphasis on as a nation and create
communities that are more reflective of the general population,
which then would lead to general better health, better mental
health.
So with that, if you want to comment on that----
Ms. Greenlee. Just briefly about both. With regard to the
VA, I completely agree with you. I believe in this network, and
we do the right thing even when we don't get paid for doing the
right thing. In 2008, the Administration on Aging began to
partner with the Department of Veterans Affairs (VA) because we
had soldiers coming home from the two wars at that point who
didn't have resources in the community, that the VA had not
built a home and community-based infrastructure.
So, because we saw the value of the network, what we could
provide given our skill set, VA began a brokerage arrangement
where we said VA, let's introduce you to our network so that
they can bill directly for their services to the VA. The VA is
completely committed to this program. It is growing. Every year
they provide more resources, and they're moving to take this
nationwide, to use that infrastructure.
And then on your second point, I never talked about this in
a hearing before, but I will tell you there are occupational
hazards in this job, that sometimes it makes you cry. It just
does, and the people who do this work will tell you, and you'll
probably start crying for different reasons, so I'll tell you
about one where I did, and that was December, not last year but
the year before, when I visited an Alzheimer's program in
Washington, D.C.
Right after I began, I started to tour and look at the
programs in Washington so I would be familiar with what we were
providing, and we were providing services or are providing
support to an Alzheimer's program. In that December, they
brought the children in that were about age 4 to sing, and
really, you just had to cry. When you see seniors and young
people together, especially seniors in a nursing home or people
with dementia, it's just special and very magical, and there
are many places around the country that also see that, that
bring together kind of the whole family, the whole community
because it's valuable to both.
I think it's helpful to seniors, but I must tell you I
think it's also helpful to children so that they continue to
see a positive view of aging and learn all the things we would
hope that they would learn about their elders. So there are
wonderful things that we're doing.
Senator Manchin. Thank you, and thank you, Congresswoman,
for your questions.
I want to thank you for your testimony. If you would,
you're more than welcome to stay right there.
Ms. Greenlee. Okay, I will.
Senator Manchin. And then we'll bring the others. I think
we have enough seats, because I was going to bring you back
anyway. So rather than sending you back and then bringing you
back, you just stay right where you are.
Ms. Greenlee. Okay.
Senator Manchin. Let me just say, first of all, I want to
welcome Senator Ron Stallings, Dr. Ron Stallings for being with
us.
Ron, if you'd stand up.
Ron does a great job.
[Applause.]
Ron is chairman of the Senate Health Committee. He's a
practicing physician. He brings a world of practical experience
to that committee, and I just enjoy working with him.
Thank you so much, Ron.
The first witness on the second panel is going to be
Suzanne Messenger, and I would like for all of our panelists to
come forward, and I'm going to read a little bio on all of you,
and then we'll start right down, if you will. We have Brenda
here, Janie, Helen, and James.
The first witness on the second panel will be Suzanne
Messenger, and Suzanne is a West Virginia state long-term care
ombudsman. I'm sure she'll explain her duties when she starts
speaking. Her job is to empower seniors and their family
members to make informed, long-term care decisions.
Then we will hear from Brenda Landers. Brenda is the
Director of the Metro Area Agency on Aging, one of West
Virginia's four regional Area Agencies on Aging. Her agency
oversees programs delivery in southwestern West Virginia and
contracts with local senior centers to provide meals,
transportation, and other services.
After Brenda we'll be hearing from Janie Hamilton. Janie is
the Executive Director of the Kanawha Valley Senior Services in
Charleston. Her organization provides critical programs like
in-home care, transportation and nutrition services to seniors
of the Kanawha Valley. Janie is also an only child and
caregiver of her 83-year-old mother that lives with her at her
home. So she has the real hands-on experience.
We'll then hear from Helen Matheny. Helen is the Director
of the Alzheimer's Disease Outreach Program at the Blanchette
Rockefeller Neurosciences Institute at West Virginia
University. The aim for her program is to provide physicians
with training and tools to improve screening, diagnosis,
treatment and care of patients with Alzheimer's disease and
related dementias. Ms. Matheny also serves as a member of the
National Advisory Council on Alzheimer's Research, Care and
Services.
And finally we'll be hearing from James Clagg on behalf of
himself and his wife, Ellen. James and Ellen volunteer at the
Milton Senior Center. Ellen serves as assistant treasurer of
the Center and works with the Center's kitchen. James calls
bingo every Tuesday and drives the bus on Center trips. James
and Ellen have been married for 23 years and have lived in West
Virginia all of their lives.
So I want to thank each and every one of you for coming and
taking time to be with us.
And with that, Suzanne, we'll call on you.
STATEMENT OF SUZANNE MESSENGER, STATE LONG-TERM CARE OMBUDSMAN,
WEST VIRGINIA BUREAU OF SENIOR SERVICES, CHARLESTON, WV
Ms. Messenger. Thank you, Senator Manchin and Congresswoman
Capito, for the opportunity to testify here today.
As state long-term care ombudsman, I advocate for the
rights of long-term care residents with the goal of enhancing
their quality of life--a lot of living goes on in long-term
care facilities--and promoting self-determination.
By devoting our time and resources to the areas of
preventing financial abuse and ensuring a robust long-term care
ombudsman program, I believe we can improve the effectiveness
and efficiency of our aging network and continue our mission of
person-centered services.
Although there are many legal definitions of financial
exploitation, it's basically stealing. It can be the simple
unauthorized use of a credit card or it can be a really
complicated fraud scheme.
In 2010, a MetLife study estimated that the annual
financial loss suffered by seniors through financial
exploitation was $2.9 billion. Remember, that's almost twice
the budget of the Administration on Aging, $1.6 billion, $2.9
billion stolen from our seniors.
Exploiters are criminals, but sadly they're often friends
and family members or others that the seniors thought they
could trust. It can be even more complicated when the person is
stealing through legal means, which sometimes happens through a
durable power of attorney, a legal document that provides them
access to the senior's money. These cases often come to the
ombudsman's attention when residents are issued discharge
notices.
The perpetrators spend the money. They don't save it. Many
times the seniors are unaware that it's even happening, and
they're reluctant to come forward because it's their family.
They're also under the misunderstanding that this power-of-
attorney representative holds some magic power over them and
that somehow they can punish them or do something wrong to them
if they challenge them, when really the reverse is true.
In order to stay this exploitation, we need better laws,
and right now our legislature is considering reforming West
Virginia's power-of-attorney law and enacting the Uniform Power
of Attorney Act through Senate bill 449 or House bill 4390.
This will provide some important protections for our seniors
and agents, and even third parties who rely on that.
But we also need better education, and Older Americans Act
programs are great at providing that kind of education,
education to seniors that they're really the ones in charge
here. They're the boss, not the agent, and that's sort of
different from how many of them understand it now. And
unfortunately, people in the community are under that same
misconception, and even many attorneys. So we need better
education to address financial exploitation.
