[Senate Hearing 113-791]
[From the U.S. Government Publishing Office]
S. Hrg. 113-791
REDUCING SENIOR POVERTY AND HUNGER: THE ROLE OF THE OLDER AMERICANS ACT
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON PRIMARY HEALTH AND AGING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
ON
EXAMINING REDUCING SENIOR POVERTY AND HUNGER, INCLUDING S. 1028, TO
REAUTHORIZE AND IMPROVE THE OLDER AMERICANS ACT OF 1965
__________
JUNE 19, 2013
__________
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
TOM HARKIN, Iowa, Chairman
BARBARA A. MIKULSKI, Maryland
PATTY MURRAY, Washington
BERNARD SANDERS (I), Vermont
ROBERT P. CASEY, JR., Pennsylvania
KAY R. HAGAN, North Carolina
AL FRANKEN, Minnesota
MICHAEL F. BENNET, Colorado
SHELDON WHITEHOUSE, Rhode Island
TAMMY BALDWIN, Wisconsin
CHRISTOPHER S. MURPHY, Connecticut
ELIZABETH WARREN, Massachusetts
LAMAR ALEXANDER, Tennessee
MICHAEL B. ENZI, Wyoming
RICHARD BURR, North Carolina
JOHNNY ISAKSON, Georgia
RAND PAUL, Kentucky
ORRIN G. HATCH, Utah
PAT ROBERTS, Kansas
LISA MURKOWSKI, Alaska
MARK KIRK, Illinois
TIM SCOTT, South Carolina
Pamela Smith, Staff Director
Lauren McFerran, Deputy Staff Director and Chief Counsel
David P. Cleary, Republican Staff Director
______
Subcommittee on Primary Health and Aging
BERNARD SANDERS (I), Vermont, Chairman
BARBARA A. MIKULSKI, Maryland RICHARD BURR, North Carolina
KAY R. HAGAN, North Carolina PAT ROBERTS, Kansas
SHELDON WHITEHOUSE, Rhode Island LISA MURKOWSKI, Alaska
TAMMY BALDWIN, Wisconsin MICHAEL B. ENZI, Wyoming
CHRISTOPHER S. MURPHY, Connecticut MARK KIRK, Illinois
ELIZABETH WARREN, Massachusetts LAMAR ALEXANDER, Tennessee (ex
TOM HARKIN, Iowa (ex officio) officio)
Sophie Kasimow, Staff Director
Riley Swinehart, Republican Staff Director
(ii)
C O N T E N T S
__________
STATEMENTS
WEDNESDAY, JUNE 19, 2013
Page
Committee Members
Sanders, Hon. Bernard, Chairman, Subcommittee on Primary Health
and Aging, opening statement................................... 1
Burr, Hon. Richard, a U.S. Senator from the State of North
Carolina....................................................... 4
Baldwin, Hon. Tammy, a U.S. Senator from the State of Wisconsin.. 5
Warren, Hon. Elizabeth, a U.S. Senator from the State of
Massachusetts.................................................. 6
Murphy, Hon. Christopher, a U.S. Senator from the State of
Connecticut.................................................... 7
Franken, Hon. Al, a U.S. Senator from the State of Minnesota..... 42
Witnesses
Altman, Nancy J., Co-Director of Social Security Works and
Chairman of the Board of Directors of the Pension Rights
Center, Washington, DC......................................... 8
Prepared statement........................................... 9
Hollander, Ellie, President and Chief Executive Officer of the
Meals On Wheels Association of America, Alexandria, VA......... 18
Prepared statement........................................... 19
Bedlin, Howard, Vice President, Public Policy and Advocacy at the
National Council on Aging, Washington, DC...................... 23
Prepared statement........................................... 25
Downey, Paul, President and Chief Executive Officer of Senior
Community Centers, and President of the National Association of
Nutrition and Aging Services Programs, San Diego, CA........... 32
Prepared statement........................................... 34
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Handwritten messages written on paper plates................. 46
(iii)
REDUCING SENIOR POVERTY AND HUNGER: THE ROLE OF THE OLDER AMERICANS ACT
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WEDNESDAY, JUNE 19, 2013
U.S. Senate,
Subcommittee on Primary Health And Aging,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:03 a.m., in
room SD-430, Dirksen Senate Office Building, Hon. Bernard
Sanders, chairman of the subcommittee, presiding.
Present: Senators Sanders, Franken, Baldwin, Murphy,
Warren, and Burr.
Opening Statement of Senator Sanders
Senator Sanders. We've got an important hearing, and I'm
delighted by the turnout. I thank our panelists very much for
being with us today to discuss an issue that, frankly, does not
get enough discussion.
In my view, if a nation is to be judged by how it cares for
the weakest, the most vulnerable people amongst us, the United
States would not get particularly high marks. That's true with
regard to how we deal with children, but today we're focusing
on the needs of elderly people.
Elderly people, by definition, are folks who have lived
their whole lives. Many of them have worked their whole lives.
Many of them have raised kids. Many of them don't have a lot of
money, never had a lot of money. They reach the end of their
lives, when they are no longer able to go out and earn a
living, and they are plagued by what happens to people who get
old with many, many illnesses and frailties and weaknesses.
They are vulnerable.
I think both from a moral point of view--and we're going to
touch on the other aspect--from an economic point of view, we
just cannot turn our backs on the millions and millions of
seniors who are hurting in this country who need help today. I
know there's a bit of mythology out there pushed by folks who
represent moneyed interests who seem to think that all seniors
are doing just great. They're just great. They're all
vacationing in Florida and so forth and so on. And they have
not looked at the reality of what is life for many, many
seniors. We have a panel today that is going to get into that
to some degree.
In America today, half of all seniors are unable to afford
even basic living expenses or are living right on the edge.
Four million seniors live on less than $11,000 a year. Let me
repeat that. Four million seniors live on less than $11,000 a
year. Frankly, I don't know how anybody lives on $11,000 a
year.
Even before the economic downturn, the number of seniors
who are dealing with hunger more than doubled from 2001 to
2009. So when we talk about the recession, the economic
downturn, too often we forget about the impact of that
recession on seniors, but hunger has gone up.
One of the most effective programs ever designed to address
the needs of vulnerable seniors is the Older Americans Act. It
was signed into law by President Lyndon Johnson in 1965, the
same year as Medicare and Medicaid programs were signed. They,
of course, are much better known than the Older Americans Act.
The Older Americans Act provides Federal funding for many
essential services for seniors, including job training,
caregiver support, transportation, health promotion, benefits
enrollment, and protections from abuse. Significantly, more
than 40 percent of the Older Americans Act funding is used to
provide meals to millions of frail and isolated seniors through
programs like Meals on Wheels and through congregate meal
programs at senior centers.
So when you talk about the Older Americans Act, 40 percent
of the funding is going to nutrition programs for seniors who
need that help. Now, these meal programs not only work to ease
isolation, but anybody who has any understanding of the Meals
on Wheels program knows that its importance is not just the
actual nutrition and the meals that isolated seniors get, but
also the fact that somebody is knocking on their door to see
how they are, to chat with them for a few minutes, which can
mean an enormous amount to somebody who's living alone and who
doesn't communicate much with the world.
One of the additional benefits of the Older Americans Act
is that it brings huge numbers of volunteers from all over this
country into the community to help seniors. But it is not just
the help that seniors get directly through the meals program
and the other programs that's important. When we invest in
these programs, we save money, and sometimes some of my friends
don't fully get that.
But common sense and many, many studies tell us that if you
are not providing nutrition to seniors, if seniors are
malnourished, what happens to those seniors? It doesn't take a
genius to figure it out. If you're malnourished, by definition,
you're going to get sick more often than you should. If you're
old and you're sick, where do you end up? You may end up in the
emergency room, a great expense to Medicaid or the healthcare
system. If you're malnourished and you're weak and you fall and
you break your hip, which happens, you end up in the hospital
at an expense of tens and tens of thousands of dollars.
The simple truth is that it makes a lot more sense to
provide adequate nutrition to frail seniors than to spend money
on preventable hospital costs. The simple truth is that we can
feed a senior for an entire year for the cost of 1 day in a
hospital--feed a senior for an entire year for the cost of 1
day in a hospital, and we're cutting back on feeding seniors.
Providing adequate nutrition reduces the need for nursing
home care, for which the average cost is about $80,000 per
year. Many, many seniors would much prefer to stay at home. We
can do that. It saves the system money and keeps seniors in
contact with their friends and their family. But to do that, we
have to make sure that their basic needs are taken care of.
Despite the success of the Older Americans Act in keeping
seniors healthy, independent, and out of hospitals and nursing
homes, its vitally important programs have been inadequately
funded for years, even before sequestration, which cut $40
million from senior meals programs. Just think about that, what
priorities we have as a nation when we are cutting $40 million
from senior meals programs.
Despite all of that, despite sequestration, only a small
portion of the seniors who needed the services provided by the
Older Americans Act were actually receiving them. And now
sequestration means as many as 19 million fewer meals will be
served. These cuts have resulted in wait lists from one end of
the country to the other and have resulted in some programs
simply closing their doors. Imagine that. Imagine that.
In the year 2013 in the United States of America, our
seniors should not be worried about where they will get their
next meal. They should not be forced to decide whether they pay
their utility bills or buy the prescription drugs they need.
That is not rhetoric. That is reality, and I suspect every
person sitting up here has met seniors who are experiencing
that choice--can't afford to pay for my electricity, can't
afford my phone bill, can't afford my prescription drugs, can't
afford to eat, so what choice do I make? We should not be
having that situation in America in 2013.
The choice is ours. This committee will play an important
role in that debate. Either we waste billions of dollars on
emergency room visits and unnecessary hospital stays, or we
provide older Americans the resources they need to live
healthier, more secure, and more dignified lives.
The good news is the Older Americans Act is an important
part of the solution. The congressional authorization for the
Older Americans Act expired in 2011. And while it has been
extended with stopgap measures, it deserves not only to be
fully reauthorized, but to be expanded in order to address the
current crisis and the growing needs.
The Older Americans Act Reauthorization bill, S. 1028,
which I put forth with 17 co-sponsors, strengthens and
modernizes the core programs of the act, such as the meals
program, and States that it is the sense of the Senate to do
more than maintain the status quo, that funding for the act
should increase by at least 12 percent over fiscal year 2010
levels.
The bill also updates the definition of greatest economic
and social need, increases the focus of economic security in
the act, supports the modernization of senior centers, and
strengthens the important provisions to protect seniors,
especially the most vulnerable among us, including those living
in nursing homes, from abuse and exploitation.
The HELP Committee will be doing a markup on this
legislation next month. This markup is long overdue. And, in my
opinion, I have not the slightest doubt that the vast majority
of the American people support these programs. They want these
programs expanded, and they want us to get our priorities
right.
I want to thank, again, all of our panelists for being
here. And let me give the mike over to the Ranking Member,
Senator Burr.
Opening Statement of Senator Burr
Senator Burr. Mr. Chairman, thank you. Thank you for
holding this hearing today on the Older Americans Act and how
that legislation might better solve the issues of hunger and
poverty for our seniors.
Let me say to our witnesses thank you for being here to
instill with us your knowledge on this issue.
Nearly 48 years ago, President Lyndon Johnson signed this
act into law with a very simple goal, providing limited Federal
funding and guidance to a network of State and local
communities committed to caring for our older, more vulnerable
Americans. He stated then, ``The grants under this law will be
modest in dollars but will be far reaching in results.''
As a general matter, I agree with this original goal. We
believe that the Older Americans Act can be an example of how
the Federal Government leverages our limited funds for greater
coordination and involvement at a local level. I've seen the
OAA's impact throughout my home State on the dignity and
independence seniors are afforded by our local Area Agencies on
Aging and the caring folks in each community who believe
treating that generation, the generation that came before them,
with respect and care, is our responsibility.
In 1992, North Carolina took a step forward in simplifying
the sources of funding for these programs by creating the Home
and Community Care Block Grant. Prior to the block grant's
creation, North Carolina was stuck in a maze of various sources
of funding from the Federal Government and the State, each with
a further maze of requirements and reporting that diverted
attention from basic program administration.
Now, North Carolina's practitioners are able to focus on
caring for seniors rather than complying with a confusing set
of requirements. Although I continue to hear of existing
inefficiencies, this flexibility has ultimately improved the
care seniors in our State receive.
Appropriations for the Older Americans Act remain small as
a relative item of our Federal budget. But that remains in
keeping with the original intent President Johnson outlined in
1965. It is also unlikely to change until Congress gets the
Federal Government's budget deficit and overall debt in order.
For that reason, it's even more important that any
authorization of this law own up to some basic inequities in
how title III funds are allocated to States and by examining
the needs of seniors in each State and allowing States the
flexibility to better target funds accordingly. I continue to
believe that the current OAA formula is an impediment to
directing funds where they're most needed.
In addition, greater programmatic funding and transfer
flexibility, elimination of unnecessary reporting requirements,
and removal of legislation that fosters fragmentation of
organizations and agencies on the local level are all concerns
I've heard from North Carolinians under current program
administration. Any reauthorization that intends to make this
program better must acknowledge these realities and fix them.
Finally, there's no greater challenge to the Federal
Government's purse than the number of Americans preparing to
retire and enter the later years of their lives. Our
entitlement programs will face a considerable strain as a
result of increased enrollments of our Nation's seniors. Many
challenges will arise as a result of how we finance these
unprecedented expansions.
OAA should remain as easy as possible for local Areas on
Aging to administer so that these programs are easy to maximize
to the maximum extent possible the weight that will be placed
on Medicare, Social Security, and other programs from a growing
population of seniors. In short, the Older Americans Act
reauthorization should remain true to President Johnson's
original intent, minimal Federal funding and direction with
maximum reliance on the State and local creativity through
administration.
I thank you, Senator Sanders, and my colleagues. And I
again thank the witnesses.
Senator Sanders. Thank you, Senator Burr.
Senator Baldwin.
Statement of Senator Baldwin
Senator Baldwin. Thank you, Mr. Chairman. I appreciate the
fact that you're holding this hearing today, and I appreciate
your leadership in strengthening economic security for our
Nation's seniors.
The Older Americans Act has been a nearly 50-year promise
enacted in the same year that we created Medicare. This 50-
year-old promise is made so that seniors in our country may
live in dignity with independence and, hopefully, in the
comfort of their own homes.
The Older Americans Act programs often serve as a lifeline
to seniors. However, their importance is too often forgotten by
lawmakers. Today, rather than tell you about being raised by my
grandparents or my own personal support for the Older Americans
Act or even to detail my work with our chairman to reauthorize
and strengthen this law, I thought I'd let Wisconsin seniors
tell you about their own experience with Older Americans Act
nutrition programs.
Last month, the La Crosse Aging Unit in La Crosse, WI, sent
me 40 paper plates with handwritten messages on each one from
seniors who value their Older Americans Act meal programs.
Powerful special interests always get a say in Washington, but
today I want to make sure that some of these seniors' voices
are heard.
Gladys writes,
``A large number of seniors are alone or disabled and
do not do well for themselves nutritionally or
socially. The nutrition sites and senior centers
provide both a social life and a balanced meal at least
once a day. These sites are needed now, and the need
will increase. Please keep funding.''
Father Bob writes,
``When I found the La Crosse Aging Unit and the
mealtime lunch service, they made such a huge and
tremendous relief and change in my life. I'm quite sure
if I had not found this service of Meals on Wheels,
many days I would not have the energy or the
willingness to even try to make a sandwich. I am so
glad that I found this service.''
Mary writes,
``Please make it one of your priorities to restore
full funding to Meals on Wheels and other programs that
meet vital needs in our community and across the U.S.
As one undergoing new treatments, the meals are a
wonderful service at this time in my life.''
And Donna writes,
``I enjoy having meals at the nutrition site as they
are good and good for me, and I use them as my main
meal. We have a wonderful time playing cribbage before,
and wherever there is cribbage, you will find me.''
I will be submitting the plate messages as well as about 30
others that I received for the record, and I look forward to
hearing from our panel. I stand ready to work with my
colleagues on a bipartisan basis to reauthorize the Older
Americans Act.
[The information referred to can be found in Additional
Material.]
Senator Sanders. Thank you, Senator Baldwin.
Senator Warren.
Statement of Senator Warren
Senator Warren. Thank you, Mr. Chairman, and thank you,
Ranking Member Burr, for holding this meeting today.
We're going to talk about a lot of different things that
happen to seniors economically. But since we're talking about
the Meals on Wheels program, I really do want to come back to
this, because what strikes me about this is there is such a
profound economic issue here, that however else you've thought
about this thing, for every dollar spent on the Meals on Wheels
program, we save $50 in Medicare costs. I don't know many
places where you can get a 50 to 1 return on an investment.
Spending $25 a year on meals for seniors across the State
will result--every $25--in a 1 percent reduction in the number
of seniors who are in low-skill nursing homes. So this is a
profound economic issue. These are investments we make. If we
are concerned about the rising cost of Medicare, we have right
in front of us an open door on a way to help bring down those
costs.
