[Senate Hearing 116-548]
[From the U.S. Government Publishing Office]
S. Hrg. 116-548
THE OLDER AMERICANS ACT:
PROTECTING AND SUPPORTING
SENIORS AS THEY AGE
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
MAY 8, 2019
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Serial No. 116-06
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
47-481 PDF WASHINGTON : 2022
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SPECIAL COMMITTEE ON AGING
SUSAN M. COLLINS, Maine, Chairman
TIM SCOTT, South Carolina ROBERT P. CASEY, JR., Pennsylvania
RICHARD BURR, North Carolina KIRSTEN E. GILLIBRAND, New York
MARTHA McSALLY, Arizona RICHARD BLUMENTHAL, Connecticut
MARCO RUBIO, Florida ELIZABETH WARREN, Massachusetts
JOSH HAWLEY, Missouri DOUG JONES, Alabama
MIKE BRAUN, Indiana KYRSTEN SINEMA, Arizona
RICK SCOTT, Florida JACKY ROSEN, Nevada
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Sarah Khasawinah, Majority Acting Staff Director
Kathryn Mevis, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Susan M. Collins, Chairman.......... 1
Opening Statement of Senator Robert P. Casey, Jr., Ranking Member 3
PANEL OF WITNESSES
Lance Robertson, Administrator and Assistant Secretary for Aging,
Administration for Community Living, U.S. Department of Health
and Human Services, Washington, D.C............................ 4
Richard Prudom, Secretary, Department of Elder Affairs,
Tallahassee, Florida........................................... 17
Laurence W. Gross, Chief Executive Officer, Southern Maine Agency
on Aging, Scarborough, Maine................................... 20
Faith Lewis, Great-Grandparent, Simpson, Pennsylvania;
Accompanied by Xziylan Everitt, Great-Grandaughter............. 22
APPENDIX
Prepared Witness Statements
Lance Robertson, Administrator and Assistant Secretary for Aging,
Administration for Community Living, U.S. Department of Health
and Human Services, Washington, D.C............................ 37
Richard Prudom, Secretary, Department of Elder Affairs,
Tallahassee, Florida........................................... 56
Laurence W. Gross, Chief Executive Officer, Southern Maine Agency
on Aging, Scarborough, Maine................................... 66
Faith Lewis, Great-Grandparent, Simpson, Pennsylvania;
Accompanied by Xziylan Everitt, Great-Grandaughter............. 70
THE OLDER AMERICANS ACT:
PROTECTING AND SUPPORTING
SENIORS AS THEY AGE
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WEDNESDAY, MAY 8, 2019
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 2:56 p.m., in
Room 562, Dirksen Senate Office Building, Hon. Susan Collins
(Chairman of the Committee) presiding.
Present: Senators Collins, McSally, Hawley, Braun, Casey,
Blumenthal, and Rosen.
OPENING STATEMENT OF SENATOR
SUSAN M. COLLINS, CHAIRMAN
The Chairman. The Committee will come to order.
Good afternoon. Let me begin with an apology. We had two
votes that were unexpectedly scheduled, and as someone who has
never missed a vote in all the time I have been privileged to
serve in the U.S. Senate, I did not want to start with that
today.
Senator Casey will be on his way, but since we are behind
schedule, I thought that I would begin with my opening
statement, and again, my apologies to those who have been
waiting for us to begin.
In 1965, President Lyndon Johnson signed into law the Older
Americans Act. This landmark legislation represented a vision
well ahead of its time. With reauthorization efforts currently
underway, I am committed to ensuring that the Older Americans
Act continues to match the goals we set to permit seniors to
age with dignity, respect, and community.
The Older Americans Act focuses on the well-being and
social needs of our seniors. Providing nutritious food,
installing grab bars, and giving rides cost far less than
taking pills, undergoing surgeries, and moving to nursing
homes. In Maine, the average cost of serving one senior Meals
on Wheels is $1,854 for an entire year. By contrast, a single
day in a hospital is $2,262, on average, and just 10 days in a
nursing home is approximately $3,100. What we have learned from
the past decade of public health research is that maintaining
one's health at home is efficient and cost-effective and
compassionate.
For 54 years, the Older Americans Act has targeted the
social determinants of health, even before the field that links
social and medical outcomes was fully recognized. The act
expires on September 30th, so along with my colleagues I am
working to sponsor its reauthorization. The bipartisan
coalition includes Ranking Member Casey, Senator Enzi, Senator
Sanders, and HELP Committee Chairman Lamar Alexander and
Ranking Member Patty Murray.