If we can empower our seniors to take control over their
money and prevent that, just think the good that we can do with
$2.9 billion extra in our economy.
Another way to empower our seniors is by ensuring a robust
ombudsman program. The long-term care ombudsman program is the
only Older Americans Act program that's specifically designed
to serve residents in residential care facilities. Through
complaint investigation and consultation and information, our
ombudsman supported residents in exercising their rights,
staying free from abuse, receiving quality services, and
enhancing their dignity.
When one administrator was asked what would be the
situation if there was no ombudsman program--and this was a
facility administrator--he said residents would lose a channel
of communication and support that helps them exercise their
rights and freedoms.
Reauthorization and adequate appropriation of the Older
Americans Act is one way to provide a solid basis for ombudsman
services. Fully funding the Elder Justice Act, which is a
complementary act that can provide a strong safety net for the
ombudsman program and many of its partner agencies, is another
way to strengthen this. Enabling residents to solve problems
before they escalate into major issues, helps assure that
residents have the best quality of life and quality of care
that they can.
Preventing financial exploitation and power-of-attorney
abuse not only protects our vulnerable adults but it also
allows for a more efficient system based on choice and autonomy
rather than dependence and fear. Ensuring a robust ombudsman
program empowers our residents and helps assure quality of life
and quality of care, which are the hallmarks of an effective
and efficient senior aging network.
Thank you for the opportunity.
[The prepared statement of Suzanne Messenger appears in the
Appendix on page 49.]
Senator Manchin. Thank you.
We'll go down through the witnesses and then we'll go to
questions, okay?
Brenda, if you would?
STATEMENT OF BRENDA LANDERS, DIRECTOR, METRO AREA AGENCY ON
AGING, DUNBAR, WV
Ms. Landers. Good morning, Senator Manchin, Congresswoman
Capito, Assistant Secretary Greenlee, and other distinguished
members of the committee. Again, I'm Brenda Landers, the
Director of Region 2 Metro Area Agency on Aging, located in
Dunbar, West Virginia. Again, thank you for the opportunity to
testify on behalf of the West Virginia Area Agency on Aging. I
will attempt to explore the history of the AAAs, identify and
address future challenges facing West Virginia's aging
population, and provide recommendations for the reauthorization
of the Older Americans Act.
West Virginia's AAAs assisted in establishing many non-
profit organizations in the early 1970s. These organizations
became the county aging programs, offering services such as
nutrition, transportation, and social services which have
become very visible and much-needed services in West Virginia.
The West Virginia Bureau of Senior Services, BOSS, is the
state unit on aging designated to receive Federal and state
funds for senior programs. BOSS contracts with the four
regional AAAs to administer funds from the Older Americans Act
and the West Virginia Bureau of Senior Services.
The AAAs develop or enhance comprehensive, coordinated
community-based systems that serve all 55 counties through four
regional offices located in Wheeling, Dunbar, Petersburg and
Princeton, West Virginia. The AAAs contract with aging county
providers for the provision of meals, transportation, and in-
home services. The AAAs also have a monitoring system in place
to address waste, fraud, and abuse.
It's the AAAs responsibility to provide assistance to the
service providers, as well as to manage and monitor the
responsible use of Federal funds utilized for specific
programs. Each AAA employs a monitor and has a monitoring
review process to determine compliance with the requirements of
state and Federal funding entities, applicable laws and
regulations, and stated outcomes. AAA monitoring activities
include desk audits, review of reports submitted by the
providers, site visits to review financial and programmatic
records, and observation of daily operations.
Regarding the reauthorization of the Older Americans Act,
on behalf of the West Virginia Area Agencies on Aging, I
respectfully submit the following recommendations: consolidate
funding for congregate meals and home-delivered meals to allow
flexibility and meeting the demands of the affected
communities; expand the range of Title III services for which
cost sharing is permitted; and require states to request a
waiver for cost sharing for nutrition and case management.
Also, provide additional funds to states as an incentive for
high performance and achieving program goals. In addition, our
West Virginia AAAs would recommend an increase in the monies
for the core Titles of the Older Americans Act; and also new
use of Federal monies to augment existing state funds for
ADRCs.
West Virginia remains one of the oldest states in the
nation. Planning for the future will make sure the needs of
senior West Virginians and their families are met. The National
Area Agency on Aging recommends establishing new provisions
with dedicated funding, authorizing the AAAs to assist county
and city governments in preparation for aging in their
communities. These provisions would authorize funding and
outline the roles and activities to be performed by full-time
planner/community organizer position. The new position would
take the lead role in working with other agencies and
stakeholder organizations in the development of a comprehensive
livability plan and implementation strategy.
West Virginia communities will need to provide an array of
services, including facilitation of more accessible housing,
preventive health care, including health and lifestyle
education, and immunizations and screenings to reduce injuries
and the onset of chronic diseases, and a range of in-home
health assistance to keep people in their homes longer.
The four West Virginia AAAs received a $488,000 grant for
Money Follows the Person or Take Me Home West Virginia program.
This program will assist West Virginians as they move from a
nursing facility or a hospital to a residential setting in a
community. The West Virginia AAAs recently applied for the CMS'
Health Care Innovation Challenge in the amount of $7 million.
The intent of this program is to develop and utilize strategies
to decrease the behavioral health risks for preventable chronic
diseases in West Virginia's senior population.
The AAAs proactively carry out, under the leadership of the
West Virginia Bureau of Senior Services, a wide range of
functions related to advocacy, funding, planning, coordination,
inter-agency linkage, information sharing, brokering,
monitoring, and evaluations. West Virginia Aging and Disability
Resource Center plays an integral part in meeting the needs of
seniors and persons with disabilities. The ADRCs strive to
reduce consumer confusion and build trust and respect by
enhancing individual choice and informed decision-making.
It's important that the ADRCs remain independent since they
are the first place to get accurate, unbiased information on
all aspects of life related to aging and living with a
disability. ADRCs are reaching many consumers who do not
frequent the county senior centers. There's a great need for
Federal dollars to accompany state monies to continue the
ADRCs' mission.
It's very important that we view seniors and the aging Baby
Boomer population as community assets, not simply the focus of
burgeoning cost. West Virginians need to devote more efforts to
foster job creation and create incentives for employers to hire
this population. The modern focus of aging no longer remains on
increasing the quantity of years but rather on enhancing the
quality of years lived through a balance of physical, mental,
and social healthful behaviors.
As West Virginia's 65 and older population increases, it's
important that individuals have access to an array of services
that promote physical activity, mental fitness, social health,
and overall health and wellness support. The provision of
health promotion and disease prevention programs are essential
for effectively enhancing the health of our senior population
while reducing the burden of their health care costs.
In conclusion, thank you for the opportunity to share with
you the history and the goals of the West Virginia AAAs and
their plans to address future challenges to our aging
population.