So count me in as one of the strong supporters here and one
of the people who will be active on this. But I do want to say
a second part of this. This is also a profound moral question,
a question about helping people retain their independence and
how we treat people who have worked and supported themselves
all their lives, supported us as children, and supported their
parents when it was their turn. But most of all, what is our
measurement of who we are as a people other than how we treat
those who are more vulnerable?
I see this whole question. While Meals on Wheels is
specific and it's a way to focus in on it, this is a place
where good economics emerges with the decisions that are right
for us as a country, as human beings. So I want to do
everything I can to support the work of this committee, to
support your work, so that when you're out there on the front
lines, you've got a good partner here in Washington. I think
that should be our goal.
Thank you, Mr. Chairman.
Senator Sanders. Thank you, Senator Warren.
Senator Murphy.
Statement of Senator Murphy
Senator Murphy. Thank you, Mr. Chairman, and welcome to our
guests today.
Senator Baldwin, I think this will be the first time that
paper plates have been submitted for the congressional records.
So congratulations on that milestone.
Let me just briefly add this because I think we're eager to
hear your testimony. There are a number of stunning statistics
out there today about how little people are able to save for
retirement. As defined benefit plans vanish and wages remain
stagnant and the under-employment rate continues to grow, more
and more Americans just can't put money away like they used to
for retirement.
One of the most amazing statistics is that nearly half of
people in their fifties today don't have anything more than
$25,000 saved for retirement. You couple that with
conversations that we're having here right now, today, with
members of the Senate and the House who want to further
diminish retirement savings by cutting Medicare and Social
Security benefits, and you are on the verge of an absolute
crisis. Eight million Americans today, senior Americans,
struggling with hunger may be a paltry number compared to what
we face 10 or 20 years from now.
So it just underscores how important the Older Americans
Act is, given the retirement savings crisis that we are
currently living in today and I think that we are going to be
even deeper into, especially if we make bad policy choices here
in the Congress 10 years from now. And so that's why this
debate is so important.
I'll add one more piece to this. One of the most important
things that the Area Agencies on Aging do in Connecticut and, I
imagine, around the country is they try to help seniors manage
some of the difficult choices that they have to make today,
especially with regard to healthcare.
We're talking about proposals in the House to effectively
create more and more private sector choice in Medicare,
something that I don't think is a great idea, but we do that
today in Medicare Part D. And the only way that a lot of
seniors are able to negotiate the myriad of choices that they
have within that program is through the help that the Area
Agencies on Aging give them.
So it's not just about the direct support from nutrition
programs. It's also about all of the counseling services that
come through the Older Americans Act and come through these
agencies, which are helping seniors today and may provide
enormous help for them in the future.
Mr. Chairman, I'm so glad to be having this hearing today.
I look forward to working with you on a strong reauthorization
of this act.
Senator Sanders. Thank you very much, Senator Murphy.
We have a wonderful panel, and let me begin by introducing
Nancy Altman. Nancy has a 35-year background in the area of
Social Security and private pensions. She serves as the co-
director of Social Security Works and chairman of the board of
directors of the Pension Rights Center.
She is also the co-chair of the Strengthen Social Security
Campaign, a coalition of over 300 national and State
organizations representing over 50 million Americans. So we are
delighted that Nancy is with us.
Ms. Altman, why don't you begin.
STATEMENT OF NANCY J. ALTMAN, CO-DIRECTOR OF SOCIAL SECURITY
WORKS AND CHAIRMAN OF THE BOARD OF DIRECTORS OF THE PENSION
RIGHTS CENTER, WASHINGTON, DC
Ms. Altman. Thank you, Mr. Chairman.
In the nearly half century since the Older Americans Act
was first signed into law, it has more than proven its value.
To fully understand its vital role, it's imperative that
Members of Congress understand just how vulnerable the
overwhelming majority of seniors are.
Policymakers must examine the facts and reject pervasive
but false stereotypes. Many hear that the percentage of seniors
living in poverty has declined and that life expectancies have
increased, and they jump to the wrong conclusion. They assume
that most seniors are well off. As Chairman Sanders said, a
picture is sometimes conjured up of hoards of affluent self-
centered retirees, driving luxury cars and enjoying endless
rounds of golf. Nothing could be further from the truth.
Almost one out of two Americans aged 65 or older are either
already unable to meet basic needs of food, shelter, and
clothing, or are one serious economic setback away from
poverty. For groups that have been disadvantaged during their
working years--African-Americans, Hispanics, and women--the
percentages are even higher, and all those percentages increase
with age.
The overwhelming majority of other seniors are only
slightly better off. Despite the stereotype of wealthy seniors
living in gated communities, only the rare outlier has income
that even would constitute upper middle class, much less
wealthy. Nor do most seniors have substantial savings, stocks,
or other liquid assets.
Ignoring home equity, which, of course, is illiquid, half
of those 65 and over have a total net worth of less than
$28,000. Half of unmarried women age 65 or older have a total
net worth of less than $8,000, again, aside from home equity.
These figures should not be a surprise. The economic
vulnerability of people as they age is not new. Destitute
senior citizens are a byproduct of industrialization and
urbanization. As people age, physical and mental decline often
preclude work. Even for those capable of work, there is age
discrimination. Though it's no longer legal, it still exists.
And although the distinction is not frequently made in
current policy discussions, wage insurance, not savings, is
what's needed to prepare for the loss of wages as a result of
old age. Social Security's mandatory universal wage insurance
has reduced poverty dramatically, but its benefits are modest.
No one is getting rich from Social Security.
Moreover, as important as Social Security is, seniors
remain economically vulnerable as long as they are one serious
illness away from bankruptcy. That recognition led to the
enactment of Medicare.
Past Congresses also understood that as important as Social
Security and Medicare are, more is needed to promote the well-
being of older Americans. Over 40 percent of those age 65 or
older report difficulty or even inability doing such things as
walking, shopping, or preparing meals. Again, it is the rare
senior with sufficient affluence to hire cooks, chauffeurs, and
other caregivers. That recognition led to the enactment of the
Older Americans Act.
S. 1028, the Older Americans Act Amendments of 2013,
reauthorizes and improves in a variety of ways this vital and
time-tested statute. Among other important provisions, it
directs the Bureau of Labor Statistics to develop a more robust
version of its consumer price index for the elderly. This has
the potential for substantially improving the economic security
of all older Americans, but particularly America's veterans, as
well as the oldest of the old, the poorest of the poor, and
those disabled at young ages.
I see that I am just about out of time. But I discuss at
some length in my written statement this provision and also the
very valuable pension counseling projects which S. 1028
reauthorizes.
In conclusion, wage insurance in the form of Social
Security and health insurance in the form of Medicare are
essential to the economic well-being of the Nation's elderly.
Both programs should be expanded. In addition, Congress should
enact S. 1028 and adequately fund the Older Americans Act.
Older Americans have contributed enormously to our Nation's
commonwealth. Older veterans have served the Nation by
jeopardizing life and limb, protecting the rest of us.
Reauthorizing, improving, and fully funding the Older Americans
Act is the least that a grateful nation can do to repay these
sacrifices.
Thank you, Mr. Chairman.
[The prepared statement of Ms. Altman follows:]
Prepared Statement of Nancy J. Altman
Chairman Sanders, Ranking Member Burr, and members of the
subcommittee, thank you for holding today's hearing on reducing senior
poverty and hunger. Together with Social Security and Medicare, the
Older Americans Act is vital to the national goal of ensuring that
Americans age with security, independence, and dignity after a lifetime
of work.
As co-director of Social Security Works, I co-chair the Strengthen
Social Security Campaign, a broad-based coalition of over 300 national
and State organizations representing 50 million Americans, including
seniors, workers, women, people with disabilities, veterans, children,
young adults, people of low-income, the LGBT community, people of
color, communities of faith, and others. I also chair the board of
directors of the Pension Rights Center, and serve on the board of
directors of the National Academy of Social Insurance.
In 1982, I had the privilege to serve as the top assistant to Alan
Greenspan in his capacity as the chairman of the so-called Greenspan
commission, whose recommendations formed the basis for the Social
Security Amendments of 1983. Prior to that, I was fortunate to serve as
a legislative assistant to Senator John C. Danforth (R-MO).
the truth about the economic vulnerability of america's seniors
The Older Americans Act plays a crucial and integral role, with
Social Security and Medicare, in reducing poverty and hunger in this
country. To fully understand that vital role, it is essential to see
clearly the economic and health status of America's older population.
It is imperative that policymakers examine the facts and reject
pervasive but false stereotypes about older Americans. One particularly
pernicious but widely held myth is that most seniors are affluent self-
centered retirees, driving luxury cars, enjoying endless rounds of
golf, and routinely dining out. Former Senator Alan Simpson (R-WY), for
example, has described the overwhelming number of seniors who object to
his proposals to cut Social Security as ``greedy geezers'' and ``these
old cats 70 and 80 years old . . . who live in gated communities and
drive their Lexus to the Perkins restaurant to get the AARP discount.''
Instead of correcting this false and pejorative stereotype, many seem
to accept it as true. In an op ed column in the Washington Post, writer
Dana Milbank, for example, applauded Senator Simpson's comments for
``being colorful, provocative and honest in an arena that discourages
all three.'' (Emphasis added.)
Despite Milbank's claim of the accuracy of this stereotype, it is
false. In truth, almost one out of two Americans aged 65 or older--48
percent--are either already unable to meet basic needs of food,
clothing, and shelter, or are one serious economic setback away from
not being able to meet those most basic subsistence needs.\1\ The
percentage of women in this category is even higher. More than one out
of two--52.6 percent--are poor or economically vulnerable and at risk.
For African-Americans over age 65, the percentage is higher still--63.5
percent. For Hispanics, the percentage is 70.1 percent.
---------------------------------------------------------------------------
\1\ Defined as incomes less than twice the U.S. Census Bureau's
Supplemental Poverty Measure (SPM) threshold. The SPM is a more refined
and comprehensive measure of poverty than the Federal Poverty Level
(FPL). Developed 50 years ago, the FPL equals three times the cost of a
1963 minimal food diet, adjusted for inflation, and simply counts
before-tax cash income. In contrast, the Supplemental Poverty Measure
equals the 33d percentile of expenditures on food, clothing, shelter,
and utilities, and in determining incomes takes into account government
benefits and a range of expenses, such as taxes, out-of-pocket medical
costs, and work expenses. Twice the poverty line is a measure of
economic deprivation used routinely by researchers and government
programs. It is the measure used in the Older Americans Act Amendments
of 2013 to determine the income level at which contributions for
services are encouraged.
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Moreover, this economic vulnerability increases with age, as the
chart below shows. For those aged 80 or over, the percentage of those
who are poor or one economic shock away from becoming poor is 58.1
percent. For women age 80 or over, the percentage is 63.4 percent. For
African-Americans, it is 72.2 percent. For Hispanics, the percentage of
those aged 80 or over who are poor or at risk is 74.1 percent. For
those who fall into multiple categories of disadvantaged groups, the
percentages are even higher. For example, more than three out of four--
76.6 percent--of Hispanic women, aged 80 or over, are poor or
economically vulnerable.
The overwhelming majority of seniors who do not fall into the
category of economic vulnerability are only slightly better off.
Despite the stereotype of seniors wealthy enough to drive luxury cars
and live in gated communities, only the rare outlier has income that
would even constitute upper middle class, much less wealthy, as the
following chart reveals.
Half of senior households have total incomes at or below $25,757.
Three out of four senior households have total incomes, from all
sources, of less than $50,000. More than 9 out of 10--92 percent--have
incomes, from all sources, of less than $100,000.
Unmarried seniors--widowed, divorced, or never married--have, on
average, even lower total incomes. Half have total incomes at or below
$17,261. Almost nine out of ten unmarried seniors--89 percent--have
incomes less than $50,000. Nearly all--97 percent--have total incomes
from all sources of less than $100,000. Only 0.3 percent of unmarried
seniors have incomes of $200,000 or more.
Nor do most seniors have assets on which to fall back. Half of
those 65 and over have total net worth, excluding equity in their own
homes, equal to or less than $27,322. Half of unmarried women aged 65
or older have total net worth, excluding equity in their own homes,
equal to or less than $7,754.
the reasons behind the economic vulnerability of america's seniors
These figures should not be a surprise. The economic vulnerability
of people as they age is not a new phenomenon. Prior to
industrialization and urbanization, most workers lived on farms with
extended families that could care for them as they aged. With
industrialization and urbanization, workers often moved away from
extended families and found themselves dependent on wage incomes.
The underlying conditions affecting the economic status of seniors
were not so different from today. As people aged, ill health or
ordinary physical and mental decline often precluded work. Even those
capable of work generally found themselves unable to keep or find work.
As a writer in 1912 explained, ``The young, the vigorous, the
adaptable, the supple of limb, the alert of mind are in demand.'' It
should be noted that the Age Discrimination in Employment Act was not
enacted until 1967. Prior to that, employers could and did discriminate
against older workers openly and legally. Want ads would routinely
include age restrictions.
Through no fault of their own, unemployed seniors rarely had
sufficient assets to maintain their standards of living until death.
Despite today's policy proposals directed at encouraging or mandating
retirement savings, the vast majority of workers cannot accumulate
sufficient savings during working years to last, for an average life
expectancy or beyond, until death. \2\
---------------------------------------------------------------------------
\2\ For a detailed analysis of why this is true, see Altman, ``The
Striking Superiority of Social Security in the Provision of Wage
Insurance,'' 50 Harvard Law School Journal on Legislation 109 (2013),
available at http://www.harvardjol.com/archive/volume-50-number-1/.
---------------------------------------------------------------------------
Although the distinction is not frequently made in current policy
discussions, wage insurance, not savings, is what is needed to prepare
for the loss of wages as the result of old age. Insurance is called for
when financial loss is predictable for a group but unpredictable for
individuals. People need life insurance, not savings, to guard
dependents in the event of the policy holder's death. Similarly,
because workers do not know how long they will live, they need life
annuities or, if married, joint and survivor annuities, not private
savings, for protection against a destitute old age. To manage the risk
of lost income as the result of death, old age, or permanent and
serious disability, wage insurance--like the life insurance, joint and
survivor annuities, and disability insurance provided by Social
Security--is what is called for.
Prior to the enactment of Social Security, universal, mandatory
wage insurance did not exist. As people aged and found that they were
no longer able to work, they routinely moved in with their children.
Those who had no children or whose children were unable or unwilling to
support them typically wound up in the poorhouse. The poorhouse was not
some Dickensian invention; it was an all-too-real means of subsistence
for the elderly in the world immediately preceding the enactment of
Social Security.
When Social Security became law, every State but New Mexico had
poorhouses (sometimes called almshouses or poor farms). The vast
majority of the residents were elderly. Most of the ``inmates,'' as
they were often labeled, entered the poorhouse late in life, having
been independent wage earners until that point. A Massachusetts
Commission reporting in 1910 found, for example, that only 1 percent of
the residents had entered the almshouse before the age of 40; 92
percent entered after age 60. These were the only ``gated communities''
in which most of America's elderly have ever resided.
A second 1912 commentator vividly described the dreadful fate
awaiting workers as they aged:
``After the age of 60 has been reached, the transition from
non-dependence to dependence is an easy stage--property gone,
friends passed away or removed, relatives become few, ambition
collapsed, only a few short years left to live, with death a
final and welcome end to it all--such conclusions inevitably
sweep the wage-earners from the class of hopeful independent
citizens into that of the helpless poor.''
the essential roles of social security and medicare in providing
economic security
Destitute senior citizens were a byproduct of industrialization.
Social Security's mandatory, universal wage insurance changed that.
Prior to the enactment of Social Security, no national figures on
poverty existed, but the States that surveyed their residents found
that nearly half of those 65 years of age and over had less than
subsistence income. It is no coincidence that when Social Security's
modest but vital benefits are disregarded, around one out of two
seniors today has income below subsistence, as well.
The importance of Social Security is revealed in the following
chart, which shows the sources of income for those aged 65 or older. As
the chart displays, the bottom three-fifths of the income scale receive
most of their incomes from Social Security. It is important to note
that the chart is a snapshot in time, revealing the income in a single
year. Many of those in the top two quintiles are still working. They
are still receiving a large proportion of their incomes from earnings
and have often not yet begun drawing down assets. Once they retire,
however, their earnings will disappear and their savings will likely
shrink. They are apt to join the ranks of the lower quintiles.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Although the chart does not disaggregate by race or gender, Social
Security benefits are particularly important to women and minorities.
Around half of all African-Americans, Hispanics, and unmarried women,
aged 65 and older, receive 90 percent or more of their income from
Social Security.
The reliance on Social Security is even greater as people age and
exhaust other sources of support. For those aged 80 and over, three out
of four rely on Social Security for half or more of their income. For
almost one out of two--45 percent--Social Security constitutes 90
percent or more of their income. For widowed, divorced, or never-
married women and for people of color, the percentages are even higher
at those ages.
As important as Social Security is in its role of providing some
measure of economic security to American workers and their families as
they age, policymakers have understood that seniors would remain
economically vulnerable as long as they were one serious illness away
from bankruptcy. That recognition led to the enactment of Medicare. As
vital as Social Security and Medicare are, past policymakers understood
that these programs are necessary but not sufficient to ensure old age
security.
the indispensable role of the older americans act in improving the
lives of seniors
More than modest cash income in the form of Social Security and
health insurance in the form of Medicare is needed to promote the well-
being of older Americans. As people age, their ability to drive and
perform other activities of daily living are reduced by loss of
balance, strength, flexibility, vision, hearing, and by other
limitations. Over 40 percent of those aged 65 or older have difficulty,
or even inability, in performing one or more daily tasks of living,
such as walking, shopping, cooking, getting in and out of chairs, and
light cleaning.