My chief goal is to get across the finish line, on time, a
robust and bipartisan Older Americans Act that will strengthen
support for its bread-and-butter programs, while providing more
flexibility for States to meet local needs. I have focused on
five priority areas as we draft our bill: one, family
caregivers; two, nutrition; three, social isolation; four,
transportation; and, five, elder justice.
Last year, the National Family Caregiver Support Program
served more than 700,000 caregivers, but with 10,000 Americans
turning 65 each day, this program has not kept pace with our
changing demographics, so I am working with my colleagues to
increase the funding authorization. Senator Casey and I are
also proposing to increase flexibility for States to better
meet the needs of older adults in their communities, from those
caring for their fellow seniors to those caring for their
grandchildren.
Last year, through home-delivered nutrition programs, the
Older Americans Act provided seniors across this country with
358 million meals. That includes meals to 4,600 seniors in the
State of Maine. In many States, however, the need for Meals on
Wheels is growing. In my State, for example, there is a chronic
wait list of 400 to 1,500 people, depending on the time of
year. Increasing funding for this critical program to close the
gap is another of my priorities.
In addition to reducing food insecurity, Meals on Wheels
combats social isolation, too. Carol Kotal, a former data entry
specialist from Portland, Maine, receives Meals on Wheels. She
lives alone and is unable to walk or stand for long periods, so
when a volunteer comes by once a week with meals for her and a
can of food for her cat, she is so grateful to see a friendly,
familiar face. While increasing resources for this community-
building program, I am also working on new policies
specifically geared toward reducing social isolation.
One such solution is transportation to help seniors get to
more community activities. What works in one place is different
from what works in another, so I am working to build on a grant
program that ranges from supporting public transit to on-demand
and volunteer-based services for seniors. We also need new
tools to help seniors obtain information about rides and bus
routes more easily.
In rural Maine, transportation is a major barrier for our
older Americans. Tailored options for seniors from rural to
urban America will go a long way toward helping older Americans
stay home in their communities.
Finally, at the core of the Older Americans Act is respect
for our seniors and preventing neglect, exploitation, and
abuse. States are spearheading initiatives to raise awareness,
to train law enforcement officers and health care providers,
and to support prevention efforts.
Elder abuse, however, remains far too prevalent. In this
year's reauthorization, I am including a provision that would
help to equip communities with the skills and resources that
they need to stem the tide of abuse. This has been a major
focus of our Committee. Protecting seniors is a mark of a just
society.
The Older Americans Act is a shining example of a Federal
policy that works. Every $1 invested into the Older Americans
Act generates $3 to help seniors stay at home through low-cost,
community-based services.
At today's hearing, we will hear from Federal, State, and
local administrators, as well as seniors, about how this
bedrock system works and what opportunities exist to build on
its strengths as we extend and improve this important law.
By enriching the lives of our seniors, the Older Americans
Act improves the lives of all Americans.
I am now please to turn to our Ranking Member, Senator
Casey, for his opening remarks.
OPENING STATEMENT OF SENATOR
ROBERT P. CASEY, JR., RANKING MEMBER
Senator Casey. Thank you, Chairman Collins, for holding
this hearing on the reauthorization of the Older Americans Act.
As the Chairman mentioned, this hearing today will serve as
an important step in congressional efforts to reauthorize this
important legislation and the programs connected to it. I am
pleased that the Aging Committee will be playing such an
integral role in shaping this reauthorization.
The Older Americans Act reminds us who we are as a country.
It represents our commitment to the generations who made us who
we are today, and it lifts up the seniors who need our help the
most. This act serves over 11 million Americans each year,
including about 400,000 seniors throughout Pennsylvania.
That is why I am pleased that 34 Area Agencies on Aging,
which represent about 60 percent of the counties in my home
State, answered two questions for us recently. Number one,
``How is the Older Americans Act currently working?'' The
second question we asked that they answered was, ``How should
this important law be strengthened?'' We are grateful for that
kind of feedback.
In every city and every town, the aging network said that
there is no match for the high-quality services that senior
centers and Area Agencies on Aging provide to older
Pennsylvanians. The Older Americans Act programs support
Pennsylvanians and their caregivers by providing meals,
respite, and protection from fraud and abuse, and importantly,
the Older Americans Act helps seniors age in the location of
their choice, which, of course, is most often their homes and
their communities.
Our witnesses today will echo much of the comments made by
the Pennsylvania aging network. Yet we must always strive to
improve as we always do in reauthorization.
It is for this reason that I am pleased that aging service
providers in Pennsylvania also shared very concrete
recommendations on how to make the Older Americans Act work
better. They suggested that we do more to support grandparents
raising grandchildren and improve programs designed to fight
social isolation, and they said that we need to strengthen
innovation to better show the worth of the Older Americans Act
programming throughout the country.