[The prepared statement of Brenda Landers appears in the
Appendix on page 56.]
Senator Manchin. Thank you so much, Brenda.
Janie.
STATEMENT OF JANIE HAMILTON, DIRECTOR, KANAWHA VALLEY SENIOR
SERVICES, CHARLESTON, WV
Ms. Hamilton. Senator Manchin, Congresswoman Capito, I'd
like to thank you and your committee for the vision to come and
look and hear from us who are advocating for the seniors of our
country, and especially the State of West Virginia.
My agency, Kanawha Valley Senior Services, is the county-
level agency that provides social services, in-home personal
care and assistance through Waiver Medicaid Personal Care,
Lighthouse, the FAIR program, the VA Homemaker Program,
Creative Care, which is what we call our private-pay, in-home
care program, the Family Caregiver Respite and Daycare--we have
the social model located at the Tiskelwah Center in
Charleston--and there is also a center, as you well know, at
the Hansford Senior Center in St. Albans. There are health and
wellness opportunities, computer literacy, transportation and
support for 12 nutrition sites in Kanawha County.
As a local provider, my issue is to absolutely encourage
you to reauthorize the Older Americans Act. And as Secretary
Greenlee said, we have a flat funding for the last 10 years,
and as the Baby Boomers are coming into this area of need, we
are going to have to look at ways to increase funding. As she
stated, her budget is very low for the amount of services we
provide.
The oldest Americans are the fastest growing segment of our
population, and that's going to continue for the next 20 years.
So we really need to look at ways to increase the funding, as
well as be efficient. We need to allow the cost sharing in the
in-home care services, as has been already reported. We need to
add more prevention and health education in all of the three
program titles of BCMD, as well as Title 8.
We need to reduce and/or relax the excessive regulations
and redundant regulations. Sometimes our reporting causes us to
lose more time and money than we can be reimbursed for, and
that means every dollar we spend administering programs is a
dollar less we have in providing service to the seniors
themselves.
We definitely need more flexibility in the funding of the
state units on aging, and we need a mechanism for the
modernization of senior centers, perhaps adding an incentive
for Federal community block grants to allocate money to senior
center modernization.
You know, 30 years ago, when economies were in much better
shape, the City of St. Albans reached out and funded their own
senior center. No other community does that in our state. That
should have been done. The original intent of the Older
Americans Act was that the local level would embrace their
seniors and fund their centers, and that isn't being done, and
it can't be done now. There's no way we can go back to
communities and municipalities and say you need to start
funding your senior center at some level. The levels are very
low, if any at all. So our senior centers are going to fall
into disrepair because of the lack of funding because we're
trying to just provide services.
At the county level, we don't really have the money to help
them write their own grants and get monies from other sources.
As a county agent provider, my mission is to assist our
aging population in attaining or maintaining a good quality of
life for their remaining years using the resources available
effectively. As economic problems prevail, the competition for
available funds and other resources increase, making that part
of my job a time-consuming endeavor. I spend way too much time
seeking out funding instead of managing the programs.
With the surging boom in our aging adults just beginning to
skyrocket, as you both alluded to, we are in the early stages
of a challenge our country has never, ever seen before.
Another point I would like to make is there's a remarkable
increase in Boomer generation grandparents raising their
grandchildren. This is at the same time trying to assist their
own aging parents. The number of grandparents raising
grandchildren is increasing, currently 5.8 million children in
the US. This adds a whole other dimension of need to the aging
seniors.
Mental health services is another area of need. We are
lacking severely in mental health services across the board,
and right now I meet with 50- to 70-year-old adults whose
parents are still living but suffering with some type of a
mental health problem. The aging child doesn't know what to do
for their parents, and they really don't have the time or
energy to assist their parents, or even hook them up with what
may be available for them. They're unprepared to cope, have no
idea where to turn, and agencies like ours don't have
advertising dollars. So that's where some of the flexibility
needs to come in.
There are seniors facing addicted, mentally unstable adult
children who are exploiting them, literally stealing their life
savings out from under them, and they often have their
medication stolen by family members who are addicted, or
perhaps they're selling them on the street just for the money.
Perhaps some funding for policing these things, educating the
seniors about these things. We've had some movement in that
area, but it definitely needs to be expanded upon.
We spend a lot of time in my agency showing proof of
services. Extreme amounts of time is spent and not always
reimbursed, again, for those hours. We have the layered
challenge of complicated reporting requirements and excessive
hoops to jump through to prove services. It causes us to spend
money that we can't put toward assisting seniors.
As an example, the local VA has a slow reimbursement
turnaround to the point where they're actually paying us
interest because of their lateness in payments. VA cases are
randomly assigned. So some more collaboration with the aging
network and the VA definitely needs to be done so that we can
bridge these services and work together to serve our senior
veterans.
We need more flexibility in all of this. When Senator
Manchin was our governor the Lighthouse program was developed.
Right now, it is the most user-friendly service we have
available. It allows for those who qualify to receive all that
they need and not limited to personal care only. This is funded
entirely by the State of West Virginia. There is a waiting
list, but this model needs to be looked at at the Federal level
for funding services.
The Family Caregiver Program is a wonderful program.
Challenges by family member include availability of time, lack
of training, their lack of health literacy, personal, physical,
mental and financial issues, all that causes that adult family
caregiver a lot of stress and then puts their health at risk.
The success of the Alzheimer's Family Caregiver Respite
programs is high, but we definitely need many, many more, as
I'm sure Helen will attest to in the next few minutes.
We need to learn best practices and imitate them in all
communities, and keep funding, if not increase it.
Community awareness of the symptoms of Alzheimer's is
another thing, and elder abuse and exploitation, both in the
urban and rural settings, must increase with some sort of maybe
anonymous call-in line or a website where reporting can be
done. We need to train local law enforcement, case management
and social workers. EMTs and clergy all need to be included in
awareness trainings that assist in detecting the symptoms at
the earliest time so that plans for their care can be made by
the individual before they become incompetent. A lot of times,
family members don't realize that their parents are
deteriorating mentally, and therefore they don't say ``You need
to make those plans for your future care before it's too
late.'', and then a family member is left to try to guess.
Transportation is definitely an issue, as you know, in a
rural setting. We have a hard time providing all that's needed,
and one thing that would be very helpful is routing software.
If we had the funding, if there was specific funding or some
collaboration with companies that provide this type of
software, we could be much more efficient in our transportation
efforts.
As a family caregiver and a sandwich generation
participant, I'm the only child to my 84-year-old mother. She
shares my home, and we have taken the steps to make her care
needs as smooth as possible as they arise. I depend currently
on the transportation services that my agency provides to get
her to and from all her medical appointments.