Very few seniors, even those with incomes and assets above the
median income figures, have sufficient affluence to hire chauffeurs,
cooks and other caregivers. That recognition led to the enactment of
the Older Americans Act in 1965, the same year that Medicare was
enacted.
In the nearly half century since the Older Americans Act was signed
into law, it has more than proven its value. It has been reauthorized
and improved under both Republican and Democratic administrations. It
has worked synergistically with Social Security and Medicare to
dramatically improve the security of seniors. The Older Americans Act
Amendments of 2013 (S. 1028) continues that long tradition of extending
and improving this important statutory achievement.
improving economic security
The foundation of a secure old age is income. For those unemployed
older Americans who can and want to work, S. 1028 reauthorizes the job-
based training program known as the Senior Community Service Employment
Program.
In addition, S. 1028 directs the Secretary of Labor, through the
Bureau of Labor Statistics, to improve the Consumer Price Index for the
Elderly (CPI-E), and report about it to Congress within 2 years. This
is an extremely important proposal. It has the potential for
substantially improving the economic security of older Americans.
Consumer Price Index for the Elderly
As described above, Social Security benefits are vitally important.
They are adjusted automatically every January when there has been
inflation in the preceding year. Some describe these annual adjustments
as ``increases,'' but they are not. They are intended to prevent
erosion in the purchasing power of Social Security's modest benefits,
which averaged just $1,267.55 in May 2013, or $15,210.60 a year, for
retired workers and just $1,157.25 in May 2013, or $13,887 a year, for
all beneficiaries.
President Richard Nixon, who championed these automatic
adjustments, explained their importance when he signed them into law on
July 1, 1972:
``One important feature of this legislation which I greet
with special favor is the automatic increase provision which
will allow social security benefits to keep pace with the cost
of living. This provision is one which I have long urged, and I
am pleased that the Congress has at last fulfilled a request
which I have been making since the first months of my
Administration. This action constitutes a major break-through
for older Americans, for it says at last that inflation-proof
social security benefits are theirs as a matter of right, and
not as something which must be temporarily won over and over
again from each succeeding Congress.''
As President Nixon recognized, this basic benefit protection is an
extremely important feature of our Social Security system. Once workers
retire, they no longer have salaries or wages which are capable of
increasing with the increasing productivity of the Nation. A worker who
earns $40,000 and retires in 2015 at age 66, for example, will receive
a Social Security benefit that replaces 39.8 percent of those earnings.
That retired worker will receive no gain as the Nation becomes
wealthier and more productive. Rather, that income is, in colloquial
terms, ``fixed.'' This explains why seniors on average have much lower
incomes than the general population. Indeed, those aged 80 and over
have median and average incomes less than half the incomes of working-
age adults.
If Social Security were not adjusted to take account of inflation,
Social Security benefits, which already fail to reflect national
productivity gains once they begin to be paid, would slowly but
inexorably erode over time in real terms as beneficiaries aged. This is
no small matter. Two-thirds of seniors receive half or more of their
incomes from Social Security. These earned benefits would lose value at
the same time that seniors exhausted other assets and that their health
care costs were increasing. It is important to note that most assets of
seniors are not protected against inflation and are not guaranteed for
life. Full inflation protection is virtually nonexistent under
employer-sponsored pension plans.
To ensure that the value of Social Security's vital but modest
benefits does not erode as people age, it is crucial that the automatic
adjustment be as accurate as possible, and does not under-measure
inflation. At the time of the enactment of automatic adjustments, in
1972, the Bureau of Labor Statistics produced only one measure of
inflation--which today is referred to as the Consumer Price Index for
Urban Wage Earners and Clerical Workers, or CPI-W. Ironically, the
index measures the cost of living of workers, not retirees, but was the
only, and so best, measure available.
In recognition, though, that seniors have very different
expenditures from those of workers or the population as a whole, the
Older Americans Act of 1987, signed into law by President Ronald
Reagan, included a provision directing the Secretary of Labor to
develop, through the Bureau of Labor Statistics, a consumer price index
for older Americans. In response, the Bureau of Labor Statistics
created and continues to produce the Consumer Price Index for the
Elderly, referred to by the shorthand, CPI-E.
In calculating the CPI-E, the Bureau of Labor Statistics takes the
work it does in constructing the Consumer Price Index for All Urban
Consumers and narrows it to capture the subset of those aged 62 and
over. The Bureau has never, however, conducted surveys of expenditures
and points of purchase tailored specifically to those aged 62 and
older. This is important because seniors often buy different goods in
different quantities and shop at different stores in different
frequency than the general population. Consequently, the Bureau has
labeled the CPI-E, ``experimental.'' S. 1028 would require the Bureau
of Labor Statistics to undertake those various surveys, so that the
CPI-E would no longer be ``experimental.''
The current CPI-E has historically reported higher rates of
inflation than the consumer price indices measuring the inflation
experienced by workers or the general population. This is unsurprising.
On average, seniors spend a higher percentage of their incomes on
health care than workers or the general population, and health care
costs have grown, and are projected to continue to grow, at a faster
rate than other goods and services. On average, seniors spend a lower
percentage of their incomes on apparel, transportation, and recreation
than workers or the general population, and those goods and services
have not experienced as rapid inflation. If a more robust CPI-E were
produced, as S. 1028 mandates, the differential in inflation between
what seniors experience and what workers and the general population
experience could be even greater.
As the existing CPI-E reveals, the current measure of inflation
used to automatically adjust Social Security benefits under-measures
the inflation experienced, on average, by Social Security
beneficiaries. Despite that fact, some prominent policymakers have
proposed switching to a less accurate, stingier inflation adjustment
for seniors than the already inadequate current-law measure.
Notwithstanding rhetoric to the contrary, those policymakers implicitly
acknowledge that the shift to the even less accurate measure, the so-
called chained CPI, for Social Security and other programs that serve
the elderly and those with serious and permanent disabilities is
nothing more than a benefit cut masquerading as a technical adjustment.
Three leading proposals to shift to the chained CPI--the proposal of
former Senator Alan Simpson and Erskine Bowles, the proposal of the
Debt Reduction Task Force chaired by former Senator Pete Domenici and
Alice Rivlin, and the proposal contained in the Administration's
current budget--all call for measures to ameliorate, to a small extent,
the impact of the chained CPI, as the graph below shows.\3\
---------------------------------------------------------------------------
\3\ Social Security Works created the graph from calculations based
on estimates of the Social Security Office of the Actuary, Social
Security Administration. ``Average Earner'' is a worker with career
average earnings of $40,728.
These proposals are poorly targeted benefit cuts. As the graph
reveals, the largest cuts fall on the oldest old, because the cut
compounds over time. The increasingly large cut occurs as other
resources are exhausted and health costs are increasing, on average. In
addition, the benefit cut in the form of the chained CPI creates a
substantial burden on the poorest in society.\4\
---------------------------------------------------------------------------
\4\ The Administration's budget proposes to exempt means-tested
programs from the switch to the chained CPI, but this still leaves many
poor and near-poor unprotected. The Supplemental Security Income
program (``SSI'') is a program for the aged, blind, and disabled who
have extremely limited income and assets. If an individual receives
Social Security, because he or she worked a sufficient number of
quarters to qualify, the SSI benefit is reduced dollar for dollar after
disregarding the first $20. There are 2.8 million people who receive
income from both Social Security and SSI--the so-called dual
eligibles--so part of their income will still be subject to the benefit
cut. Moreover, because the SSI income and asset limits are so meager,
there are at least 9.4 million poor or near-poor who receive only
Social Security, and so would be subject to the cut imposed by the
chained CPI. (Near poor is defined as within 125 percent of the Federal
Poverty Level.)
---------------------------------------------------------------------------
In 2012, around 9.6 million veterans received Social Security. That
represents 21 percent of all adult beneficiaries. In addition, a number
of veteran-specific programs are adjusted for inflation in the same way
as Social Security. Because of the number of programs that would be
subject to the chained CPI, veterans could receive double, triple, or
more cuts from the chained CPI.\5\ It is not surprising that numerous
groups representing veterans, including the American Legion and the
Veterans of Foreign Wars, oppose the chained CPI--not just for narrowly
defined veterans programs, but also for Social Security and other
programs crucially important to those who have served our Nation in
uniform.
---------------------------------------------------------------------------
\5\ Military and veterans benefits that are indexed in the same
manner as Social Security include Military Retirement pensions, for
which many veterans are eligible; Veterans Pension benefits; Veterans
Disability Compensation; and Dependency and Indemnity Compensation.
Other Federal programs that veterans benefit from, beyond Social
Security and veteran-specific programs, would be affected, as well. For
a more detailed discussion of the programs affected, see Alison
Shelton, ``Inflation Indexation in Major Federal Benefit Programs:
Impact of the Chained CPI,'' AARP Public Policy Institute, March 2013,
available at http://www.aarp.org/work/social-security/info-03-2013/
major-federal-benefit-programs-impact-of-chained-cpi-AARP-ppi-econ-sec
.html.
---------------------------------------------------------------------------
In addition to improving the economic security of seniors in
general, particularly the oldest of the old and the poorest, switching
to the more appropriate CPI-E would help veterans. Those who have
served our Nation in the military deserve not only our immense
gratitude. They deserve the most secure old age the Nation can provide.
They certainly deserve an accurate cost of living adjustment for the
benefits they have earned. S. 1028 would move the Nation an important
step further toward that goal.\6\
---------------------------------------------------------------------------
\6\ As a general point, it is a great improvement to the Older
Americans Act that veterans, as well as LGBT, Holocaust survivors, and
Alzheimer's, are explicitly named as a category deserving to benefit
from additional outreach. It is also an important improvement that S.
1028 adds an objective regarding services that are culturally and
linguistically responsive to seniors and their caregivers. On a related
note, the Strengthen Social Security Coalition recently released a
transition report for the new Commissioner of the Social Security
Administration. The report discusses the need to improve access for
those with limited English proficiency. The report is available at
http://www.strengthensocialsecurity.org/transitionreport.
---------------------------------------------------------------------------
Pension Counseling and Information Program
Further improving the economic security of seniors, S. 1028
reauthorizes the Pension Counseling and Information Program. Pensions
and other public and private retirement plans provide important
supplements to Social Security for those who have them. They are
complicated legal arrangements, however. Most beneficiaries of these
plans cannot afford the legal assistance they may need to obtain the
retirement benefits they have earned.
The Pension Counseling and Information Program funds six regional
counseling projects, which provide assistance and information to
individuals in 29 States. The Program also funds one national pension
assistance resource center, the Pension Rights Center, which provides
consultation, technical assistance and substantive legal training to
the six regional projects, as well as Area Agencies on Aging, Aging and
Disability Resource Centers, legal services providers, and others. The
Pension Rights Center also created and hosts PensionHelp America, a Web
site for those who are outside the jurisdiction of, or simply unaware
of, the regional projects.
The Program is both extremely valuable and cost effective. Since
its inception in 1993, the Program has recovered more than $175 million
in benefits for 50,000 clients, a return of $8 for every Federal dollar
spent on the program. A major shortcoming, however, is that it only has
sufficient funding to cover 29 States. I recommend that Congress enact
S. 1028 and increase funding, as the bill recommends, of all the
reauthorized programs, including this one, which would allow residents
of all 50 States to have access to a regional counseling project.
improving food security
Notwithstanding the great wealth of the United States and the
modest economic security provided by Social Security and Medicare,
hunger is a serious problem affecting seniors. In 2011, nearly 1 in 12
Americans aged 60 or older experienced ``food insecurity,'' a phrase
coined by the U.S. Department of Agriculture to describe those with
uncertain or limited access to an adequate supply of food. Three
hundred thousand veterans age 60 or over fell into this category.
Almost one in five grandparents caring for grandchildren reported food
insecurity, as well. These statistics would be worse without the Older
Americans Act programs which provide meals in group settings, delivered
to homes of those who cannot travel, transportation services for those
who can, and other related services and programs. S. 1028 reauthorizes
and improves these crucial programs. Congress should repeal
sequestration and instead increase the funding for these vital
programs.
conclusion
Wage insurance in the form of Social Security and health insurance
in the form of Medicare are vital to the economic well-being of the
Nation's elderly. Both programs should be expanded. As crucial as these
programs are, though, they are not sufficient. The services and
programs authorized under the Older Americans Act work synergistically
with Social Security and Medicare, to reduce poverty and increase
economic security and to reduce hunger and increase food security. In
addition, the Older Americans Act serves other vital goals, including
reducing elder abuse and increasing physical security, providing
support for caregivers, and facilitating, through those and other key
services, the ability of seniors to continue to live at home as they
age.
S. 1028, the Older Americans Act Amendments of 2013 reauthorizes
and improves this vital and time-tested statute. Congress should enact
it and then ensure that its provisions are adequately funded. Older
Americans have contributed enormously to our Nation's common wealth.
Older veterans have served the Nation by jeopardizing life and limb.
Reauthorizing, improving, and fully funding the Older Americans Act is
the least that a grateful nation can do to repay these sacrifices.
Senator Sanders. Thank you very much, Ms. Altman.
Our second witness is Ellie Hollander. Ms. Hollander has
over 25 years of leadership and management experience in both
non-profit and for-profit organizations. She is the president
and CEO of the Meals on Wheels Association of America, and I
just want to congratulate Ms. Hollander for doing an
extraordinarily good job for that vitally important program.
Ms. Hollander.
STATEMENT OF ELLIE HOLLANDER, PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF THE MEALS ON WHEELS ASSOCIATION OF AMERICA,
ALEXANDRIA, VA
Ms. Hollander. Chairman Sanders, Ranking Member Burr, and
Senators, thank you very much for the opportunity to be here
today and to testify before you.
I'm Ellie Hollander, president and CEO of the Meals on
Wheels Association of America, representing senior nutrition
programs in all 50 States and territories. The majority of
these programs to which I will refer today collectively as
Meals on Wheels rely in some part on Federal funding authorized
through the Older Americans Act.
Every day, Meals on Wheels programs provide nutritious
meals and social contact, whether directly in their homes or in
congregate settings, to seniors 60 years and older who are at
significant risk of hunger or losing their ability to remain
independent and in their own homes where they want to be. Most
are over 75 and need help with daily tasks, like going outside,
dressing, and bathing. Many are isolated and living alone and
in poverty. They have serious health conditions and take
between 6 and 26 medications.
For most of these seniors, Meals on Wheels is their
lifeline, seniors like Mary. Mary is 90 years old and she lives
in eastern Pennsylvania. Until about a year ago, she was
preparing her own meals. But after a debilitating fall and a
long-term recovery, it is no longer safe for her to cook.
Living on a very modest pension and Social Security, it's
become more difficult for her to make ends meet. And, sadly,
her pension check, which used to cover both her gas and
electric bills, barely covers her electric bill today.
For those of you on this subcommittee who have personally
delivered meals, stories like Mary's are all too familiar. But
for those of you who have not yet had the privilege, I would
welcome the opportunity to join you on some meal deliveries. I
think you will find it sobering.
To enable us to continue to help Mary and other millions of
seniors like her, legislative action is critically necessary to
reauthorize and adequately fund the Older Americans Act senior
nutrition programs. There are six reasons why.
No. 1, the need is severe. Nationally, there are 8.3
million seniors currently struggling with hunger. Yet we are
providing nutritious meals to only 2.5 million. While the
infrastructure exists to complete that gap, to fill the gap,
the resources simply don't.
No. 2, the demand is increasing. The demographic swing to
an aging population is already in motion. Baby boomers are
turning 60 at a rate of 12,000 a day, and by 2030, the
population will double to over 70 million.
No. 3, funding levels have not kept pace. Real funding
levels adjusted for inflation have decreased 18 percent over
the past 20 years. At the same time, the population over 60 has
increased 34 percent, leaving a funding deficit of about $514
million just to return to 1992 levels.
No. 4, there is an unrecognized and a substantial return on
investment. Meals on Wheels programs enable seniors to continue
to live at home, averting far more costly healthcare
alternatives, such as hospitals and nursing homes. This, in
turn, reduces Medicare and Medicaid expenses, potentially
saving billions of dollars.
The Center for Effective Government recently found that for
every $1 invested in Meals on Wheels programs, there is up to a
$50 return in Medicaid savings alone. And we know, as Chairman
Sanders referenced, that we can feed a senior meals on wheels
for an entire year for the same cost for that senior to be in
the hospital for 1 day or 6 days in a nursing home.
No. 5, sequester has added insult to injury, exacerbating
an already horrific situation due to year-over-year declines in
both Federal and State funding, increased transportation and
food costs, and diminished individual contributions. The impact
of the sequester has added another $51 million in reductions to
these programs between now and September 30th.