We also need to do more to ensure that Area Agencies on
Aging are prepared to meet seniors where they are--in their
homes and communities, and they believe it is important that we
invest in data collection to show how successful these services
are at keeping seniors healthy and out of the hospital.
I am pleased we will have the opportunity today to learn
more about the successes of the Older Americans Act and to hear
recommendations for how the law can be improved. I look forward
to continuing working with Chairman Collins, members of the
Aging Committee, and members of the Health, Education, Labor,
and Pensions Committee on this important reauthorization.
Thank you, Chairman Collins.
The Chairman. Thank you very much, Senator Casey.
We are now pleased to turn to our witnesses. On our first
panel is Assistant Secretary for Aging, Lance Robertson.
Secretary Robertson, I am very pleased to welcome you today.
As Assistant Secretary for Aging and the Administrator for
the Administration for Community Living--that may be one of the
longest titles in the Federal Government--Mr. Robertson
spearheads the implementation of the Older Americans Act.
Assistant Secretary Robertson's leadership in the field of
aging began in Oklahoma, where he served for 10 years as the
Director of Aging Services within the State's Department of
Human Services. Prior to that he spent 12 years at Oklahoma
State University where he co-founded the Gerontology Institute
and served as the executive director of the Nation's largest
regional gerontology association. Assistant Secretary
Robertson, we are delighted to have you. Please proceed with
your testimony.
STATEMENT OF LANCE ROBERTSON, ADMINISTRATOR
AND ASSISTANT SECRETARY FOR AGING, ADMINISTRATION
FOR COMMUNITY LIVING, U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES, WASHINGTON, D.C.
Mr. Robertson. Thank you, Chairman Collins.
Chairman Collins, Senator Casey, and members of this
Committee, thank you for an opportunity to discuss with you
today the Older Americans Act. I am honored to represent the
HHS Administration for Community Living, which was created in
2012 around the fundamental principle that older adults and
people with disabilities should be able to live where they
choose, with the people they choose, and to fully participate
in their communities. By funding services and supports and
advancing research, education, and innovation, ACL helps make
this principle a reality for millions of Americans.
For more than 50 years, the Older Americans Act has
provided critical services that have enabled millions of older
Americans to live independently, with dignity, in their homes
and communities. Its programs are highly successful because
they are flexible, they meet the unique needs of each State and
community, and because they require the input of each
individual served.
This work has never been more important. Every 7 seconds,
one of America's 78 million Baby Boomers celebrates their 60th
birthday. That is 10,000 people every day--the equivalent of a
small town in America.
Now, I may be a rare breed because I have had the privilege
of working in Older Americans Act programs at every level.
Before I was appointed to this role, I led these programs for
the State of Oklahoma, and I was also very involved in work at
the local level in my 12 years at Oklahoma State University, so
based on my experience, I believe the Older Americans Act is
one of the Nation's greatest success stories.
The act has a limited Federal presence that establishes
broad policies and guidance. It works in partnership with
States, tribes, area agencies, volunteers, and service
providers at the community level with appropriate flexibility
to assess and respond to local needs based on the input of
consumers. It is a model based not on Federal prescriptiveness,
but instead on ``bottom-up planning.''
Our programs support some of life's most basic functions
such as bathing and preparing meals. They also include
transportation services, adult daycare, senior and wellness
center activities, homemaker and chore services, to name a few.
The programs address elder abuse and assist with the practical
considerations such as home modifications. They also include
services adapted to the unique needs of Native Americans.
They also support family caregivers who provide the
majority of long-term support to older family members and
without whom far more people would need care in institutional
settings.
In 2017, the act provided services to over 11 million
people--one out of every six older adults. In addition, it
provided critical caregiver support, such as respite care, to
over 716,000 people.
Given that Medicaid is the primary payer for nursing homes,
supporting community-based options, which usually cost less,
will continue to be an important tool in managing public and
private expenditures.
However, the act did not create a stand-alone system, and
it did not intend to cover all costs associated with serving
older Americans. Rather, its funding is used strategically to
advance changes in our overall system of care and to fill gaps
in services. The aging services network has done an outstanding
job in meeting this intent. As the Chairman mentioned, for
every Federal dollar, these programs typically secure about $3
from other sources.
Now, the effective prevention role that our programs play
is pivotal to one of Secretary Azar's top priorities, and that
is, transforming health care to a value-based health care
system--one that focuses on sustaining health to avoid the need
to treat disease. Such a system will pay providers based on
outcomes rather than on procedures performed. The goal is to
lower costs while also improving outcomes for Americans.