We live in St. Albans. I work in Charleston now. It is much
easier for me to meet her at her appointment. I'm her health
advocate. But if I didn't have those transportation
opportunities to get her up there, I would really, really be in
a fix because I do need to work. I have a 20-year-old. That's
the youngest of four children. And as you kind of mentioned,
Shelley, kids don't just quit needing you just because they
become of legal age. And so we're still sandwiched even though
we don't have grade-school children at home or high-school
children at home. We're still sandwiched between those two
needs of our family members.
My mother enjoys the socialization opportunities available
at the Hansford Senior Center in St. Albans, and I believe that
these things have added to her quality of life, and she agrees.
I couldn't work full time and help raise my children without
this aging network that is in place, and I cannot imagine
trying to do this in a rural area of our state.
So again, I will ask that you look at making sure that the
Older Americans Act is reauthorized; if not, some funding
increases put in place, and look at allowing cost-sharing for
the in-home care programs. We need some support for the
modernization of our senior centers, which you very well know
is a very, very local level of quality of life for seniors in
the area.
Our future is sure to test our country's ability to rise to
the occasion and look to the good of those who are in need of
protection rather than those who are capable of working towards
their own support. We have had such a rich life here in our
country. Those who have made this country great are living
longer in larger numbers than ever before. We owe them all a
debt of gratitude and all the support they need to spend their
final years in peace and comfort. Don't forget, our children
are watching.
Thank you so much for this opportunity.
[The prepared statement of Janie Hamilton appears in the
Appendix on page 64.]
Senator Manchin. Thank you, Janie.
Helen.
STATEMENT OF HELEN MATHENY, DIRECTOR, ALZHEIMER'S OUTREACH AND
REGISTRY PROGRAM, BLANCHETTE ROCKEFELLER NEUROSCIENCES
INSTITUTE, MORGANTOWN, WV
Ms. Matheny. Senator Manchin and Congresswoman Capito,
thank you very much for this opportunity to testify on
strengthening the aging network. Senator, as you mentioned, I
serve as the Director of the Alzheimer's Outreach and Registry
program at the Blanchette Rockefeller Neurosciences Institute.
The institute is a unique, non-profit medical research
institute dedicated to the study of memory and memory
disorders, with its focus on Alzheimer's disease and related
dementias. BRNI is operated in alliance with West Virginia
University, as well as in collaboration with other academic
institutions.
The Institute's Alzheimer's Outreach and Registry Program,
the only one of its kind in the country, provides physicians
with education and tools to improve screening, diagnosis,
treatment and care of patients with Alzheimer's disease and
related dementias. The continuing education sessions help
connect the medical community with local resources to better
link patient treatment and care, as well as to support
caregivers through the disease progression.
The program also maintains the West Virginia Alzheimer's
Disease Registry. The registry is a secure database that
compiles demographic, diagnostic, and medical treatment
conditions information about patients who have been diagnosed
with Alzheimer's disease or a related dementia.
As I begin my discussion today, I would like for you to
keep in mind a few key facts about Alzheimer's disease in West
Virginia. I know you're well aware that, according to the
Alzheimer's Association, 44,000 West Virginians age 65 and
older have been diagnosed with Alzheimer's disease. Also,
Alzheimer's shares similar risk factors as stroke and
cardiovascular illnesses, including smoking, high cholesterol,
obesity and diabetes.
Efforts to address this devastating disease must be bold.
Until we find a cure for this disease, I strongly believe we
need to develop a system of quality care for individuals with
Alzheimer's disease and related dementias. This system would
include four key components.
The first area is detection. It is important to distinguish
dementia from temporary reversible conditions that may cause
loss of cognitive functioning. Despite the availability of
assessment tools, structured assessments for dementia have not
routinely been incorporated into practice. One solution to this
challenge is to utilize the Medicare annual wellness visit. It
requires that detection of possible cognitive impairment be
included in each visit, potentially resulting in earlier
detection of dementia.
The next component is diagnosis and care planning. In
primary care settings, physicians report insufficient time and
reimbursement as important causes of misdiagnosis of care. Many
times physicians will focus on the issue that brought the
patient in that day. I recommend that Congress pass legislation
to create Medicare coverage for a package of services that
covers a clinical diagnosis of Alzheimer's disease, as well as
care, planning, and coordination for the individual and their
caregivers.
Next I suggest we build upon the medical home model and
utilize technology to enhance quality and care coordination. An
electronic medical record template could be standardized to
include screening and diagnostic tools, educational information
for the patient and caregivers, and links to resources.
Finally, the system could include tools for advanced care
planning such as advance directive and medical power-of-
attorney forms.
The third area of the system is caregiver support.
Approximately 70 percent of individuals with Alzheimer's
disease and related dementia live at home and receive care from
family and friends. In 2010, more than 105,000 Alzheimer's
caregivers in West Virginia provided more than $120 million of
unpaid care. I'm sorry, 120 million hours of unpaid care. West
Virginia is fortunate to have the Family Alzheimer's In-Home
Respite or FAIR program that can serve as a national model of
care. I encourage expansion of quality, affordable home- and
community-based services for individuals with Alzheimer's
disease and their caregivers by increased funding for programs
such as our FAIR program.
Another great resource for seniors is the new
WVSeniorCare.com website that provides information about
medical and social services, as well as health care facilities.
Finally, the fourth component of the system is workforce
development. This is a critical piece that we must address the
shortage of physicians, nurses, and other health care
professionals to improve care for an aging population. Congress
should explore the increased use of available tools such as
tuition assistance, loan forgiveness, housing subsidies, and
stipends that encourage health care professionals to pursue
specializations in primary care and geriatrics, particularly
providers who make a commitment to work in under-served
communities.
The reality is that there are many West Virginians just
like the Smiths. Mrs. Smith is 93 years old and is nearly
blind. She's a diabetic, has congestive heart failure, and is
in and out of the hospital numerous times a year. Her husband
has hearing problems, and his vision is impaired due to a
stroke. The Smiths live in their own home. Because of their
illnesses, they're on multiple medications and they face high
deductibles and medical co-payments. The Smiths, like many
seniors, want and need high-touch, not necessarily high-tech,
care. They need assistance with chores around the home and
medication management. The Smiths need and deserve a quality
system of care.
In conclusion, I applaud your interest in identifying ways
we can improve the efficiency and the effectiveness of the
aging network. I want to thank you, Senator Manchin and
Congresswoman Capito, for the opportunity to share with you
suggestions about developing a system of quality care. I look
forward to continuing to work with you on these issues, and
I'll be glad to answer any questions.
[The prepared statement of Helen Matheny appears in the
Appendix on page 69.]
Senator Manchin. Thank you, Helen.
James.
STATEMENT OF JAMES CLAGG, VOLUNTEER, MILTON SENIOR CENTER,
MILTON, WV
Mr. Clagg. Mr. Chairman and members of the committee, thank
you for the opportunity to testify before the Senate Special
Committee on Aging. We are James and Ellen Clagg. We represent
the Milton Senior Center and the Cabell County Community
Service Organization.
``Why don't you go to the center with me today? We have a
lot of fun over there.''