And, finally, No. 6, the impact of the sequester on seniors
is real, and it must be stopped. Based on a member survey that
we recently conducted, the pain is being felt. Almost 70
percent are cutting the number of meals served. Over 70 percent
are establishing for the first time or adding to existing wait
lists. More than half are reducing the number of seniors
served. Almost 40 percent are reducing the number of days they
deliver meals, and one in six programs are closing their doors
altogether.
Since my start with Meals on Wheels on February 11, I've
had the opportunity to experience firsthand what Meals on
Wheels volunteers and staff encounter every day. I now fully
understand what it means to say that we are more than just a
meal, that we are, in fact, a social connection, a safety
check, a friend, a member of the extended family.
Meals on Wheels programs are effective and efficient, and
they are doing precisely what they were designed to do. Even if
the social and moral obligation doesn't prompt immediate action
to reauthorize and bolster the Older Americans Act, the
business and economic cases certainly should.
Due to the urgency of this issue, I'm joined today by my
entire board of directors who, along with me, wish to extend
our appreciation to you, Chairman Sanders, and the members of
the subcommittee for your leadership and commitment to
addressing the critical issue of senior hunger in America. I
sincerely thank you for the opportunity to testify.
[The prepared statement of Ms. Hollander follows:]
Prepared Statement of Ellie Hollander
Chairman Sanders, Ranking Member Burr, and members of the
subcommittee, good morning. Thank you for the opportunity to testify
today at this critical hearing about the issues of hunger and poverty
among our senior citizens and the pivotal role of the Older Americans
Act, specifically Senior Nutrition Programs authorized under title III
C.
I am Ellie Hollander, president and CEO of the Meals On Wheels
Association of America, the oldest and largest national organization
comprised of and representing local, community-based Senior Nutrition
Programs in all 50 States and territories. Some of these programs serve
meals at congregate locations like senior centers, some deliver meals
directly to the homes of seniors whose mobility is limited, and the
majority of the members of our Association provide both services.
Although I have only been with the Meals On Wheels Association for
a few months, I have, in that time, witnessed the efforts of this
subcommittee and in particular, Mr. Chairman, your leadership and
commitment to our seniors and to raising awareness about the critical,
growing, and often hidden issue of senior hunger in our country. On
behalf of our membership and our board of directors, who have joined me
for this hearing today, I want to express our deepest gratitude.
As a national organization, the Meals On Wheels Association
supports local Senior Nutrition Programs by:
Providing education, training and professional development
for Meals on Wheels staff and volunteers to equip them with the
specific skills and tools they need to meet the ever-growing
nutritional demands of the seniors in their communities;
Securing financial and other resources to assist local
programs in keeping their programs sustainable and advancing their
mission so no senior goes hungry;
Funding and conducting timely and relevant research on
senior nutrition, best practices and the social and economic impact of
Senior Nutrition Programs; and,
Raising awareness about the issue of senior hunger and the
tireless work undertaken every day by our local Meals on Wheels
programs.
For more than 40 years, Older Americans Act Nutrition Programs, in
communities large and small, urban and rural, have been serving our
country's most vulnerable, frail and isolated seniors. What started as
a demonstration project has grown into a highly effective community-
based, nationwide network of more than 5,000 Senior Nutrition Programs.
While not all programs receive Federal funding, for my testimony today
I am referring to those that rely, in part, on Federal funding provided
through the Older Americans Act. That funding is then leveraged by
those programs to help raise the remaining funds needed to provide
daily nutritious meals and social contact to seniors 60 years of age or
older who are at significant risk of hunger and losing their ability to
remain independent in their own homes. Of course, this is one of the
primary purposes of the Older Americans Act, a successful, community-
driven model that needs to be reauthorized and funded at far more
appropriate levels that take into consideration inflation, demographic
shifts, and the growth in senior hunger and poverty rates.
However, before I get into the numerous and compelling reasons why
the Older Americans Act should be reauthorized, strengthened, and
properly funded, we should not lose sight of the seniors for whom these
programs were created to serve and for whom it is their lifeline today,
as well as the millions of other seniors who need meals but are not
able to receive them.
Seniors like Mary. Mary is 90 years old and lives in eastern
Pennsylvania. She began receiving meals from her local Meals on Wheels
program in August of last year. Up to that time, she was preparing her
own meals, but after a fall that required hospitalization and weeks of
therapy, it was no longer safe for her to be at the stove. Married for
over 56 years, Mary and her late husband, who worked as an auto
mechanic, raised two children, a daughter and a son. For 18 years she
worked as a sewing machine operator in a local sewing mill.
Financially, it is very difficult to make ends meet, living on a very
modest pension and Social Security. Sadly, Mary's pension check used to
cover the cost of both her electric and gas bills, but now it barely
pays the electric bill. Mary is enjoying the meals she receives and
states, ``Meals on Wheels is a marvelous program. Every volunteer is
tops, so concerned, always happy and asking how are you feeling when
they visit to deliver my meals.''
For those of you on this subcommittee who have personally delivered
meals, stories like Mary's are all too familiar. For those of you who
have not yet had the privilege to deliver meals in your State, I would
like to personally extend an invitation to do so with me. The reality
is sobering. For those seniors who are struggling with hunger, it often
means choosing between paying for medications or eating, or paying the
electric bill or eating. These are tradeoffs that no one should have to
make, especially our most vulnerable seniors.
Of those receiving Meals on Wheels:
The majority are women who are over 75 and live alone;
63 percent have between 6 to 15 serious health conditions,
such as heart disease, hypertension, arthritis, and diabetes;
61 percent take between 6 to 26 medications; and,
39 percent live in poverty.\1\
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\1\ National Survey of Older Americans Act Participants. U.S.
Department of Health and Human Services, Administration on Aging. 2011.
http://www.agidnet.org.
The profile of those seniors who are able to make it out of their
home and into a congregate setting, such as a senior center, is
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slightly better:
The majority are also women who are over the age of 75 and
nearly 40 percent live alone;
40 percent have between 6 to 15 serious health conditions,
such as those listed above;
31 percent take between 6 to 26 medications;
26 percent live in poverty; and,
72 percent need help going outside.\2\
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\2\ Id.
For both Meals on Wheels and congregate meal recipients, an
overwhelming majority need help bathing, dressing, going to the
bathroom, and managing their medications. On top of these sad
realities, many of the basic necessities of daily life that we take for
granted every day, such as interacting with others and having access to
nutritious food, are simply not options without Older Americans Act
Nutrition Programs.
You probably have heard it said many times that Meals on Wheels is
``more than just a meal.'' That's because in addition to a daily
nutritious meal, it is a safety check, a social visit from someone who
cares, who is reliable and trusted. In short, Meals on Wheels is their
lifeline, enabling seniors to live at home, independently and in better
health.
So now that I have described the typical profile of the seniors
being served, let's delve into the driving reasons why reauthorizing,
strengthening, and providing adequate funding for the Older Americans
Act is a necessity:
The need is severe. We are merely scratching the surface on meeting
the needs of an exponentially increasing hungry senior population as
the gaps widen between need/demand and availability/affordability.
Since the onset of the recession, the number of seniors struggling with
hunger has increased in 44 States, including in each of the States that
members of this subcommittee represent.\3\ Nationally, there are 8.3
million seniors \4\ currently struggling with hunger. We are providing
nutritious meals to only 2.5 million.\5\ The difference in those
numbers is devastating--nearly 6 million American seniors are still in
need of reliable, nutritious meals. While the infrastructure exists to
fill that gap, the resources fall substantially short.
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\3\ Senior Hunger Report Card. National Foundation to End Senior
Hunger. May 2012. http://bit.ly/13S6C3s.
\4\ Ziliak, James & Craig Gundersen. Senior Hunger in America:
2010. University of Kentucky Center and University of Illinois. May
2012. http://bit.ly/ZVLL01.
\5\ 2011 Older Americans Act State Program Reports. U.S. Department
of Health and Human Services, Administration on Aging. March 2013.
http://www.agidnet.org/.
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The demand is increasing. The demographic swing to an aging
population is already in motion. Baby Boomers are turning 60 at a rate
of 12,000 a day. By 2030, the senior population will double to over 70
million.\6\ If one in seven seniors today is struggling with hunger, it
is overwhelming to imagine 10 million struggling with hunger in a mere
17 years in the greatest and most affluent country in the world.
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\6\ Aging Statistics. U.S. Department of Health and Human Services,
Administration on Aging http://www.aoa.gov/Aging_Statistics/.
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Funding levels have not kept pace. ``Real'' funding levels
(adjusted for inflation) for Older Americans Act Nutrition Programs
have decreased 18 percent from 1992 to 2012. At the same time, the
population over 60 has increased 34 percent.
Programs effectively leverage Federal funding to raise more. Older
Americans Act funding provides on average about 31 percent of home
delivered and 44 percent \7\ of congregate programs' total annual
budget. To bridge the funding gap, programs cultivate and leverage
public-private partnerships to garner grants and donations from State
and local communities, companies, private foundations, and individuals
(including recipients and/or their families who may be able to pay for
or contribute to the cost of their meals).
---------------------------------------------------------------------------
\7\ 2011 Older Americans Act State Program Reports. U.S. Department
of Health and Human Services, Administration on Aging. March 2013.
http://www.agidnet.org/.
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There is an unrecognized but substantial return on investment.
Meals on Wheels and congregate programs, which help keep seniors
independent in their communities and able to live in their own homes
for as long as possible, avert far more costly alternatives such as
hospital and nursing home care. This, in turn, reduces Medicare and
Medicaid expenses.
The Center for Effective Government recently found that for every
$1 invested in Meals on Wheels programs, there is up to a $50 return in
Medicaid savings alone.\8\ And we can feed a senior through Meals on
Wheels for an entire year for about the same cost for that senior to be
in the hospital for 1 day,\9\ or a nursing home for 6 days.\10\
Contributing to the business case, Brown University \11\ conducted a
recent study that found that by investing more in home-delivered meals,
we can keep more seniors out of nursing homes. Specifically, the
research found that for every additional $25 a State spends on home-
delivered meals each year per person over 65, the low-care nursing home
population--seniors who are nursing home eligible but could remain in
their homes with only a little outside support--decreases by a
percentage point. In terms of Medicaid spending, 1 percentage point can
translate to billions of dollars in savings.
---------------------------------------------------------------------------
\8\ Schieder, Jessica & Lester, Patrick. Sequestering Meals on
Wheels Could Cost the Nation $489 Million per Year. The Center for
Effective Government. April 2013. http://bit.ly/16jmmRU.
\9\ Average Costs to Community Hospitals Per Patient: 1990-2009.
U.S. Census Bureau, Statistical Abstract of the United States. 2012.
http://1.usa.gov/X0XlWc.
\10\ Market Survey of Long-Term Care Costs. MetLife Mature Market
Institute. 2012. http://bit.ly/Z6op5F.
\11\ Thomas, Kali & Mor, Vincent. The Relationship between Older
Americans Act Title III State Expenditures and Prevalence of Low-Care
Nursing Home Residents. Brown University. December 2012. http://bit.ly/
16wl0B2.
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Sequester has added insult to injury. Exacerbating an already
horrific situation compounded by year-over-year declines in funding at
both the Federal and State level, increased transportation and food
costs, and diminished individual contributions yet to rebound from the
recession, the impact of the sequester on Older Americans Act Nutrition
Programs has added another $51 million in reductions to these programs
for the remainder of 2013--compressed between now and September 30.\12\
There is no telling what the ``run rate'' impact of the sequester will
impose for the subsequent years during which it is scheduled to
continue, but it won't be pretty.
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\12\ Funding Allocations to States and Tribal Organizations. U.S.
Department of Health and Human Services, Administration on Aging. May
2013. http://1.usa.gov/16vSXSm.
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The impact of the sequester on seniors is real, and it must be
stopped. Based on a survey we recently conducted of our member programs
that receive Federal funding through the Older Americans Act:
Almost 70 percent are cutting the number of meals served;
Over 70 percent are establishing for the first time or
adding to existing waiting lists;
More than half are reducing the number of seniors being
served;
40 percent are eliminating staff positions;
Almost 40 percent are reducing the number of days they
deliver meals;
25 percent are reducing the number of days open for
congregate sites; and,
1 in 6 programs are closing congregate sites or home-
delivered meal programs altogether.\13\
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\13\ Sequester Survey. Meals On Wheels Association of America. June
2013. http://bit.ly/17rq4JQ.
The objectives of the Older Americans Act Nutrition Programs are to
reduce hunger and food insecurity, to promote socialization and health
and well-being. And services are targeted to those with the greatest
economic and social need, including most at risk for nursing home
placement. We know that these programs are saving lives and taxpayer
dollars every day. They are efficient and effective, and they are doing
precisely what they were designed to do.
Since my start with Meals On Wheels on February 11, at a time when
the threat of the sequester was looming, I have traveled across the
country to visit individual programs in Georgia, Indiana, Wisconsin,
Kansas, Massachusetts, Texas, and South Carolina. While I have learned
that each Meals on Wheels program is unique, the challenges they face
are nearly uniform.
I have had the opportunity to conduct meal deliveries in nearly
every State I have visited. And I have seen firsthand the full
continuum of experiences--from my visit with Mrs. Gove, confined to a
wheelchair from polio who volunteers as a Caller Coordinator for her
church, to Mr. Hiatt, a farmer who had recently been discharged from
the hospital following back surgery, to Mr. Huebschen, a distinguished
military veteran who after 50 years in a loving marriage was recently
widowed. I have arrived when someone was in immediate need of
assistance and moments after a recipient passed away. I have been
welcomed into homes and offered a seat to visit with people who had
never met me before, simply because I announced I was from Meals on
Wheels. Now, I fully understand what it means to say that we are more
than just a meal; that we are, in fact, a social connection, a safety
check, a friend, a member of their extended family. I cannot imagine
how we can allow these seniors in need--who are our parents,
grandparents, aunts, uncles, teachers, neighbors, veterans--to bear the
brunt of our inability to work in a nonpartisan fashion to prop up this
program which is, in fact, working well. Even if the moral obligation
doesn't prompt action, the business and economic cases certainly
should.
Thank you sincerely for the opportunity to testify before the
subcommittee. I hope it has been insightful and compelling. I look
forward to answering any questions you might have and to working with
you to address the critical issue of senior hunger in America.
Senator Sanders. Ms. Hollander, thank you very, very much.
Our next panelist is Howard Bedlin. Mr. Bedlin has served
as an advocate for older Americans for over 30 years, including
10 years at AARP and more than 15 years in his current position
as vice president for Public Policy and Advocacy at the
National Council on Aging.
Mr. Bedlin, thanks for being with us.
STATEMENT OF HOWARD BEDLIN, VICE PRESIDENT, PUBLIC POLICY AND
ADVOCACY AT THE NATIONAL COUNCIL ON AGING, WASHINGTON, DC
Mr. Bedlin. Thank you, Chairman Sanders, Ranking Member
Burr, and members of the subcommittee. On behalf of the
National Council on Aging, I appreciate the opportunity to talk
with you today.
NCOA is the Nation's oldest service and advocacy
organization representing seniors and those who serve them, and
our particular focus is on the vulnerable and disadvantaged
seniors. Since two of my colleagues are addressing hunger
issues, I'll focus my remarks on the critical role the Older
Americans Act plays in reducing senior poverty and economic
insecurity, an area that few understand or appreciate.
We estimate there are over 23 million Americans over age 60
who are economically insecure, struggling with rising health
and energy bills, growing debt, and job loss. The recession hit
seniors hard. Millions have seen their retirement savings
diminish. Median family wealth declined by over 15 percent
among those aged 55 to 64, and by 14 percent among those 65 to
74.
For example, an Area Agency on Aging professional in
Raleigh, NC, recently told us,
``I'm regularly dealing with seniors who have credit
card debt that's often snowballed into thousands of
dollars with no way possible to get out from under the
debt and credit card payments not leaving enough income
to cover basics like food and utilities.''
For many seniors, the only solution is to work longer or
return to work from retirement, but they face serious
challenges. The unemployment rate for workers over age 65 is
the highest it's been since the Great Depression, and they
spend far too much time struggling in search of work.
Older Americans Act Title V, the Senior Community Service
Employment Program, or SCSEP, is the only workforce program
designed exclusively to maximize the contributions of
vulnerable seniors. Nearly 90 percent of participants live in
poverty, and more than a third are homeless or at risk of
homelessness.
Beyond job training and placement, program participants
provide millions of hours of community service with a value
estimated at over a billion dollars. If Congress is serious
about creating job opportunities for Americans in need, we
should be investing more in the SCSEP program.
Seniors with income just above poverty and those with
chronic illness spend more of their income out-of-pocket on
healthcare than any other group. Older Americans Act Title III-
B, Home and Community-Based Supportive Services, plays a modest
but critical role in helping to address a growing crisis
largely ignored by Congress, the fact that Americans are forced
to impoverish themselves by spending down their life savings
before receiving help with needed long-term care. With median
nursing home costs now at $84,000 a year, it doesn't take long
to essentially go bankrupt onto Medicaid.
Title III-B also supports Multi-Purpose Senior Centers, a
gateway to community services that prolong independence,
improve economic well-being, and promote community engagement.
A third program, title III-D, provides health promotion and
disease prevention services that reduce the need for
hospitalization and emergency room visits. The aging network is
uniquely positioned to provide the support and education
seniors need to better care for themselves and stay healthier
longer.