Addressing these social determinants of health, which, of
course, are factors that are not specifically about health but
which have a direct impact on health and well-being, is
critical to that goal. The social determinants include things
like having enough nutritious food options, having a safe place
to live, and having access to education, medical care, social
support, and employment--the very things our network provides.
As you have been working on reauthorizing this important
legislation, we have been pleased to provide information about
the significance of its programs as well as technical
assistance on particular policy proposals that are being
considered. HHS has developed three proposals for your
consideration which also enhance flexibility. We have made
tremendous progress in advancing the goals and objectives of
the act through the combined efforts of the aging services
network. This network literally has built a foundation of this
Nation's formal system of home and community-based care, and we
have done it in partnership with older Americans and their
families. I believe keeping the people we serve front and
center is the best way to ensure continued success.
Thank you for this opportunity to participate in today's
hearing. I have appreciated the Committee's support of the
Older Americans Act and the national aging services network,
and I look forward to our continued work together. I am happy
to answer any questions.
The Chairman. Thank you very much, Mr. Secretary.
I want to take up where you just left off about the social
determinants of an older person's health. Traditionally,
improving the health of older adults has focused on the health
care system. Are they getting to the doctor often enough? Are
they being treated for diseases that they might have? But there
is increasing recognition that improving health requires a
broader, more holistic approach that addresses the social
determinants of health.
Our Committee has had hearings on the effect of prolonged
loneliness and isolation of seniors on their health, and the
fact that one expert gave us that has stayed with me because it
was so startling is that the impact of prolonged isolation on
the senior's health was the equivalent of smoking 15 cigarettes
a day. I mean, just think about that.
I think we do need to take a broader look at the picture.
The World Health Organization defines these social determinants
as the conditions in which people are born, grow, work, live,
and age, and the wider set of forces and systems shaping
conditions of daily life.
Could you address two questions? First, how does the Older
Americans Act currently address the social determinants of
health for older adults? And, second, what more should we be
doing now that we have a broader understanding of how important
those factors are?
Mr. Robertson. Thank you, Madam Chairman. Chairman Collins,
again, I cannot thank you enough for your support around the
conversation of social determinants of health. You are
absolutely right. When I think about the Older Americans Act
and I think about all the programs that are offered through the
Administration for Community Living, it is all about meeting
people where they are at, really finding the lowest-cost and
most preferred way of taking care of their needs.
When I think about some of the services, whether it is
transportation or case management, certainly homemaker services
and nutrition being the biggest service, all of that points
toward a lower-cost, most preferred way of taking care of
someone's needs and also combats social isolation, which, as
you said, is really a growing conversation around better care
for older Americans.
Again, I think to your first question, certainly the Older
Americans Act I believe is framed around supporting social
determinants of health, community-based services, making sure
that those are provided to Americans each and every day in
communities all across our country.
I think to your second question, what more can be done, I
think you kind of alluded to it at the beginning of your
question. It is about better integration between the social
services side of the conversation with the health care
conversations that are happening.
I am really honored, of course, to be working for Secretary
Azar. This is one of his four priorities, transforming that
health care system. You know, he talks about how can we make
sure that we are paying for value? How can we support health?
How can we look at the lowest-cost settings? What can we do to
avoid hospitals, nursing facility stays, readmissions, things
that cost all of us a lot, both as taxpayers and as a Federal
Government? That balance, as you just alluded to, Chairman
Collins, is certainly evident, I think, to most all of us, and
that is the future State must include much more advanced
conversations around integrating, again, the social services
aspects and the services that our networks offer each and every
day with that higher cost health care conversation.
The Chairman. How difficult is it for an Area Agency on
Aging, which frequently is administering these programs, to
alter a program? For example, if there is someone who wants to
participate in Meals on Wheels because they are homebound and
yet may be above the income level, can they buy into the
program? Or are there ways to have co-pays that may help more
people who are struggling, cannot really afford someone to come
in and cook for them, and yet may not qualify under the
traditional criteria?
Mr. Robertson. Chairman Collins, again, a great question. I
think there is sort of a balance in answering that question
because I think you are also sort of alluding to folks that are
in the more formal acute-care cost system---Medicaid, if you
will--and, yes, there are qualifiers, financial eligibility,
those sorts of things that may determine their access to
particular services.