This is how I was introduced to the Milton Senior Center.
My wife had been attending for about a year, and she enjoyed it
very much.
My first thought was, ``How can a bunch of old people have
fun?''
[Laughter.]
``What could they possibly be doing?''
When I started attending the center, the people I met were
ordinary folks just like us. Some are still living in their own
homes, but others are living below levels that they would
prefer. Others are living alone in subsidized apartments, some
in trailer parks. Most are failing in health and have limited
income.
Where or how can they have fun?
At the senior center, they have a place to become part of
another family.
I'm sorry.
The members may not be blood related. However, each one, in
time, becomes a brother or a sister within the family.
We participate in a variety of games, bingo the favorite.
We work table puzzles, exercising on our machines, have crafts
to work on, sew, and make lap quilts for the shut-ins.
The Cabell County Community Service Organization, or CCCSO,
as we know them, provides a warm meal daily. At this meal, we
talk and exchange thoughts on any subject that might come to
mind, a home atmosphere with family members.
The center provides a number of presentations by locals, as
well as professionals. Senator Manchin visited us this past
month and asked for our opinions and shared with us his on
different subjects currently before Congress.
We have health screenings at least once a month where blood
pressure and blood sugar levels are tested at no cost.
We also have monthly dinners where singers delight us with
their music. Schoolchildren at Christmas have a wonderful
program for our enjoyment.
Fun? You bet. But more than fun. A place where, for a few
hours, we become a member of our family, members who will
listen to our gripes, comfort each other in times of sorrow,
and share in our joys. The center has become a major part of
our lives.
In conclusion, we are grateful for the Milton Senior Center
and CCCSO for all the help they provide the aging residents of
Milton and Cabell County. We strongly urge you to support all
senior citizen programs no matter what the organization may be
called or what state they represent.
We are one family, all created by God, depending on him and
each other. As our senator, we need your continued help and
support.
Thank you for allowing us this brief time to testify before
the committee.
[The prepared statement of James and Ellen Clagg appears in
the Appendix on page 75.]
Senator Manchin. Thank you, James, to all of you.
Before we start our questions, again I want to recognize
Mrs. Rocky Goodwin, representing Senator Jay Rockefeller here,
who has been very involved in these issues also.
Rocky, would you have anything that you want to say?
Mrs. Goodwin. The Senator apologizes that he couldn't be
here today. He's been working diligently over the weekend on
the surface transportation bill. But thanks, Senator Manchin,
for convening this hearing today, and Congresswoman Capito for
being here. He asked me to bring back all of the wisdom and
recommendations of our stellar panel today.
Senator Rockefeller has a long history with supporting
issues related to seniors. You may know that under his term as
governor, we instituted all of the senior programs in every
county, and he is proud that that has continued.
Certainly, from hearing from the ombudsman programs about
the needs that you've expressed here today to the more detailed
implementation of local programs from the Area Agencies on
Aging and the county programs, and as you say, it's a family
program, it's not just a county program in Milton, but also
across the state, and has worked hard with obviously the
Blanchette Rockefeller Neurosciences Institute on identifying
need.
So the Senator has a staff in Washington, D.C. of
legislative folks who deal with all of the issues that we've
discussed today, legal help, the funding issues, and also has a
number of case workers in the state, and you probably have
dealt with his folks.
Please know that the door is always open to receive those
recommendations that you have, as you here today on the front
lines have the best information on policy moving forward. So,
thank you.
Senator Manchin. Thank you, Rocky, appreciate it.
Let me start with our questioning now, and I'm going to go
to each one of you, and I want to thank you again. Then
Congresswoman Capito can proceed with hers.
First of all, to Suzanne Messenger, I know you talked about
the exploitation--and I think, Jane, you did, too--of our
seniors. Let me tell you how this came to light to me. One of
my first Aging Committee meetings, Mickey Rooney came, and I
don't know if you all read about that or heard about that, but
having a high-profile person like Mickey Rooney that we grew up
watching every one of his movies and just as a person you
think, well, they're untouchable, they'll never fall into that
trap, and when he tells you his story about what happened to
him by a family member that just about literally wiped him out,
I think it brought home to me. And I would never think of that
because, you know, you think your family will take care and you
don't have to worry about that in your family, but it can
happen in any family.
How do you think that the best way to prevent that or
educate residents and our caregivers? Is it the punishment, the
laws? Is it the ombudsman overseeing? They don't want to talk.
I mean, he even told us, he says I didn't want to believe it.
He said I knew something was going on, and I knew my money was
gone, but I didn't want to think it was my own flesh and blood
or someone very close to me that I raised.
How do we do this?
Ms. Messenger. I think it has to be a multifaceted
approach, Senator Manchin, and certainly good laws are a place
to start. Our legislature is working on----
Senator Manchin. I guess, Suzanne, what I'm asking, do you
see a lack? Have we missed laws that should be there? Is the
punishment not severe enough for the crime they're committing
in exploiting their own family?
Ms. Messenger. That's a good question, Senator Manchin, and
I suspect that's a piece of it. Another piece of it is many of
us don't realize--the awareness simply isn't there. I think
Mickey Rooney, one of the best things he did was make it okay
to talk about these sorts of things and not to think, well, I
should have known better, that shouldn't have happened to me, I
did something wrong because now this person has all my money,
to reach out and ask for help, to get better education among
the people that help our seniors.
As I said earlier, many people think that a power of
attorney gives me some magic power over somebody, and it works
just the opposite. You have power under the person you're
supposed to be helping, and I think many of our seniors and
many of us in this room maybe don't have as good an
understanding about that.
It's okay to ask questions, to do better education about
what happens, and then we absolutely have to have prosecution.
We have to enable our prosecutors and law enforcement. These
are complicated cases. They're paper-specific. They take lots
of bank records. The people that are involved are sick people
who get sicker and may even pass away before this works its way
through the court system. So maybe we need to think about
having an expedited process to address financial exploitation.
Senator Manchin. The final on that to follow up is that
basically you talked about drug abuse.
Ms. Messenger. I don't think that was me.
Senator Manchin. Okay. I'm sorry.
Ms. Messenger. I could talk about drug abuse if you'd like.
Senator Manchin. First of all, it's an epidemic in this
nation, not just in West Virginia, not just in your county, or
not someone in your family, because I don't think there's a
person in this room right now, and I'm one of those people,
that doesn't know someone in their immediate family or extended
family, very close, that has not been affected by this. Most of
it is legal prescription, and I did not realize how many family
members are taking from their own family, especially their
grandparents. I just did not realize the severity of this
problem.
I don't know what we do on that except I'm thinking of
this, and you chime in and help me on this, Janie. Let's say my
mother is on prescription, whatever it may be, probably pain
relief, a painkiller, and she has to go back because they're
missing, and she doesn't know if she took too many or what
happened to them. So she has to go back at more frequent times,
more frequencies to make sure she has her medication. Now,
something has happened. A pharmacist right then should be able
to flag that and know, wait a minute now.