For example, title III-D provides modest funding for
evidence-based chronic disease self-management and elder falls
prevention programs. Elder falls are common--one in three
seniors fall every year--expensive, projected to cost the
Nation $60 billion in 2020, and often avoidable. Research has
shown that several community-based programs reduce falls and
produce a positive return on investment.
A fourth program was added in the 2006 reauthorization with
subsection 202(20) under title II that strengthen benefits
outreach and enrollment assistance to low-income seniors, which
is really important, because only about a third of low-income
seniors eligible for assistance actually get it, for example,
with Medicare low-
income protections and SNAP. The 2006 amendments further
strengthened the program's ability to promote economic security
with new provisions to help prevent elder financial abuse and
exploitation, which cost victims an estimated $3 billion a
year.
Going forward, the Older Americans Act works well and major
structural changes are not needed. The reauthorization process,
which should occur every 5 years, provides an important
opportunity to reassess the Act's successes and limitations and
modernize services. Particularly, in times of fiscal restraint,
changes can be made by identifying and incorporating innovative
best practices to improve efficiency and outcomes.
NCOA urges members of the HELP Committee to continue the
tradition of bipartisan and timely reauthorization of this
important statute and come together to pass a bill before the
August recess. S. 1028, the Older Americans Act Amendments of
2013 introduced recently by Chairman Sanders, is an excellent
starting point for serious bipartisan discussions.
NCOA supports the bill, as it incorporates several of our
priorities, including defining and establishing economic
security as a goal, increasing attention on seniors with the
greatest economic needs in the development of State and area
plans, promoting senior center modernization, and emphasizing
the delivery of evidence-based chronic disease management and
falls prevention in area plans and supportive services
programs.
Finally and in conclusion, I'm compelled to mention that
sequestration's arbitrary reductions to OAA programs seriously
fail to recognize our current age wave or account for years of
flat funding that did not keep pace with inflation. If
continued, this penny-wise, pound-foolish policy will increase
unmet needs in mandatory program spending and harm millions of
seniors and their families.
NCOA strongly urges that Congress fund OAA services at
levels that protect and strengthen the program so it can meet
the rapidly growing need among vulnerable seniors and their
families.
Thank you.
[The prepared statement of Mr. Bedlin follows:]
Prepared Statement of Howard Bedlin
On behalf of the National Council on Aging (NCOA), I greatly
appreciate the opportunity to talk with you today about the role of the
Older Americans Act (OAA) in reducing senior poverty and hunger. NCOA
is a nonprofit service and advocacy organization headquartered in
Washington, DC. NCOA's mission is to improve the lives of millions of
older adults, especially those who are vulnerable and disadvantaged. We
work with thousands of organizations across the country to help seniors
find jobs and benefits, improve their health, live independently, and
remain active in their communities.
Enacted in 1965, the same year as Medicare and Medicaid, the Older
Americans Act is a critical program that supports the health and
economic security of older adults. Over nearly 50 years, the OAA has
helped countless older adults remain healthy, out of hospitals and
nursing homes, independent, active, and working longer. In doing so,
the OAA has kept health care costs down. And the Act holds even greater
potential to bend the future cost curve of the big three entitlement
programs.
OAA programs are delivered through a national network of 56 State
agencies on aging, over 600 area agencies on aging, more than 200
tribal organizations, and nearly 20,000 local providers--serving an
estimated 10 million seniors. OAA services are targeted to older
individuals with the greatest social or economic need, including those
with low incomes, minorities, and those living in rural areas. Programs
provide for basic human needs, such as food, jobs, transportation, home
and community services, and health promotion/disease prevention.
Through these services, the OAA plays a critical role in reducing
poverty and hunger among older Americans. NCOA believes OAA
reauthorization provides the ideal opportunity to further strengthen
the Act for seniors in need today and tomorrow. We support S. 1028, the
Older Americans Act Amendments of 2013, introduced recently by Chairman
Sanders and cosponsored by 17 colleagues, and believe it is an
excellent starting point for serious bipartisan discussions.
As detailed in our statement below, the OAA plays a critical role
in reducing poverty and hunger among older Americans, and we believe
reauthorization provides a critical, timely opportunity to strengthen
the ability to more effectively address these growing national
problems.
growing poverty and economic insecurity among america's seniors
There are over 23 million Americans aged 60+ with incomes below 250
percent of the Federal poverty level ($28,725 annually for a single
person). These older adults struggle each day with rising housing and
health care bills, inadequate nutrition, lack of access to
transportation, diminished savings, and job loss. Out-of-pocket health
costs for Medicare beneficiaries with incomes between 100 percent and
200 percent of poverty are estimated at about 23 percent of income--
highest among all income groups. Millions of seniors teeter just above
the poverty line--just one unexpected expense or other bad break away
from it.
People like Frank from St. Johnsbury, VT, who shares,
``I am one paycheck away from foreclosure and bankruptcy.
Struggling to make ends meet, I went back to college at age 59.
Graduated at age 61, I continued training in my career field
learning new, valuable skills but find I can't seem to get
ahead because I am strapped with debt.''
The recession hit seniors like Frank hard. Millions of older
Americans have seen their hard-earned retirement savings diminish.
According to the Federal Reserve Board, median family wealth declined
by 15.2 percent among those aged 55-64, and it fell by 13.9 percent
among those aged 65-74. An estimated 12 percent of adults aged 55-64,
and 21.5 percent of women in this age group, face retirement with
negative net worth, contributing to a rise in bankruptcies that has
grown at the fastest pace ever.
Baby Boomers face increased financial uncertainty due to the
economic downturn, particularly due to declining home values,
diminished retirement accounts, and job loss caused by the recession.
Estimates suggest half of all Baby Boomers will live on incomes less
than $27,000 per year. Moreover, from 1992 to 2007, the average overall
debt for 55- to 64-year-old households more than doubled to $70,370.
Many mature workers face retirement without any pension, as 44 percent
of workers in their fifties have neither a defined benefit nor a
defined contribution pension.
The Census Bureau has historically estimated poverty rates using an
``official'' poverty measure created about 50 years ago. It has serious
shortcomings, however, when it comes to accurately estimating poverty
among older Americans primarily because it fails to account for their
relatively higher out-of-pocket medical expenses. The Census Bureau
recently released an alternative measure, known as the supplemental
poverty measure (SPM), which is more accurate and comprehensive since
it provides a more current income standard for meeting basic needs. It
accounts for regional cost-of-living variations and the impact of both
non-cash benefits received and non-discretionary expenditures,
including medical out-of-pocket expenses--the major source of the
significant differences between these measures for persons 65 and over.
For similar reasons, NCOA believes the experimental consumer price
index for the elderly (CPI-E) is a more accurate measure for
determining future cost-of-living adjustments for senior benefits
because it factors in the disproportionate amount seniors spend on
health care. We, therefore, support Section 209 of S. 1028, which
further revises and improves this index.
Under the supplemental poverty measure, about one in seven (15
percent) individuals ages 65 and older have incomes below the poverty
level, compared to about 1 in 10 (9 percent) using the 1960s measure.
Under the SPM, nearly one-half (48 percent) of older Americans (almost
20 million seniors) have incomes below 200 percent of poverty, compared
to about one-third (34 percent) under the ``official'' measure. More
than half of the seniors in 10 States have incomes below 200 percent of
poverty using the SPM, including three States represented by members of
the HELP Committee--Georgia with 53.8 percent (third highest),
Tennessee with 52.2 percent (fourth highest), and Rhode Island with
51.8 percent (seventh highest). In addition, more than 52 percent of
older women, and over 58 percent of Americans age 80 and older, have
incomes below 200 percent of the SPM threshold. Conversely, only 19
percent of seniors have income above 400 percent of the SPM measure,
compared with 32 percent under the 1960s measure.
As a result of our aging population and increasing economic
insecurity, aging services organizations across the country are
experiencing large increases in the demand for their core services,
such as job training and assistance, help with applying for benefits,
and subsidized meals. These organizations also find themselves
stretched to try to assist clients with significant financial problems
that are difficult to solve, such as threats of foreclosure or
eviction, high credit card debts, and a pervasive and growing sense of
economic insecurity.
An Area Agency on Aging professional in Raleigh, NC stated:
``I am regularly dealing with [seniors who have] credit card
debt that has often snowballed into thousands of dollars, with
no way possible to get out from under the debt, and credit card
payments not leaving enough income to cover basics like food
and utilities.''
What struggling older adults need--and what they cannot now get in
most communities--is one place where they can go to receive: (1) a
comprehensive assessment of their economic situation; (2) a summary of
the range of options that best meet their needs, expressed in clear and
plain language; and (3) assistance with connecting to and accessing the
appropriate programs and services, including employment and training.
Leveraging 21st century strategies and technology, the OAA can be
strengthened and better positioned to meet the increasingly complex
needs of vulnerable and disadvantaged boomers and seniors. We believe
the OAA should contain: (1) a goal of economic security; (2) policy and
program guidelines that ensure the improved coordination of public
benefits and private resources; and (3) authorization of resources that
ensure the training and robust implement of a holist approach by the
aging network.
In order to measure impact and best structure programming to meet
the economic needs of older adults, the network first must adopt and
define a measurable goal as a benchmark. The term ``economic security''
should be defined and stated as an objective of the OAA. Although
economic security has long been an implied goal, the recent economic
downturn and its negative impact on the housing, employment, and
financial markets have made it an even more pressing matter for those
concerned with the well-being of older adults.
NCOA greatly appreciates and supports the various provisions in S.
1028 that strengthen the OAA's ability to improve economic security
among older Americans, and enable the aging services network to more
effectively respond to seniors' specific needs and struggles. We are
particularly supportive of the provisions to include economic security
as a priority in the declaration of objectives, provide a new
definition of economic security, and focus increased attention on
seniors with the greatest economic needs in the development of State
and area plans. This addition will better enable the aging service
network to meet the needs of seniors today and tomorrow.
Current Older Americans Act Programs that Reduce Senior Poverty and
Economic Insecurity
OAA Title V: The Senior Community Service Employment Program
(SCSEP)--For many older Americans, the only solution to their financial
insecurity is to work longer than planned or return to work from
retirement. Yet, older adults face challenges to staying in the
workforce. Not only has the nature of work changed, but the work
opportunities are far fewer.
According to the Bureau of Labor Statistics, the unemployment rate
for workers aged 65+ was 7.6 percent in May 2013, the highest it has
been for this age group since the Great Depression ended, and more than
double the 3.3 percent unemployed at the start of the recession in
December 2007. These challenges will only worsen, as the total number
of economically vulnerable seniors will increase to 30 million by 2020.
Once unemployed, older workers spend long periods of time searching
for work. The average duration of looking for employment is 54.6 weeks,
compared to about 9 months for younger workers. Once they have lost a
job, older Americans are more likely than any other age group to remain
out of work for 99 weeks or more. By January 2012, older workers
displaced in 2009-11 were half as likely to have regained employment
(23.5 percent) than the nationwide average (56 percent).
Many seniors simply stop looking for work and choose to draw on
their Social Security benefits instead. Discouraged mature workers are
not looking for work because they believe that none is available,
employers will find them too old, they lack the necessary schooling/
training, or they face other types of discrimination. In August 2010,
discouraged mature workers represented nearly 20 percent of older
persons not in the workforce.
The Senior Community Service Employment Program (SCSEP) is the
Nation's only workforce development program designed exclusively to
maximize the productive contributions of a rapidly growing older
population. Authorized under Title V of the OAA, workers aged 55+ with
incomes at or below 125 percent of the poverty line are provided part-
time community service employment and training. SCSEP matches eligible
older adults with eligible host agencies. They are paid minimum wage
for an average of 20 hours per week while they build skills and self-
confidence to help them transition into unsubsidized employment.
Participants train in a variety of occupations including customer
service, office and computers, food service, and health care. For most,
their SCSEP experience leads to permanent employment.
Mainstream employment and training programs are not as effective in
serving this population, particularly those with outdated skills who
face discrimination in hiring. Significant numbers of SCSEP
participants are struggling to make ends meet. Nearly 90 percent live
in poverty, with incomes at or below $10,890. More than one-third are
homeless or at risk of homelessness. About two-thirds are female, and
many of these older women spent the majority of their adult lives as
caregivers and did not acquire the skills that would make them
competitive in today's workforce.
SCSEP is administered by State agencies and 18 national sponsors,
including NCOA. In fiscal year 2010, approximately 120,000 older
workers were assisted by the program, dropping to 76,864 for the
program year ending June 30, 2012. This year, work hours have been
scaled back in most communities to 12 to 15 hours a week. The overall
decrease in the number of participants is due to attrition and lack of
resources to add new seniors to the program. Wait lists for the program
are approaching 100 in several of the communities that NCOA serves, and
that number exceeds 600 in New York City alone.
While older workers develop skills and receive training and
placement assistance in SCSEP, they also help local organizations that
are struggling to meet growing needs with shrinking State, Federal, and
charitable dollars--to maintain or increase their capacity to provide
services to their communities, such as delivering meals to the
homebound, assisting in libraries, and administering disaster relief.
SCSEP participants provide millions of hours of community service,
including serving other older adults, with a value to States and
communities estimated at over $1billion.
The need for SCSEP has never been greater. If Congress is serious
about creating job opportunities for Americans in need of employment,
we should be investing more in the SCSEP program.
OAA Title III-B: Home and Community-Based Supportive Services--
Grants under this title fund a broad array of services that enable
seniors to remain in their homes for as long as possible, including
transportation, case management, adult day care, and in-home services
such as personal care, chore, and homemaker assistance. Funding is also
available to multi-purpose senior centers that coordinate and integrate
services for the older adults such as congregate meals, community
education, health screening, and exercise/health promotion programs. In
fiscal year 2010, title III-B programs provided:
Personal Care, Homemaker, and Chore Services--more than 35
million hours of assistance to frail seniors at risk of nursing home
placement.
Adult Day Care--over 10 million hours of services and
supports for care for dependent adults in a supervised group setting.
Transportation Services--over 27 million rides to doctor's
offices, pharmacies, senior centers, meal sites, and other important
activities.
These OAA programs play a modest but critical role in helping to
address a growing crisis faced by millions of families that Congress
has largely ignored: the institutional bias in our long-term care
system, and the ongoing necessity for individuals and families to
impoverish themselves by spending down their life savings before
receiving the services and supports they need. With the median annual
rate for a private nursing home room now costing $84,000, it does not
take long for the average American to quickly spend-down to poverty and
onto Medicaid. Investments in home and community services could reduce
rates of institutionalization and impoverishment among our rapidly
growing senior population, particularly the rapidly growing group of
those over age 85, who are at greatest risk of needing care. Medicaid
long-term care services are also costing the Federal and State
governments over $150 billion a year, which could be significantly
reduced with increased investments in far less expensive OAA services.
Title III-B also supports multipurpose senior centers, recognized
by the OAA as community focal points, which have become one of the most
widely used services among America's older adults. Today, nearly 11,000
senior centers serve 1 million older adults every day. Senior centers
serve as a gateway to the Nation's aging network--connecting seniors to
vital community services that: (1) prolong independence and delay
institutionalization; (2) empower them to better manage and delay the
onset of chronic disease; (3) improve their physical, social, mental,
and economic well-being; and (4) promote active community engagement.
In seeking to appeal to and serve younger seniors, senior centers
must make changes that connect them in new ways with their communities,
such as upgrading their facilities and equipment. According to a
February 2010 study by the Council of Senior Centers and Services in
New York, many senior centers have aging physical plants and need to
renovate to meet growing demands.
OAA reauthorization provides an opportunity to create authority to
modernize multipurpose senior centers to foster innovation, leadership
and capacity building. Senior center leaders understand that those
receiving such investments would be held to a certain level of
accountability, standards or accreditation. We should help the
``innovators'' continue to develop and test new models and provide
technical assistance and training so that senior centers can better
meet the needs of our growing aging population.
NCOA greatly appreciates and supports Section 403 of S. 1028, which
would support and promote modernized multipurpose senior center models,
build an evidence base of innovative practices to meet diverse needs,
enable renovations to meet growing demands, and conduct an evaluation
of the programs. We also support various provisions to improve care
coordination among a broad array of health and home and community-based
services.
OAA Title III-D: Evidence-Based Health Promotion and Disease
Prevention--Title III-D initiates programs that help older adults
prevent or manage multiple chronic disease and increase healthier
lifestyles. According to the Medical Expenditure Panel Survey, over 53
percent of Medicare patients are treated for five or more chronic
conditions during the year, accounting for nearly 78 percent of total
Medicare expenditures. The aging network is in a unique position to
give older adults the support and education they need to care for
themselves and stay healthier longer.
According to the Kaiser Family Foundation, the out-of-pocket
financial burden of health care is higher for seniors in poor health.
Median out-of-pocket spending in 2006 was 20.6 percent for Medicare
beneficiaries in poor health and 14.2 percent for those in excellent or
very good health.
OAA evidence-based health promotion programs are effective at
helping participants adopt healthy behaviors, improve their health
status, and reduce their use of hospital services and emergency room
visits. These low-cost programs empower older adults to take control of
their health by maintaining a healthy lifestyle through increased self-
efficacy and self-management.