You see, I don't know what we're lacking. Is there some
type of reporting, Good Samaritan reporting? Everything doesn't
have to be criminal, but I know that family members don't want
to tell on their grandkids or their children that's taking the
drugs and using them not for the purpose they were prescribed
to me for. But there has to be somebody that can get us on the
trail of that to stop that.
Do you have any recommendations on that?
Ms. Hamilton. Well, there's a lock box program in place
that has been funded through some small grants that can be
effective. But again, you've got a senior that has trouble with
a medicine bottle, and you have a lock box with a combination
of some sort, it's good for the storage of the medications
maybe you don't take very often. There does need to be a system
in place whereby a responsible caregiver can oversee.
Oftentimes, pain medication is only taken as needed. So if
the person has a 30-day supply and they haven't taken but 5 or
6 throughout the 30 days, if the rest of them are gone and they
go back for a refill, the pharmacist isn't going to catch that.
He would assume that person has taken it every day.
Now, if the pharmacist could stop and say, ``Well, Mrs.
Smith, I see you've taken 30 of these in the last 30 days. Does
that mean your pain has increased? Do you need to talk to your
doctor?'' And get a conversation going. But again, that's going
to be up to the pharmacist.
Senator Manchin. Do you all have any conferences with--I
think we have a tremendous network of pharmacists that do a
wonderful job. But if they don't communicate and don't know
what to look for, are you doing that? Could we help facilitate
that on a state level?
Ms. Hamilton. We should.
Senator Manchin. Okay.
Ms. Hamilton. That's another person on our list of people
who need to have this awareness.
Senator Manchin. I got you.
Ms. Matheny. Senator, there are a lot of items that are
being talked about right now in that regard. A lot of that
responsibility falls on the primary care physician or the
physician who wrote that original prescription. If they go back
for a refill, that individual should probe and ask questions,
what happened to the medication.
The other thing is the database now that we have, the
pharmacy database, that will be an effective tool in that
toolbox too, that you can track and see what medications are
being prescribed.
Senator Manchin. Brenda, if you will, I know we talked
about the consolidation of programs and things of this sort,
and maybe you can tell us a little more about what it would
mean to your organization if we were able to do some of this,
how much better services could you do if you could consolidate
some of them?
Ms. Landers. Consolidate nutrition? Right now, when we send
out nutrition funding, they divide it between C1 and C2, which
is a home-delivered meal or a congregate-setting meal. And at
that point, if they go over in one, then they have to come back
to the AAA and say I need to transfer funds. So I think it
would be easier if the county had that liberty or that
flexibility to be able just to serve the meals that they need,
whether it be C1 or C2, because as we've often stated, every
county is different. I may have a county that has more rural;
they're going to need more C2. It would just give them the
flexibility of being able to serve either a C1 or a C2 without
coming back to the AAA and saying I need to transfer funds.
Just give them that liberty to serve all the C1 or C2 that they
need, and then they can bill us. And at the end of that grant
period, then we can say this amount was served. So it would
just give them some flexibility.
They have that ability to somewhat do that now, but then
they have to come back to the AAA and say, you know, I need to
transfer funds or I'm going to over-serve in one, and I think
that time given is at the end of May they lose that opportunity
to transfer funds. So it would just give them some flexibility
to be able to serve what they need and not have to designate
that we want to serve 15,000 C1 and 16,000 C2. If we could just
give them a little more flexibility, to serve as needed in
their communities.
Senator Manchin. Helen, if you could, explain the FAIR
program. I think you're familiar with the FAIR program. And,
Kathy, I think that you've heard from everybody about this
program we started in West Virginia because of the need we have
and how well it has worked. If you could explain a little bit,
Helen, about how you think that could be looked upon on a
larger scale, if you will?
Ms. Matheny. Well, sure. From what I understand, it is a
huge success, and it's available in every county in the state,
the Family In-Home Respite Care program, and it just provides
families that needed break with trained, screened people to
come into the homes and to help provide some chores, some
personal assistant bathing and those types of things. But it's
a really valuable resource. The legislature increased funding
last year by $1 million for it. There's still a waiting list.
But again, I think it could be a national model, something to
take a look at.
Senator Manchin. I will say this, Secretary. Our purpose
for that was to reduce our cost but to give quality care and to
have people have respect and dignity. We were wearing the
family members out, and both of us, the Congresswoman and I
both understand how much care it takes, and we have to have
competent people. But let's just say the family members were
trying. They wear out and they give up, and they say I can't do
it any longer. Well, you know what happens then, and you know
where the costs go. You just mentioned about the accelerated
cost that's involved when they come into a nursing home.
That was the whole purpose, and it has I think worked
extremely well and been extremely successful. We think it's the
best, and Sandy Vanin, who was my commissioner at that time,
really got it going, and we'd be happy to work with you to
really show you the ins and outs and the things we think are
great, the mistakes we made, how we could better improve upon
it.
Sandy, if you would be helpful if the Secretary would need
anything, I would appreciate that.
And finally, James, I want to thank you. I'm going to ask
you a question. But first of all, you basically said
everything, and the way you said it is why we're here. It's
family. Whether you have your blood family with you or not you
become family. Tell me how you and your lovely wife got into
the whole volunteering. I guess she kind of brought you along.
It was contagious, right?
Mr. Clagg. Right.
Senator Manchin. How did she get involved? What made her--
--
Mr. Clagg. She had retired recently, I think, and her
sister and her are pretty close and they wanted to get out and
find other activities now that they were retired, and they
started going over to the senior center. And like I said, they
came home and told me they had a lot of fun. I couldn't
understand it, because I was still working at the time.
[Laughter.]
Mr. Clagg. I just couldn't understand what was going on.
But now I see much clearer now.
Senator Manchin. And you see the quality of life, right? It
has improved the quality. I mean, people live for that, right?
That's their family.
Mr. Clagg. Exactly. They look forward to it every day to go
to the senior center.
Senator Manchin. How many of you think that's the only
nutritional meal they get? Just percentage wise, half of them,
10 percent, or a majority?
Mr. Clagg. Well, basically let's say, go with 25 attending,
I know 3 of the 25 ----
Senator Manchin. That's it.
Mr. Clagg [continuing]. That's probably the only meal they
get.
Senator Manchin. I know how true that is. And you know how
hard it is to cook for one person. As you grow older, it's not
worth the effort.
Yes, Janie?
Ms. Hamilton. At the senior center in St. Albans, where 50,
60, 70 people a day would be a regular number, in the past I've
seen them, the ones that are alone, take half their lunch and
package it up to take home to have for dinner. They're there
every day. So, you know, there's quite a few in that
department.
And then the men who are widowed, in that generation the
wife did the cooking. People go home and don't eat well, if at
all, because of the fact there's no one there to fix his
dinner.