A study by RTI International found that title III-D programs
stimulate innovation and allow community organizations to test out new
approaches through partnerships that extend the reach of these
services.
Two program areas funded under title III-D which are particularly
effective are the Chronic Disease Self-Management Program (CDSMP) and
evidence-based falls prevention programs, which were developed with
initial funding under OAA Title IV (see below). CDSMP is a low-cost,
evidence-based disease prevention model that has been shown through
randomized control experiments to be effective at helping people with
chronic conditions to adopt healthy behaviors, improve their health
status, and reduce their use of hospital stays and emergency room
visits.
Title III-D also provides modest funding for evidence-based falls
prevention programs in some States, offering promising directions for
simple, cost-effective interventions. One in three older Americans fall
each year. Falls are the leading cause of both fatal and nonfatal
injuries for those 65 and over. About $30 billion a year is spent
treating older adults for the effects of falls and it is projected to
double by 2020, costing Medicare $32 billion.
Randomized controlled trials of several community-based programs
have clearly demonstrated a reduction in falls: When compared with
controls, the Tai Chi: Moving for Better Balance intervention reduced
falls by 55 percent; the Stepping On program reduced falls by 30
percent; and the Otago Exercise Program reduced falls by 35 percent.
Research has shown that all of these evidence-based interventions have
positive return on investment or anticipated savings that result from
implementing falls prevention programs. For example, Tai Chi: Moving
for Better Balance demonstrated that for every $1 invested in the
program there is a $1.60 saved in direct medical costs.
NCOA appreciates and supports provisions in S. 1028 to further
promote evidence-based self-care management for those with chronic
conditions, and evidence-based falls prevention programs in area plans
and supportive services programs.
OAA Title IV: Activities for Health, Independence, and Longevity
(Program Innovations)--Title IV authorizes the Assistant Secretary for
Aging to award funds for research, demonstration and evaluation
projects. Many successful title III and other OAA programs trace their
origin to title IV work. With systematic knowledge gathering and
application, the OAA has the potential to improve program efficiency
and effectiveness, better meet the needs of an increasingly diverse
population, and help slow the growth of Medicare and Medicaid
expenditures. As Congress and the Administration consider policy
changes through reauthorization and appropriations, we urge that
greater consideration be given to this significant potential under
title IV.
A title IV success story is a Bush administration initiative known
as Choices for Independence under the leadership of former Assistant
Secretary Josefina Carbonell. Choices for Independence awarded grants
to develop and evaluate evidence-based disease management and
prevention programs to reduce the risk of disease, disability, and
injury among seniors. This is a model for working together on a
bipartisan basis to take innovations that improve efficiency and
outcomes to scale, and should be replicated in other areas.
Title II, Section 202(20): OAA Provisions on Benefits Outreach,
Enrollment and Counseling--Improving access to needed benefits is
critical to providing economic support to low-income, vulnerable
seniors. Benefits provide help paying for food, health care, home
energy, and other daily needs, alleviating poverty and allowing seniors
to live with dignity. Benefits are also a source of economic
development in local communities by increasing consumption and spending
in them.
Large percentages of vulnerable seniors and younger people with
disabilities are not participating in need-based programs for which
they are eligible. Many are not aware of these programs, do not believe
they qualify, do not understand the value of the assistance, or need
help filling out the application forms. In particular, low-income
Medicare beneficiaries continue to struggle to access the health care
benefits for which they are eligible. For example, approximately 2.3
million individuals eligible for the Medicare prescription drug low-
income Extra Help are not enrolled. Less than a third of those eligible
for assistance paying Medicare Part B premiums through a Medicare
Savings Program (MSP, for beneficiaries with incomes below 135 percent
of poverty) receive this help.
The 2006 OAA reauthorization added title II, section 202(20), which
strengthened language on outreach and enrollment assistance to seniors
in greatest need, and created the National Center for Benefits Outreach
and Enrollment. Currently administered by NCOA, the Center has become
the leading national resource working with community-based
organizations that assist seniors in accessing the need-based benefits
that help them remain healthy and independent. The Center makes widely
available state-of-the-art web-based screening and enrollment tools;
fosters the use of cost-effective benefits outreach and enrollment
strategies by local Benefits Enrollment Centers (BECs) and service
providers; provides training and technical assistance; and has
developed an online information clearinghouse of cost-effective,
promising practices related to benefits outreach and enrollment.
In 2008, Congress provided $25 million in Medicare funding for the
National Center, Area Agencies, State Health Insurance Assistance
Programs, and Aging and Disability Resource Center to perform various
outreach and enrollment activities for low-income Medicare
beneficiaries. This enabled grantees to:
Assist about 540,000 individuals in need;
Generate $1.8 billion in local economic activity;
Reduce by almost 10 percent the number of low-income
beneficiaries without access to needed benefits for which they were
eligible;
Target rural communities to improve access to Medicare
prescription drug coverage and extra help;
Assist thousands of beneficiaries to save money and make
the competitive market work better through improved information for
consumers making complex choices, fostering objective yet personalized
plan selection and decisionmaking; and
Contribute toward increasing new MSP enrollment from
192,963 in 2009 to 388,733 in 2011.
OAA provisions to reduce elder financial abuse and exploitation--
One of the key elements to ensuring economic security for older adults
is preventing elder financial abuse and exploitation. Financial abuse
is the third most commonly substantiated type of elder abuse, following
neglect and emotional/psychological abuse. While underreported, the
annual economic loss by victims of elder financial abuse is estimated
to be at least $2.9 billion annually, according to a June 2011 study by
the MetLife Mature Market Institute.
Examples of financial exploitation include cashing an elderly
person's checks without authorization; forging an older person's
signature; or misusing or stealing an older person's money or
possessions. Another example is deceiving an older person into signing
any contract, will, or other document.
NCOA appreciates and supports language in Section 708 of S. 1028 to
further strengthen current OAA provisions to reduce elder financial
abuse and exploitation. We strongly urge Congress to provide funding to
support these and other similar efforts to combat various forms of
elder abuse.
Senior Hunger and OAA Nutrition Programs
Hunger is a serious and growing problem among older Americans. The
prevalence of food insecurity is at a 17-year high and occurred in more
than 8.4 percent of households with older adults in 2011 (2.5 million
households). Eight of the top ten States with the highest rates of
senior food insecurity are in the South, including North Carolina,
Georgia, and South Carolina. The number of food insecure seniors is
projected to increase by 50 percent in 2025.
Food insecurity leads to significant health problems that can
jeopardize seniors' ability to live independently. Compared to their
peers, food insecure seniors are:
Almost twice as likely to be diabetic (19 percent vs. 2
percent).
Far less likely to be in excellent or very good health (17
percent vs. 44 percent).
Over five times more likely to suffer from depression (16
percent vs. 3 percent).
Over twice as likely to have at least one limitation with
an activity of daily living (52 percent vs. 21 percent).
The Congregate and Home-Delivered Nutrition Services Programs
successfully reduce hunger and food insecurity, promote the health and
well-being of older individuals, and delay adverse health conditions.
They have been one of the core elements of our national strategy for
reducing food insecurity among the elderly for over 40 years. These
services are targeted to those in greatest social and economic need. A
2009 national survey found that 44 percent of home-delivered meals
recipients were in poverty and 52 percent were at high nutritional
risk, while 34 percent of congregate meals recipients were in poverty
and 19 percent were at high nutritional risk. The survey also found
that 63 percent of home-delivered meal recipients and 58 percent of
congregate meals recipients relied on these services for one-half or
more of their total food for the day.
Investments in these nutrition programs help to bend the Medicare
and Medicaid cost curves by keeping frail seniors healthier and out of
expensive nursing homes. Over 35 percent of home-delivered meal
recipients have severe disabilities (with three or more impairments of
activities of daily living). This measure of dependence is associated
with nursing home admission, and demonstrates the extreme frailty of a
significant number of persons served by the home-delivered meals
program. Fully 93 percent of home-delivered meal recipients and 58
percent of congregate meals recipients report that the meals enabled
them to continue living in their own homes.
The Importance of Reauthorizing and Investing in the Older Americans
Act
The OAA continues to work well for older adults across the country
and major structural changes are not needed. The reauthorization
process, which should occur every 5 years, provides an important
opportunity to modernize and improve services by supporting
efficiencies and innovations, reassessing the Act's successes and
limitations, and addressing its ability to effectively serve older
Americans in need. It is noteworthy to recall that, during the last
White House Conference on Aging in December 2005, OAA reauthorization
was the No. 1 priority out of the 73 considered by the bipartisan
delegation of community leaders in aging. NCOA urges members of the
HELP Committee to continue the tradition of bipartisan and timely
reauthorization of this important statute and come together to pass a
bill before the August recess.
The OAA is a living document that should change to address emerging
needs and embrace new, innovative best practices. Particularly in times
of fiscal restraint, improvements can be made in the efficiency and
effectiveness of the OAA in its delivery of services and how it
coordinates with other Federal programs.
The reauthorization of the OAA will provide an opportunity to
modernize critical systems and supports designed to assist older adults
experiencing economic distress. With an increasingly diverse number of
Americans likely to find themselves in economic distress in old-age,
now is the time to shore up strategies through the OAA to ensure all
older adults have the opportunity to get on a pathway to economic
security. Reauthorization of the OAA as increasing waves of Baby
Boomers age is crucial to ensure that successes of the Act can be
better leveraged, and innovation continues to be fostered to meet the
needs of today's and future seniors.
S. 1028, the Older Americans Act Amendments of 2013, introduced
recently by Chairman Sanders and cosponsored by 17 colleagues, is an
excellent starting point for serious bipartisan discussions. NCOA
supports the bill, as it incorporates several NCOA priorities,
including explicitly establishing economic security as a goal of the
Act, promoting senior center modernization, emphasizing the delivery of
evidence-based chronic disease management and falls prevention, and
strengthening elder justice provisions. Together, these improvements
can empower seniors and improve their health and economic security,
bend downward the long-term entitlements cost curve, and promote
greater program efficiency and coordination.
At the same time, we cannot ignore the dire consequences facing
vulnerable seniors if Congress continues to cut OAA programs. NCOA
strongly urges that needed OAA funding be provided to keep older
Americans healthy, independent, and productive, thereby reducing other
Federal and State spending. OAA programs represent less than 0.2
percent of Federal discretionary spending, but offer a substantial
return on investment by leveraging State, local, and private dollars.
Despite the program's successes and efficiencies, funding for the
OAA has not kept pace with inflation or population growth for decades,
and current levels are inadequate to meet this increased need. In 2009,
in order for OAA funding to simply catch up with the growth in the
senior population and the costs of services over the past decade, it
would have had to be increased by at least 12 percent a year for
several years. Since then, OAA appropriations have continued to lag
behind the rising costs of fuel, commodities, and wages, while the
Nation's senior population, as well as demand for OAA services, has
continued to grow. Additionally, many States remain hampered by the
lingering effects of the economic downturn, and Federal discretionary
spending has faced a series of devastating, unprecedented cuts in the
name of deficit reduction.
Sequestration's arbitrary reductions to OAA programs fails to
recognize the Nation's changing demographics, or the needs of seniors
and their families. Since local, State, and Federal resources are
likely to be strained into the foreseeable future, adequate Federal
support for the OAA through the appropriations process is all the more
critical. NCOA strongly urges that Congress fund OAA services at levels
that protect and strengthen the program, so it may meet the rapidly
increasing need among vulnerable older Americans.
With the retirement of over 78 million baby boomers ahead of us and
the current, but long-lasting, implications of present economic
challenges, it is time for renewed energy and innovation to make
important, strategic improvements that will result in systems change
and ensure that older adults are able to access the coordinated public
and private resources they need to be financially secure and remain
independent. NCOA believes that the Older Americans Act is a critical
vehicle in this process.
Senator Sanders. Thank you, Mr. Bedlin.
Our final witness is Paul Downey. Mr. Downey has served as
president and CEO of Senior Community Centers in San Diego
since 1995. He is also president of the National Association of
Nutrition and Aging Services Programs and a steering committee
member for the California Elder Economic Standard Initiative.
Mr. Downey, thanks for being with us.
STATEMENT OF PAUL DOWNEY, PRESIDENT AND CHIEF EXECUTIVE OFFICER
OF SENIOR COMMUNITY CENTERS, AND PRESIDENT OF THE NATIONAL
ASSOCIATION OF NUTRITION AND AGING SERVICES PROGRAMS, SAN
DIEGO, CA
Mr. Downey. Thank you, Senator. Good morning.
Chairman Sanders, Ranking Member Burr, and members of the
subcommittee, this hearing is important to our hope that
Congress will reauthorize the OAA this session. Millions of
seniors are able to live in their community and at home by
virtue of the services OAA provides every day.
Senior Community Centers does its part by serving breakfast
and lunch, 2,100 meals daily, 7 days per week, 365 days per
year to seniors living on an average of $830 a month. Put
another way, 95 percent of the seniors we serve live at or
below the Federal poverty level or at about half of the elder
index in San Diego County, which measures income adequacy for
basics, including food and housing.
The rent for single room occupancy hotels, SROs, where most
of the seniors we serve live, averages $675 a month, leaving
about $150 for everything else, including food. Virtually every
senior that we serve is on the cusp of homelessness. That's why
Senior Community Centers also provides a full array of
services, including case management, chronic disease
management, healthcare education, civic engagement, 350 units
of permanent supportive housing, and 30 units of transitional
housing for homeless seniors. Some of these types of services
are also funded through the Older Americans Act.
But our core service and the one that is most critical
remains nutrition. Nutritious food keeps seniors healthy and
independent. They make fewer visits to the emergency room,
spend less time in the hospital, and if we do our job right, we
can eliminate the need for long-term care.
Our average cost to Senior Community Centers to provide
nutrition services for a year is about $2,000. A single day in
a nursing home in California is $330 a day. A single day in the
hospital is about $2,600 a day. Simply put, an investment in
the Older Americans Act is a win-win. Seniors are healthy, and
government at all levels saves money.
Through our meal program, as noted by the chairman, we're
able to get eyes on the client on a daily basis. One of my
home-delivered meals drivers noted that a 63-year-old male
client was frequently calling 911. He notified Dr. Pettigrew--
one of our physicians. She discovered that this client is what
is known as a hot-spotter, a frequent user of EMS services. In
2012, he had called paramedics 59 times at a cost of almost
$104,000 to the city of San Diego.
Dr. Pettigrew's intervention resulted in getting the client
a primary care physician and a referral to a psychiatrist,
because his primary problem was depression exacerbated by
isolation. He now regularly gets meals and participates in
activities at our flagship facility, the Gary and Mary West
Senior Wellness Center, and the client has called 911 zero
times in 2013. None of this would have happened without a home-
delivered meal.
This illustrates why we see the OAA as not only a social
and human service program, but also a preventative health
program. It has strong ROI. Dollars invested in the OAA do two
distinct things. They leverage other sources of funding, and
they save untold millions in Medicare and Medicaid costs. These
savings must start to be documented with better data
collection.
Also, don't overlook the fact that the OAA is a catalyst
for thousands of jobs in non-profit agencies and the for-profit
venders who supply us.
Senator Sanders, NANASP supports S. 1028, and we've enjoyed
working with your fine staff to help develop the bill. S. 1028
keeps senior nutrition strong by maintaining separate funding
for the congregate and home-delivered meals programs and
keeping the system of voluntary contributions which ensures
that we don't drive away those older adults who need us the
most.
We also support the bill which works to better connect
nutrition and transportation programs. Further, we will
continue working to ensure that we fully protect nutrition
dollars, especially from diversion into programs that are not
related to nutrition.
Overall, your bill represents a critical opportunity to
stand up for seniors and let them know that Congress has their
back. There are acres of common ground that we can find to move
this bill forward, and we should.
Let me raise a related issue, sequestration, which is
devastating senior nutrition across the country. In California,
we are losing 750,000 meals. Senior Community Centers--our
share of sequester is a cut of over $200,000, which puts 70,000
meals at risk. Please end it as soon as possible. Exempt those
programs which clearly serve the most vulnerable of our
society, such as the OAA nutrition programs. We have gone from
being providers of meals to arbiters of who goes hungry, and
that is wrong.
Thank you.
[The prepared statement of Mr. Downey follows:]
Prepared Statement of Paul Downey
Chairman Sanders, Ranking Member Burr, members of the subcommittee,
thank you for holding this hearing and inviting me to testify. I wear
two hats today: president of NANASP--the National Association of
Nutrition and Aging Services Programs--and president of Senior
Community Centers in San Diego.
This hearing is important to our hope that Congress will
reauthorize the OAA this session. Millions of seniors are able to live
in the community or at home by virtue of the services the OAA provides
every day.
Senior Community Centers does its part by serving breakfast and
lunch--2,100 meals daily--7 days per week, 365 days per year, to
seniors living on an average of $830 per month. Put another way, 95
percent of the seniors we serve live at or below the Federal poverty
level or at half the level of the Elder Index in San Diego County which
measures income adequacy for basics, including food and housing.