And I know of a veteran who lived alone who is a widower
who would walk with his walker from his home every evening or
early afternoon, late afternoon to the Tudor's to get the beans
and corn bread because that was cheap, and he would eat and go
back home on the walker, because he wouldn't even call us for a
ride because of his pride and not wanting to take something
that he had not paid for. So you have every area of need being
met at the senior centers.
Senator Manchin. I would like to have one more, and then
I'm going to turn to the Congresswoman.
Secretary Greenlee, if you would, I know Brenda brought up
the issue of older workers, and we've been blessed with some
health. When we grow older, we still want to be contributing. I
think it's very important for us to be productive for as long
as we possibly can, and think that we've paid our way.
What are you all doing, or the Administration on Aging
doing, that can help seniors who really want to work find work?
Do we have a centralized--in West Virginia, are we networking
to where a person that's looking for a more experienced--I hate
the word ``senior''--a more experienced person who has had a
lot of life experience, can we match them up? Someone who says
I need this type of person who has had 40 years' experience,
they might be 65 or 70 years of age, is there anything that you
know that we link them up in the state, or anything on the
Federal that could be done?
Ms. Greenlee. There is one section of the Older Americans
Act that is not administered by the Administration on Aging,
the Senior Community Services Employment Program. It's Title V
of the Older Americans Act, and it's meant to provide support
to low-income seniors so that they can continue working in the
workplace. It's often administered at the State level by the
Department of Labor. That's where it's administered Federally.
But when it gets to the local organizations, many of them will
run the Title V program. I took a trip to Los Angeles and met
many of the people who are getting this support, where seniors
really need some extra income, to work.
One of the requirements for the staff who are working to
help the seniors, the staff in the Title V program, is to also
work with the one-stop shops from the Department of Labor. So
if there are seniors who have more resources than the low-
income seniors, you can also get them connected to the one-stop
system. That's where, in the whole employment universe, they
are a whole other world in terms of one-stop information
assistance and employment. You want to make sure that the
senior programs can address the high-risk populations, but then
also get to the more mainstream or traditional Department of
Labor supports for other people who want to stay working.
We all know, anecdotally and through data, the number of
seniors, who because of the economy, have had to postpone
retirement or need to go back to work in order to make ends
meet.
Senator Manchin. Thank you all.
Congresswoman Capito? I'm sorry.
Representative Capito. Thank you. No, thank you. This has
been great. I want to thank all of you all who have testified.
James, I'm going to start with you. Your comments I think
touched everybody in this room, and obviously you give a lot,
but you get a lot in return, and I think that's great.
I will say, as someone who has traveled, I don't go to
Milton because that's over in Cabell. That's the next county
over from my district. But when I go to Hansford and others, I
gain a lot of wisdom that is at the senior center. So when you
said you sit down for lunch and you saw problems, you could
probably solve this debt problem for us right off the bat. So
keep that up. I know that keeps you going, and bring all your
comments to the senators and your congressmen because we
appreciate that wisdom.
You mentioned that there might be 25 people at lunch, and I
know the Hansford Center has 7. It's probably one of the
largest ones, certainly. But there are a lot more seniors out
there that, if they knew or if they maybe could get over the
fact, like you had in the beginning, what could I really want
to go to a senior center for, and it was mentioned that there
was no dollars for advertising the senior center, how do you
think we get more seniors to the senior center to realize all
the good things that are going on?
I mean, obviously, transportation is an issue. But let's
say that person didn't have a transportation issue. They had a
family member or something. How would you reach out to those
folks? Do you have any suggestions for that?
Mr. Clagg. It would have to be a more one-on-one thing.
Representative Capito. Word of mouth kind of thing?
Mr. Clagg. Word of mouth, or members that are already there
participating spreading the word to others, because when you
get to my age, and you're soon to be----
[Laughter.]
You do not care much about pamphlets being handed out to
you.
Representative Capito. Right.
Mr. Clagg. That's just something you don't understand to
start with, and it's a waste of time. So there it goes, in a
bookshelf or something.
So we need some kind of a one-on-one thing, or just like
the programs you were talking about, the one-stop shop place,
that's a terrific idea, terrific.
Representative Capito. Well, I don't know. I'm just sitting
here sort of brainstorming and thinking if you had a volunteer
corps, or I don't know. The press remembers--or the folks that
are your frequent flyers, to go out and talk to other people,
because you obviously know well. You can't advertise on the
Internet because a lot of seniors aren't on the Internet, and
you can't say how great it is. There aren't blogs around
talking about what a great time we're having down at the senior
center. I mean, that is just a generational thing.
But I will say in terms of technology, one thing that--I
keep alluding to my own personal situation here. But one thing
that I found that is a really neat tool for the future are
iPads for seniors, same as they are for children. I mean, I can
get my iPad out and show the family pictures, and it is a
really great way to spend a day. So, anyway, I'll just put that
little nugget out there. Maybe that's a good Federal-funded
technology initiative.
[Laughter.]
I mean, I know you've got the computers, but there are even
easier methods now.
I wanted to ask Suzanne Messenger about the ombudsman. Is
your program state or federally funded?
Ms. Messenger. It's a blended program. I'm the state
ombudsman, and I work for the Bureau of Senior Services. I'm a
state employee. We get Federal dollars, and we also get some
matching state dollars. I oversee the contract that the Bureau
has with Legal Aid of West Virginia.
Representative Capito. Okay.
Ms. Messenger. That's the regional office.
Representative Capito. That's what I was going to ask you.
What kind of coordination do you have with Legal Aid? Because
I'm sure your resources are really slim, and to get to this,
how do you network out from where you are? Through the legal
community, or does the bar, the West Virginia Bar Association
help you, or the law school?
Ms. Messenger. With ombudsman services?
Representative Capito. Well, just--yeah.
Ms. Messenger. Not so much with ombudsman services. We have
a good partnership with our aging and disability resource
centers. That kind of seems like a natural partnership. The
aging and disability resource centers, as you've heard many
times today, are that one stop, sort of that single entry point
for long-term care.
Representative Capito. Right.
Ms. Messenger. And then if there are problems in
residential care facilities, the ombudsman provides a good
support.
Representative Capito. Right, right. And then, Brenda,
staffing, there's a huge problem. I mean, traditionally low
paying jobs for caregivers. As soon as they--many times, we
have the issues with the abuse. If you pick somebody up that
maybe is not bonded or with an agency, I think you have some
safety issues and legal issues. Unless you have somebody right
there--and even if you do, I guess like Mr. Rooney did, it
still doesn't matter.
What are you doing to--are you looking--what kind of
workforce development things are going on right now that are
going to be able to meet this huge need?
Ms. Landers. As far as caregivers?
Representative Capito. Yeah.
Ms. Landers. We are working on a statewide registry for in-
home workers to know that they've been through proper training,
that they have looked at background searches and things, and
that's one thing that we are working on.