The rent for Single Room Occupancy hotels (SROs), where most
seniors we serve live, averages $675 per month, leaving about $150 for
all other expenses, including food. Virtually every senior we serve is
on the cusp of homelessness. That's why Senior Community Centers also
provides a full array of services including case management, chronic
disease management, healthcare education, civic engagement, 350 units
of permanent supportive housing and 30 units of transitional housing
for homeless seniors. Some of these types of services are also funded
through the OAA.
But our core service, the one most critical, remains nutrition.
Nutritious food keeps seniors healthy and independent. They make fewer
visits to the emergency room, spend less time in the hospital and, if
we do our job right, may not need costly long-term care. Consider that
our average annual cost to provide nutrition services to a senior is
just over $2,000 a year. A single day in a nursing home in California
averages $330. A day in the hospital in California averages $2,590.
Simply put, an investment in OAA is a win-win: seniors are healthy and
government at all levels saves money.
Through our meal program, we're able to get eyes on the client on a
daily basis. One of my home-delivered meals drivers noted that a 63-
year-old male client was frequently calling 911. He notified Dr.
Pettigrew, one of our physicians. She discovered that this client was
what is known as a ``hot-spotter''--a frequent user of EMS services. In
fact, in 2012, he had called paramedics 59 times at a cost of almost
$104,000 to the city of San Diego.
Dr. Pettigrew's intervention resulted in getting the client a
primary care physician and a referral to a psychiatrist--because his
primary problem was depression exacerbated by isolation. He now
regularly gets meals and participates in activities at our flagship
facility, the Gary and Mary West Senior Wellness Center, and the client
has called 911 zero times so far in 2013. None of this would have
happened without a home-delivered meal.
This illustrates why we see the OAA as not only a social and human
service program but also a preventive health program. It has strong
ROI. Dollars invested in the OAA do two distinct things: they leverage
other sources of funding and they save untold millions in Medicare and
Medicaid costs by maintaining older persons in their homes and in their
communities. These savings must start to be documented with better data
collection.
Also, don't overlook the fact that the OAA is a catalyst for
thousands of jobs in non-profit agencies and for-profit vendors who
supply the aging network.
Senator Sanders, NANASP supports your bill and we have enjoyed
working with your fine staff. S. 1028 keeps senior nutrition strong by
maintaining separate funding for the congregate and home-delivered
meals program and by keeping the system of voluntary contributions
which ensures that we don't drive away those older adults who need us
the most. We also support your bill working to better connect nutrition
and transportation programs. Further, we will continue working to
ensure we fully protect nutrition dollars especially from diversion
into programs not related to nutrition.
Overall, your bill represents a critical opportunity to stand up
for seniors and let them know Congress has their back. There are many
areas of common ground that we can find to move the OAA forward and we
should. However, without your leadership and your bill we would be
nowhere.
Let me raise a related issue: sequestration, which is devastating
senior nutrition across the country. In California, we are losing
750,000 meals. At Senior Community Centers, our share of sequester is
over $200,000 which puts 70,000 meals at risk. Please end it as soon as
possible. Exempt those programs which clearly serve the most vulnerable
of our society, such as the OAA nutrition programs. We have gone from
being providers of meals to arbiters of who goes hungry and that is
wrong.
Thank you.
Senator Sanders. Mr. Downey, thank you very much.
I think what we have heard from the excellent testimony
from all of our panelists and from what we've heard from
members of the panel here are two basic issues, and I think
Senator Warren touched on them. No. 1, the moral issue. Should
we turn our backs on the people who raised us, the people who
fought in wars, and allow them to suffer? That's the first
issue.
And the second issue we have all heard is the economic
issue, the insanity of wasting huge amounts of money by not
providing minimal services to people so they don't end up in
the hospital, they don't end up in the emergency room, they
don't end up calling 911 50 times unnecessarily, et cetera, et
cetera, et cetera.
So I want to start with Ms. Hollander. You raised an
interesting point that the funding--forget sequestration for a
moment, as humiliating and embarrassing and disastrous as that
is. Go back to where we were years ago. How has funding for
this extraordinarily cost-effective program not kept up with
need for many years before sequestration?
Ms. Hollander and then others can comment on that, please.
Ms. Hollander. I anticipated that this question might
arise, that if I did indicate that the funding levels did not
keep pace, someone was going to ask me, ``Well, what would we
need to keep pace?'' So we did the math, and it is pretty
extraordinary that $514 million would be needed just to get to
1992 levels.
Senator Sanders. Say that again. To get to where we were in
1992, we would need an additional $514 million.
Ms. Hollander. Yes, $514 million.
Senator Sanders. So the real funding for the Older
Americans Act has significantly declined.
Ms. Hollander. Correct.
Senator Sanders. Do other people want to comment?
Mr. Bedlin. Back in 2009, 4 years ago, a number of aging
service organizations calculated that just to simply catch up
with the growth in the senior population and the cost of
services, the Older Americans Act would have to be increased by
12 percent per year for several years. That was, again, 4 years
ago.
Since then, as has been indicated, the program has not kept
pace with inflation or the increasing number of individuals in
need, bearing in mind that those at greatest risk are those
over age 85, and that's where we've seen the most rapid growth
demographically. And, clearly, the program has not kept up, and
that's why we see growing unmet needs and people not getting
services that would save, frankly, State and Federal Government
significant dollars.
Senator Sanders. Mr. Downey.
Mr. Downey. We see that for a program that primarily serves
people in poverty, it puts an even greater strain, because for
a program like Senior Community Centers with 95 percent below
FPL, those seniors are not able to make much of a donation,
which is what the program is predicated on. So it puts a strain
on the local resources for us to be able to continue to,
frankly, have to fundraise from the rest of the community to
make up the difference that the seniors would normally be
providing.
The key is that when you look at some of the numbers on
healthcare or access to healthcare, lower income and those in
poverty tend to use healthcare at a higher rate because they're
primarily using the emergency room as their primary care
physician. So programs that focus on those in poverty--there's
actually a more direct correlation between investing in those
programs and reducing healthcare costs.
Senator Sanders. What we are in agreement about is in terms
of real dollars, the Older Americans Act has been significantly
underfunded for many years, and then you have sequestration
adding insult to injury. I want somebody to make the point or
to discuss again the Older Americans Act as an economic
investment in saving the U.S. Government money in terms of
Medicare, Medicaid, local police departments, ambulance
services, et cetera.
Who wants to pick up on that point?
Ms. Hollander, why don't you jump in there?
Ms. Hollander. May I clarify one quick thing for the
record? I want to make sure that the $514 million figure that I
gave you takes into consideration both inflation and population
growth. I just want to make sure that that was clear.
Senator Sanders. For the record, we got it.
Ms. Hollander. Thank you.
Nancy. Go ahead.
Ms. Altman. To respond to what you were saying, Medicare is
an extremely efficient program. It spends less per capita, even
though it covers the most expensive part of the population,
than private insurance. And yet it would be even more effective
if we prevented people from needing acute care.
As we've said, nutrition is very important. Preventing
falls is very important--all of those kinds of things. As we
say, a return of 1 to 50 is not something you can find even
with the best financial advisors.
Senator Sanders. Thank you very much.
Senator Burr.
Senator Burr. Mr. Downey, how effectively do you believe
that title III services, particularly those for nutrition, are
braided with other sources of funding for our most vulnerable
populations, be it Federal, State, or local dollars? And do we
create an impediment in any way from the Federal level for that
happening in a more natural way?
Mr. Downey. Senator Burr, I would say that when you look at
how the formula operates from the Federal level down to the
State down to the local, it is a maze to try to understand how
funding flows on a State-by-State basis. And I'm speaking as
president of NANASP when I look across the country.
So when it gets to the local level, we don't see much
funding except for the Federal dollars, and the California
Department of Aging, where the State, puts in its matching
shares. So the only dollars that we are receiving are basically
Federal dollars and a small State match. The local Area Agency
on Aging puts in no local dollars. We're dependent really
strictly on philanthropy to try to make up the rest of the gap.
In terms of impediments, I would say if there was a way to
reduce some of the byzantine nature of the formulas, I think I
would be all for seeing that so we could understand. The
sequestration is a good example. When you look at the impact,
some States are seeing zero impact for nutrition.
In the State of California, the best they can tell us right
now is our cut is somewhere between 9 percent and 20 percent,
and they can't tell us anything beyond that at this point. And
that's largely due, specifically, to the nature of your
question, which is how the formulas are working.
Senator Burr. Mr. Bedlin, oftentimes, the meals seniors
receive from the Act--the funding covers one meal a day. There
are other opportunities from Federal funding to support meals
for seniors, however, SNAP, Senior Farmers Market Nutrition
Program, and the Commodity Supplemental Food Program. How well-
aligned are the Federal eligibility requirements for the
various other Federal assistance programs that we provide from
a Federal level?
Mr. Bedlin. I can tell you that they're all targeted to a
very vulnerable, lower income population in need. My colleagues
may be able to talk a little bit more about the specific
eligibility criteria. I think they're generally similar. I
think they're relatively well aligned. I don't have the on-the-
ground experience dealing with them.
I will tell you that senior participation in those
programs, as with other low-income benefits programs, is
problematic. In the SNAP program, for example, senior
enrollment is the lowest of any age group. Again, only about a
third of the seniors----
Senator Burr. But all of you would agree that these three
Federal programs apply to the same population. You could
comingle these three programs into your operation.
Mr. Downey. Theoretically, but the challenge----
Senator Burr. Tell me the challenge.
Mr. Downey [continuing]. The challenge--for instance, you
mentioned SNAP, specifically, Senator. In California, seniors
have to choose between SSI or SNAP. So if you are living on
$830, and you're trying to make decisions about whether to take
the money, whether to take SNAP, or whether to take an Older
Americans Act meal, you choose the meal and take the money to
help pay for some of your other needs. So it doesn't all
seamlessly flow together.
Senator Burr. How about the other two programs? Are they
accessible?
Mr. Downey. They're accessible. I would say that across the
board, there's not enough funding--as was alluded to by my
colleagues, not enough funding. As a program, I have my foot on
the brake in terms of reaching out. There are more seniors in
San Diego County that need the services we provide for all of
the benefits that we've discussed, but I have my foot on the
brake because there's not enough funding from any source,
including philanthropy, to be able to meet the needs.
That's the fundamental challenge, and I would suspect my
colleagues would agree. And I know, certainly, the NANASP
members would agree that it's hard, with the demographic
onslaught that we're going to be seeing over the next 15 or 20
years, to operate when we've got our foot firmly on the brake.
Senator Burr. Ms. Hollander, the Older Americans Act
defines older Americans as age 60 and over. A recent GAO
analysis found that the prevalence of seniors having at least
one ADL limitation increases with age. Currently, the
congregate nutrition and meals program is not tied to seniors
who have one or more ADL.
In your opinion, is it important that the congregate meal
services are based on an individual's ability to perform basic
activities versus providing services on a first-come, first-
serve basis to seniors 60 and over?
Ms. Hollander. I think the spirit of the Older Americans
Act with regard to all of its programs are those that are in
greatest social and economic need. Generally, they are those
who are low-
income, could be having challenges with being able to stay in
their own home.
Most of the percentage of people that get congregate
meals--based on statistics that I have in front of me from the
Older Americans Act, a number of them do suffer from multiple
challenges, ADLs. I can give you the statistics. I can submit
them for the record if you want.
Senator Burr. Would you submit it for the record?
Ms. Hollander. OK.
Senator Burr. That would be great.
Thank you, Mr. Chairman.
Senator Sanders. Let me get to Senator Baldwin.
Senator Baldwin.
Senator Baldwin. Thank you, Mr. Chairman.
Ms. Altman, you describe a pretty stark picture of the
economic vulnerability of our seniors in your testimony, and I
appreciate your testimony. You highlight how Social Security,
Medicare, and the Older Americans Act programs work together to
improve the security of older Americans.
I agree that it's important to think about how these
programs work together. You could imagine a three-legged stool.
And if we don't adequately fund the Older Americans Act, we can
then envision it becoming a two-legged stool. I'd like to have
you talk a little bit about how our level of funding for the
Older Americans Act affects the Social Security and Medicare
programs and, potentially, their long-term solvency.
Ms. Altman. These three programs really are synergistic,
and I think past policymakers understood this. You need a basic
level--and I guess the other point, which also goes to the last
question, is that all three of these programs are extremely
efficient and, again, they work together.
So Social Security--the understanding is that once you lose
wages, you need wage insurance, which is Social Security. It
replaces just a very minimal level. For a worker who retires at
age 65 and was earning about $40,000, it replaces just under 40
percent of final pay. So that's not very much to maintain a
living standard, but it's a minimal amount.
On top of that, it's not enough to have health insurance.
So the Medicare is there, very efficiently. But those people
need services to complement both of these programs. If those
services weren't there, as we've talked about, there would be
more hospital stays. There would be more falls. There would be
more malnutrition and so forth.
So the Older Americans Act is really there as a support to
these other two programs. The three-legged stool, I think, is a
perfect analogy of how it works.
Senator Baldwin. We've had some quantification of the
leveraging impact of the Older Americans Act. Has there been
any scholarship along those lines in terms of full funding,
saving Medicare or Social Security or extending their solvency
in a specific way that you're aware of?
Ms. Altman. Well, certainly, the jobs part that Mr. Bedlin
was talking about is a very important program, because some
seniors are able to and want to continue to work, and then they
would be contributing. That would certainly extend the life of
the program, not that they'd have to work, but they would want
to work. So that certainly does.
And we talk about the real issue in the Federal budget
being rising healthcare costs overall, not really Medicare,
because Medicare is a symptom of these other costs. If people
got the preventive care through nutrition and these other
services and the abuse issues and so forth, there would be
fewer hospital stays. So, definitely, more funding for the
Older Americans Act will improve, economically, Social Security
and the finance of Social Security and Medicare and, of course,
improve the value of the lives of these people as well.
Senator Baldwin. Mr. Bedlin.
Mr. Bedlin. Yes. Briefly, with regard to Medicaid, for
example, the home and community-based services available
through the Act can delay Medicaid spend-down, which, as I
mentioned, can happen quite rapidly, and Medicaid is the
primary payer for long-term care. On the Medicare side, the
evidence-based health promotion, disease prevention programs
have the potential, and some of the individual programs under
title III-D have been found to reduce hospitalization rates,
reduce emergency room visits.
Part of the problem, though, is the Congressional Budget
Office will not look at the discretionary side for savings on
the mandatory side. There have been some private estimates. The
Lewin Group, for example, has looked at a number of these
programs and shown some significant savings. But the CBO rules
make it difficult for us to come to Congress and have scorable
savings.
Mr. Downey. Senator, I think your question also highlights
a very important need, which is better data collection
throughout the network. It's something we're committed to at my
agency. We use a simple scan card so if a senior gets a meal,
sees a social worker, sees a nurse, goes to a Tai Chi class, we
can track it so that we can demonstrate the impact of what
we're doing.
Unfortunately, throughout the aging network, and
particularly in Older Americans Act programs, we're not as
strong on the data. All of us here and, I suspect, many of the
people behind me could tell anecdotal stories all day. But what
we need to do is move toward better documentation and showing
the data so that we can absolutely prove what we all believe to
be absolutely the facts.
Senator Sanders. Senator Warren.
Senator Warren. Thank you, Mr. Chairman.
I'd like to ask about another aspect of the Older Americans
Act. We started talking about Social Security, how Social
Security provides a safety net to keep people out of poverty,
but it's a very modest safety net. And I think we'd all agree
that people need pension help to the extent they've got it. If
they put any money away during their working years, they need
that money in their retirement years.
But managing a pension can be complex. And part of what the
Older Americans Act did was establish a pension counseling and
information program, six regional projects covering 29 States,
so that there's assistance for seniors who are trying to get
access to their pensions.
Now, one project, in particular, that I've learned about is
one out of Massachusetts. It's the New England Pension
Assistance Project at the University of Massachusetts Boston,
and it uses OAA funds in order to help people recover lost
pensions. Lost pensions are pensions that people moved during
their working years. The company has since changed names or
merged with another company so that people can't find pensions
that they may now be eligible for.
It's my understanding from reading your testimony, Ms.
Altman, that this project, since 1993, has produced about $175
million for about 50,000 of our seniors, and that this is
another one that has great leverage. For every dollar that
we've spent in costs, seniors have recovered about $8 in
pension money. But it's only available in 29 States because
there's not enough funding for it now.
So the question I have is on this one. If we ended the
sequester, if we expanded the program, how much money could we
potentially recover for our seniors, Ms. Altman?
Ms. Altman. Thank you very much for that question, because
this is exactly right. This is another part, another
illustration, of how the Older Americans Act works. There is
Federal money that's leveraged in many ways.
First of all, there has to be private--they have to have
some foundation coverage as well, so these six regional offices
or counseling projects cover only 29 States, three-fifths of
the country--bringing in private money, and then getting $8 for
every Federal dollar spent, as you said. Some of the States
that are not covered are States with high numbers of retirees.
Florida is not covered. A lot of the Northwest, Washington and
Oregon, are not covered. Maryland and Virginia are not covered.
Again, I'm used to working with Social Security with the
large amounts of money. The money is very modest. It's $1.6
million to run all of these centers with all of these lawyers
handling--they've gotten returns for 50,000 beneficiaries who
have--it's a kind of program integrity. They've earned these
benefits, and they need legal assistance in actually getting
them.