Also, I think it would help with what we talked about, the
drug abuse, that we have caregivers in the home that we know
have passed background searches, that they're not stealing
medications.
Representative Capito. You know, an individual family can't
do a background check.
Ms. Landers. No, but we were working on a state registry so
that these workers would go through the registry that we have
somewhat for nurses. Now we have in-home workers that would be
on this registry that you could go and pick a home worker and
know that they're qualified and they have all of this, so
families can pick up the phone and say I need a worker, and we
have our ADRCs or our aged and disabled resource center that
could go into this registry and be able to supply a worker.
Representative Capito. Is there a shortage right now?
Ms. Landers. Of workers? Yes, because of, as you say,
because of income. I mean, the wages are just so ----
Representative Capito. And it's hard work.
Ms. Landers. It is hard work, and there's lifting and
there's tugging. We just don't have enough money, but we're
dealing with it.
Representative Capito. Then I want to go over to Helen, Ms.
Matheny, on the medical professionals, because I think one
thing that--while the primary caregiver has an experience in a
myriad of different physical and mental issues, because that's
why they're a general practitioner mostly, but there are
certain specialized areas that a gerontologist, or in the area
of gerontology
Are younger students going into this, medical students, to
face this challenge? I mean, when you look around the state and
try to find somebody who is an M.D. that has a specialization
here, it's scarce.
Ms. Matheny. Absolutely.
Representative Capito. Is it getting any better?
Ms. Matheny. It's not getting any better. The number of
board-certified geriatricians is very small in the state. And
so that's why I'm encouraging Congress to help to continue to
incentivize for that. And in the meantime, that's what we're
trying to do with our continuing education classes, is to get
out there to the primary care physicians to provide additional
training with geriatrics to help them help their patients.
Representative Capito. I think you mentioned that some
reimbursement services for these kinds of--when you talk about
pharmacists, I know this has come up from time to time. Is the
pharmacist going to get paid for the 15 minutes that they're
going to work with the senior to find out if they have
conflicting medicines or do they understand when to take it?
We went through this with the prescription drug bill when
it was created in 2003, and I don't think we've solved this
issue, because in a business that's made on the bottom line,
time is money, and if you're getting paid to talk--are you
getting paid to talk and to understand? And a lot of times, the
first time you say it, you've got to say it more than once and
in different ways.
Is this an issue? I mean, Janie, obviously----
Ms. Hamilton. I have a health background as well, and there
are a lot of health literacy issues. If I wasn't there to
advocate for my mother, she wouldn't understand or remember
half of what she was told, and she's not an ignorant person.
She's fairly savvy, but the generational thing, the lack of
health literacy--I mean, there are people across the board, all
ages that have very low health literacy.
There's a movement in our state to eliminate that, but we
have to start not only from the top down but from the bottom
up.
Representative Capito. Well, you've asked for flexibility.
Is this something that you think more flexibility in the
Federal standards, and state, or either/or----
Ms. Hamilton. Health care advocacy could be part of the
aging network if we had the health field and the aging programs
come together and fund, allow funding for a health care
advocate for maybe each senior center, at the very least, to
help do nothing but assist seniors with their communication
skills with their physician, teach them how to take charge of
their own health, help them understand what things mean, them
and/or their family members that are maybe their advocates. A
lot of times the family member is their advocate, but they
don't understand it either.
Representative Capito. Is that different than the SCHIP?
Because the SCHIP is mostly with the insurance?
Ms. Hamilton. Yes. That's just assisting the seniors. You
know, Medicare Part D, my goodness, that's a thing in itself
that has been--so many seniors are completely just at the mercy
of whomever they can get to help them make decisions. And a lot
of times, when they get the letter for open enrollment in the
mail, they just keep what they've got, and it may not be the
best thing for them. They don't even understand that they have
an option. The fact is they have to go through the process of
getting the counseling through the SCHIP program in order to
help them find that. There are a lot of complicated things that
older adults don't understand and need that support to make
better decisions for themselves.
Representative Capito. Well, I think this has been a very
interesting, enlightening panel. One of my colleagues came to
me last week. She's probably--I don't want to say how old she
is, 68 or 70 maybe. She looks at me and she goes, ``Guess
what?'' I said, ``What?'' She goes, ``I'm going to live until
I'm 100.'' And I said, ``What do you mean?'' And she goes,
``Well, the statistics are that if you get to a certain age,
that you're going to live to 100.'' And I'm thinking to myself,
is that a good thing?
[Laughter.]
She says, ``No, it's not a good thing.'' But when you look
at what Alzheimer's is doing to not only young people but more
increasingly as people get older, dementia just creeps in no
matter what, and then to certain degrees we're just going to
have all kinds of issues, especially if we are living to 100.
Maybe our bodies are taking us to 100, but our minds have left
us at 88.
So it's a challenge, and I think you all have been great
demonstrators that it can't be solved as a Federal issue no
matter how aggressive and well funded and good intentioned.
You've got to have James and Ellen at the senior center willing
to dedicate their time and energy, and the family members that
do that, too.
So I appreciate everything I've learned today, and I
appreciate all of you all working in this field. I know it's
rewarding, but it's very tough. So thank you for what you do.
Thank you, Senator, for including me.
Senator Manchin. Thank you for being here, Congresswoman.
And speaking of that, someone told me that if I start
taking the fish oil pills, that it would help my memory. The
only thing it's done is give me an urge to go swimming.
[Laughter.]
With that, let me just say this. Gaylene Miller, thank you
so much. AARP, I know you do a great job, and Angela and all of
you. And I hope this has been beneficial for you, too, because
we interact so closely with you and your organization. If you
could keep in touch with us, and also with Secretary Greenlee
here. That's great.
And let me just say this to all of you. All of you have
done a great job, and I appreciate it. The Secretary has been
so accommodating, and I thank her for her graciousness and
giving us her time.
But I don't want her to go back to Washington without at
least each one of you giving her one recommendation of what
needs to be fixed in your world, of what you're seeing.
Something can make it better, and let her evaluate that,
because if it works here, it will work anywhere. We have more
challenging demographics, and our topography also, and I think
I've said that. If you ever are looking for that pilot project,
you have a theory, you don't have to throw money at us, and if
we say give us a little flexibility, give us some
maneuverability and we'll tell you if it works or not, that's
what we're asking for, Kathy. And I just appreciate so much you
being here, I really do.
So on behalf of all of us and all of you who have come, I
hope it's been enlightening to a lot of you. And you're going
to be around, I understand, and spend some time, and I would
challenge you all to please share that with the Secretary
because she's on the front line. She's going to be the one very
much involved in the Older Americans Act and how we do this and
how we go forth, and really basically lobbying for what needs
to be done for all of us as we grow a little bit older.
Thank you, and that concludes our hearing.
[Whereupon, at 11:37 a.m., the hearing was adjourned.]
APPENDIX
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