I think that if the program were just increased modestly so
you could cover all 50 States, we're likely to double the
return. So $275 million has been collected for beneficiaries--
as I said, a kind of program integrity for the tax expenditures
that are used over the course of this program. And I think you
could easily double that.
Senator Warren. Well, thank you. This is such a modest
amount of money, and I just want to emphasize that this is not
a subsidy. This is money people earned, and it's just trying to
help them get the money they earned. So thank you, Ms. Altman.
I want to ask one other question, if I can, about the Meals
on Wheels program, Ms. Hollander. It's my understanding that--
we've been talking about it--you're trying to recover to try to
get us to the point where we were in the 1990s, at least, on
coverage for Meals on Wheels. But today, fewer than 1 in 10
people who are eligible for Meals on Wheels are actually
getting the Meals on Wheels program. Is this right?
Ms. Hollander. I don't know the answer to that.
Senator Warren. Well, this is what I have read, that the
eligibility--we just aren't able to reach--you're nodding, Mr.
Downey. We are not able to reach the people who are currently
eligible for Meals on Wheels. And the sequester has made a bad
problem worse, but it was not that we were in a good place,
reaching all of the seniors who needed Meals on Wheels. Is that
a fair----
Mr. Downey. That is absolutely correct, Senator. Before
sequester, as I noted, my foot is on the brake in terms of
outreach. We don't do outreach. We have more seniors showing up
on our doorstep needing meals than we have money to feed them
with. So the sequester just put us--we had to slam the brake
even harder in terms of what we're doing.
So the challenge is we know that they're out there. And I
don't know if it's 1 in 10, but, certainly, a significant
number of folks that should be receiving the services and
coming to the congregate meal sites and receiving the ancillary
services are not able to do so because programs like mine and
the Meals on Wheels programs simply don't have the ability to
meet the demand.
Senator Warren. So if the chairman will indulge me for just
1 minute on this, could I ask the question in the other
direction? If instead of spending $800 million on the
congregate meals programs, we doubled that to $1.6 million, can
you just speak very briefly to the question of both how many
people would be helped and how much money we would save doing
that? Whoever would like to jump in first----
Mr. Downey. Sure. It's going to be significant. I mean, we
all are painfully aware of the demographics. So we're going to
double the number of seniors in this country between today and
2030 who would be eligible for Older Americans Act programs. So
your question is very appropriate.
If we doubled it, we would simply keep at the level that
we're at with that portion that we're currently serving. And in
terms of the dollars, it's going to be multiple-fold. As I
noted in my example with just the one home-delivered meal
client, that was $104,000 saved for the city. We don't know
what the Medicare and Medicaid costs were.
The fact is that as a program, we only need to be
marginally successful to save a lot of money on the other side.
And I would argue that we are highly successful, but that's the
point. A marginal success is going to break even or do better.
Senator Warren. Thank you.
And I apologize for running over, Mr. Chairman, and perhaps
we can do this more in questions for the record.
Senator Sanders. Senator Franken.
Statement of Senator Franken
Senator Franken. Thank you, Mr. Chairman, and I'd like to
thank the Ranking Member as well for this really important
hearing. It's absolutely vital that we reauthorize the Older
Americans Act.
Over the last several years, I've done listening sessions
all over the State, at least 25, with hundreds of seniors, and
they all say the same thing, which is, ``I want to be in my
home, and I want to remain independent.'' And the Older
Americans Act allows them to do that.
So they're home, and sometimes they get Meals on Wheels.
Sometimes they get other services. Someone comes--a volunteer
will come and drive them to get a haircut or go to a congregate
dining facility or go to a doctor or a movie. And it saves
money. This has sort of been a leitmotif of this hearing. What
is the return on this investment? And that's a phrase that you
used, Mr. Downey, return on investment.
Mr. Bedlin, we heard from you that it's hard to get CBO to
score these things exactly. So what I wonder is, in your
estimation, what is the return on investment? It costs a lot
more to be in a nursing home than to be at home. If you can
keep people in their homes, you save money.
It doesn't sound like you have hard data. You said, Mr.
Downey, we need more data. The cost of the sequester--this is a
significant piece of this. As Ms. Hollander said, the funding
for the program has gone down if you adjust for inflation and
population.
What return on investment are we losing because of the
sequester? And is it basically, again, being penny-wise and
pound-foolish? Anyone can speak to that.
Mr. Downey. Yes. I'm not sure it needs much more
elaboration.
Senator Franken. Yes. We've sort of established that the
hard data isn't there. But I just hate to see us in the so-
called interest of paying down our deficit and our debt
actually hurting ourselves and hurting people at the same time.
It's a tough bank shot.
Ms. Altman. I think all four of us will agree that the
return on investment of all of these programs--the rate might
change, but they're all very good. The idea of saving a day of
hospital care is huge throughout the budget.
And in the portion I was just talking about, the pension
information, that's a $1 to $8--for every $1 spent, $8 is
recovered. So when you cut back, you're losing that kind of
leverage. For every dollar you cut, you lose $50 of--it costs
Medicare $50 more. There's $8 less of recovery.
Ms. Hollander. I would just add one thing which may be
slightly related to Senator Warren's question, which is if you
merely took the $51 million that's recently been cut by the
Older Americans Act between now and the end of the fiscal year,
and you put that back, and you multiply that by 50, that would
save you $2.5 billion, just returning that money that was just
taken away based on sequester, not even talking about the
previous decline that we were discussing. So if you take the
$50 times that, that would be just in terms of Medicaid
savings. So that's very significant.
And, if I may, I just wanted to mention that earlier in
your question, Senator Warren, you are right to say that if you
did add $1.3 million back into it, you would actually--the gap
between 8.3 million that are currently hungry, and the fact
that we're only serving 2.5 million now--for that investment,
we would be able to meet that need.
Mr. Bedlin. Senator Franken, two quick points. I did
mention earlier some data from the Lewin Group. Back a few
years ago, the National Association of Area Agencies on Aging
and the National Association for States United for Aging and
Disability tried to get Congress to enact legislation referred
to as Project 20-20 which would have increased investments in
Older Americans Act programs with regard to evidence-based
health promotion, disease prevention, and home and community
services and supports. And the Lewin data did find very
significant Medicare and Medicaid savings, which I think we
could probably share.
One very important program that we haven't really spoken
about is the National Family Caregiver Support Program. The
vast majority of long-term care is provided by family members
who are overburdened emotionally, financially, and physically.
And the longer they can continue to provide care and the more
we can provide them with support----
Senator Franken. Respite.
Mr. Bedlin. Exactly. That saves dollars, and that is
dramatically underfunded and, again, very much penny-wise,
pound-foolish.
Senator Franken. Mr. Chairman, I think you have all
witnessed what can happen when you ask an open-ended question.
I'm out of time.
[Laughter.]
Part of it was Ms. Hollander answering part of Senator
Warren's question.
[Laughter.]
Senator Sanders. In other words, you want another minute.
You have another minute.
Senator Franken. OK. One other cost that was mentioned was
the cost of elder abuse. And, again, this Act helps seniors
stay at home. In Minnesota, we have a Home Care Consumer Bill
of Rights that I've introduced on a nationwide level.
What this bill would do is allow States to develop a Home
Care Consumer Bill of Rights exactly like we have in Minnesota
to protect seniors from abuse and neglect and exploitation. My
bill would also encourage States to create a Home Care
Ombudsman Program so seniors have a place to turn.
Mr. Bedlin, we know that seniors want to stay independent
at home and doing so saves Medicaid money. How can expanding
protections for seniors to choose home and community-based
services do this? How can this be helped by this kind of
program?
Mr. Bedlin. The difficult question, I think, is which of
the Federal programs would this most logically apply to. Most
of the home and community-based services that are funded
through Federal and State governments are through Medicaid, as
you know.
While I do think the Older Americans Act plays a modest but
critical role, Medicaid is far more involved in paying for home
and community-based services, which are voluntary, and nursing
home care, which is mandatory, part of the institutional bias
in our program. So I think we need to look at a variety of
areas where we can promote these kinds of consumer protections.
In many cases, it may be more appropriate to do it at the
State level. In some cases, it may be more logical to look at
the Medicaid program and the kinds of standards that are there,
although I do think the Older Americans Act has a very
important role to play, but it is complex in terms of--a bit of
a crazy quilt in terms of how we pay for these services. Which
of these programs are the best ones, and how do they interact
and complement each other in terms of, I think, a goal that we
all support that you've articulated.
Senator Franken. In Minnesota, we have this program and it
works. And my staff will work with you if you like to make sure
that we put it in the right place.
Thank you, Mr. Chairman, for your indulgence.
Senator Sanders. Thank you, Senator Franken.
Senator Franken. I have another question.
[Laughter.]
Senator Sanders. But you're not going to ask another
question.
[Laughter.]
Let me just thank the witnesses. It's been excellent
testimony and very, very important testimony. And I want to
thank all the members who are here this morning.
I want to summarize in this respect. What we learned this
morning is that the need out there is enormous and we don't
talk about it enough. I think, as Ms. Altman was saying, it's
an illusion that every senior in America is doing just fine,
and we know that the rates of poverty are high and getting
higher.
We also know the situation is not going to get any better
tomorrow because we have a significant increase in the number
of seniors. Our population is aging. We understand--and this is
terribly important as well in this debate--real funding,
counting inflation and counting population growth, is
significantly less than it was in the 1990s. And then on top of
that, of course, we're dealing with the insult of
sequestration.
We have learned today that every dollar we invest in this
program--you don't have to be a scientist, you don't have to
have a Ph.D. to figure it out. Keeping people healthy,
preventing falls, keeping people out of emergency rooms,
keeping people from abusing the 911 system saves money.
When we're not adequately funding this program, we're
wasting money. And my friends who are worried about government
waste, well, not funding this program is wasting money.
I have been criticized for actually suggesting that we
should see a significant increase in funding. And in the bill
that we have before us, we are recommending a 12 percent
increase in funding. Between you and me, I would go a lot
higher.
But, needless to say, not everybody in the U.S. Congress
agrees with me, and there are those who say the best that you
can do, Senator Sanders, is level funding. That's all you can
do. And we understand that with inflation and everything else
and population growth, level funding just continues to downward
spiral.
Now, I happen to believe that if 100 million people are
watching this discussion that we're having today with this
panel, there would be overwhelming support for this program and
significantly increasing funding for this program. The American
people understand that it's cost-effective and it is the
morally right thing to do.
So I urge and ask all of you and your organizations and
people all over this country to stand up for seniors right now,
stand up for a cost-effective government. Let's end government
waste by not having our emergency rooms inundated with people
who should not be in emergency rooms or hospital care for
people who should not have to be in the hospitals.
Let us work together. Let's stand with seniors. Let's pass
this Older Americans Act Reauthorzation bill.
Thank you all very much.
[Additional material follows.]
ADDITIONAL MATERIAL
Hand-Written Messages on Paper Plates From Seniors at the La Crosse
County Aging Unit, WI Pon the Importance of OAA Meals and Nutrition
Programs
------------------------------------------------------------------------
Name City Message
------------------------------------------------------------------------
Joyce......................... La Crosse........ Companionship and
cost.
Mary.......................... La Crosse........ I like the food and
the price is
reasonable and I
enjoy the company.
Sue........................... La Crosse........ Thank you for my
meals. The food is
excellent. Because
of my shaking and
coughing spells, it
has been easier to
eat in my apartment.
It is not easy to
get out anymore.
Thank you.
Martha........................ La Crosse........ I do not cook for
myself. This is my
main meal.
Joyce......................... La Crosse........ Please keep the
program going. I
enjoy the food and
having lunch with
other people.
Jean.......................... La Crosse........ The cost of groceries
is too high.
Gwen.......................... La Crosse........ Love the meals and
deliveries. I would
have no meals
without the meal
delivery.
Elaine........................ Onalaska......... In some cases this
meal is the only
real nutritious meal
they get all day.
They get a visit
with other seniors
and it makes their
day.
Henry......................... Onalaska......... Meeting people and
getting a good meal.
Good variety of
food.
Carl.......................... La Crosse........ I like a good meal
and to socialize
with others.
John.......................... Onalaska......... Nutritious meals,
reason to get out.
Keep in touch with
friends. Breaks up
the day. Not a lot
of things for
seniors other than
this.
Donna......................... La Crosse........ I enjoy having meals
at the nutrition
site as they are
good and good for
me, and I use them
as my main meal. We
have a wonderful
time playing
cribbage before, and
wherever there is
cribbage you will
find me.
Ona........................... Onalaska......... Fun place to go.
People to talk with.
Good food, keeps us
in touch with
everyone.
Dorothy....................... Onalaska......... Lets us out to meet
people. Very
nourishing food.
Inexpensive compared
to restaurants. Some
people are home
bound and need the
meals.
Mary.......................... La Crosse........ Please make it one of
your priorities to
restore full funding
to Meals on Wheels
and other programs
that meet vital
needs in our
community and across
the US. As one
undergoing new
treatments, the
meals are a
wonderful service at
this time in my
life.
Wanda......................... La Crosse........ I look forward each
day to the meals and
the smiles from the
delivery person. I
would like if the
meals contained more
fruits and salads.
Thank you!
Helen......................... La Crosse........ I really enjoy the
lunches.
Janet......................... La Crosse........ I enjoy the
fellowship with
friends and the
meals are good. They
provide a balanced
meal at a reasonable
price.
Jane.......................... La Crosse........ I am able to have a
nutritious meal for
a reasonable cost
and I like to come
to the nutrition
site to socialize
with others.
Inez.......................... La Crosse........ Nutritious meal and a
reason to get up,
out and socialize.
Meg........................... La Crosse........ I enjoy volunteering
at the center and
like watching the
members have a
delicious and
nutritious meal.
They are always so
appreciative. We
also get a church to
participate in the
meal and enjoy their
company.
Marilyn....................... La Crosse........ The meals are very
good and nutritious.
They are also very
reasonable. I don't
know what I would do
without them.
Madonna....................... Onalaska......... The Harry J. Olson
Senior Center meal
site is a vital part
of the community.
The meals and
activities there
provide a social
outlet for many,
plus the healthy
meal is one that
many would not get
at home. It's time
to quit cutting back
on senior meals and
nutrition.
Gerald........................ La Crosse........ I don't like to eat
alone and the price
of a nutritious meal
is so expensive.
Bruce......................... La Crosse........ Don't have money.
Iris.......................... La Crosse........ Proper diet. Enjoy
company of
residents. Breaks up
the day. The price
is right. We can
afford 3.25, not
restaurant prices.
Gladys........................ Onalaska......... A large number of
seniors are alone or
disabled and do not
do well for
themselves
nutritionally or
socially. The
nutrition sites and
senior centers
provide both social
life and a balanced
meal at least once a
day. These sites are
needed now and the
need will increase.
Please keep
funding!!!
C............................. La Crosse........ I don't get out. And
now I get to meet
people.
Arlene........................ Onalaska......... I enjoy volunteers.
Also we have a
nutritious meal. It
helps the people to
get a good meal.
Enjoy the people.
All good company.
Millicent..................... Onalaska......... The nutrition program
provides a wonderful
noon meal at a
reasonable price. I
enjoy sharing
friendship with
other seniors.
Andrew........................ La Crosse........ I receive a good
balanced meal at a
reasonable price.
The staff and
volunteers are
polite and
courteous. This is a
positive thing for
seniors.
Dolores....................... La Crosse........ I'm 91 years old.
Your noon meals mean
so much to me. They
are so good. On the
weekends I probably
have a peanut butter
sandwich, juice,
candy, and other
sweets. Thanks.
Bernice....................... La Crosse........ I like to volunteer
and meet the people
and a lot don't have
a place to go.
Always a good meal.
Phyllis....................... La Crosse........ I enjoy coming to the
Harry Olson center
for lunch and
playing cards. And
for all the other
people who enjoy it
too.
Waldo......................... La Crosse........ Get out and see
people. Keep going.
Lydia......................... La Crosse........ This is a good
opportunity to tell
you that I really
appreciate Meals on
Wheels. I've had
them for a long time
and I don't tire of
them. Thank you
Bernice and all your
assistants. I was
very active reaching
back to the
seventies first as a
volunteer and later
as an employee.
Dave.......................... La Crosse........ Please my mom needs
Meals on Wheels sent
to the house! 95
years old and lives
at home alone!
Sally......................... La Crosse........ I love to cook but I
had cancer surgery
in December, then a
stroke and found out
I was the lowest in
iron. No strength.
So I can't stand up
long and I'm one
who's used to go-go-
go! I'm on Social
Security and can't
afford a whole lot.
I enjoy a noon meal
so thank you. Love
the cakes and fish
especially.
Fr. Bob....................... La Crosse........ When I found the La
Crosse Aging Unit
and the mealtime
lunch service, they
made such a huge
tremendous relief
and change. I am
quite sure if I had
not found this
service of ``meals
on wheels'', many
days I would not
have the energy or
the willingness to
even try to make a
sandwich . . . I am
so glad that I found
this service, the
kind of service they
do, and how much
they serve the other
people who needed
their service.
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[Whereupon, at 11:25 a.m., the hearing was adjourned.]
[all]