Within the Older Americans Act, if you take the nutrition
example you just cited, there actually is no means testing, so
anyone over 60 is eligible for a meal. I really have to give a
shout-out because at the local service level with the AAAs and
then the providers that we are honored to work with and support
at ACL, they are really, I think, trying to think through how
do you, to the extent that you can, make that service delivery
the most affordable but also person-centered? Because I think
in some instances, as you pointed out, there may be some people
that need assistance beyond what may traditionally be provided,
and again, I think for ACL, for the work that we are doing at
HHS, we are about how do we continue to drive decisions that
could be made more at a State and local level. It is about that
flexibility.
It is silly for us to believe that one particular position
on meal delivery that works in Maine may work in Pennsylvania
or some other State across the country, so to the extent that
we can, we certainly, as with the three proposals we have
advanced on the Older Americans Act reauthorization, want to
continue to push more State and local level decisionmaking
control and flexibility.
The Chairman. I think you will hear, when you hear from
Larry Gross, who runs the Southern Maine Area Agency on Aging,
some really innovative ways, but I am unclear how difficult it
is to get permission to alter some of the programs, and we will
explore that further, but I want to yield to my colleague.
Senator Casey. Thank you, Chairman Collins.
Assistant Secretary Robertson, we are grateful you are
here. Thanks for your work. We all know, as we have said
several times now, that something on the order of 11 million
people are served by this act every year. Whether it is meals
or transportation or support for caregivers, it is a big deal
for lots of Americans.
These same Americans who benefit from the Older Americans
Act also, of course, are most often Medicare and Medicaid
beneficiaries.
The services provided through the Older Americans Act that
help people age in their homes and communities are also
reducing spending in both Medicare and Medicaid by providing
the supports to keep people healthy and out of the hospital,
and Mr. Secretary, you made reference to that in your opening
comments.
It is important we raise the capacity of the aging network
to show the return on investment of the act and the programs in
the act that provide this kind of support.
The first question I have is: What are the lessons learned,
in your judgment, from the aging network's current partnerships
with programs like Medicare Advantage, for example? Second, how
can these lessons learned be translated into the fee-for-
service and Medicaid space?
Mr. Robertson. Thank you, Senator Casey, for that question.
That certainly in my mind pushes us toward a conversation
around business acumen, and I think within our networks--and I
understand the history. Really the business acumen work we are
involved in started with a public-private partnership and the
SCAN and Hartford Foundations sort of funding that effort,
which from there sort of blew up.
Your point is a great one. We have been investing now
pretty heavily since 2012 at ACL in the area of business
acumen. Obviously, the success of the Older Americans Act
program is going to be driven by how well the local service
provider can do its job, the level of business acumen they
bring to those conversation, the sophistication with which they
can partner and contract.
So you are absolutely right. It is one of my five pillars,
Senator Casey, and certainly aligns with our support of the
network pushing us toward really efficiency and effectiveness
in all the work that we do.
We also, of course, work with our national organizations,
some of whom are in the room today, to really help make sure we
keep an accurate pulse on what those CBOs need. There are, as
you know, thousands of them across the country that we are
honored to support and work with.
When it comes to specifically some of the different payment
models that they are exploring, we try to walk right alongside
them, so at ACL we recently funded some States, some programs,
actually, to do innovation work and payment models around
Medicaid Advantage, so your reference to that---or Medicare
Advantage, so your reference to that is a very good one.
We, of course, want to continue to encourage partnerships,
and then, most importantly, we want to share best practices.
There are some, you know, with States like Indiana and many
others, that are doing some pretty innovative things around
that CBO contracting work. Our goal is to really push out that
information so that it is an encouragement and really an
educational opportunity for other CBOs that are interested in
taking that next step.
Senator Casey. Thanks very much, and I am sure we can talk
more about those lessons learned.
Assistant Secretary, I notice in some of the material we
have that you have some organizational changes that you are
proposing, the administration is proposing, and I am holding in
my hand a document here from the Federal Register, which is
scheduled to be published tomorrow, and it seems like rather
substantial changes. I was surprised you did not make reference
to it, but I wanted to ask you some questions about those
changes.
In particular, I wanted to get a sense of the consultation
that would undergird these kinds of changes. One organization I
am curious about is the Consortium for Citizens with
Disabilities, so-called by the acronym CCD, which, for the
benefit of everyone here, is a coalition of 115 organizations
representing individuals with disabilities, including the Arc
of the United States, a major organization that we well
familiar with, the American Association of People with
Disabilities, and the National Council on Independent Living,
so my question about this organization, CCD, is: Prior to your
decision to undertake this reorganization, did you hold
meetings with or consult with CCD?
Mr. Robertson. Thank you, Senator Casey, and you are right.
With an FRN announcement now available publicly, we are moving
forward with some reorganization plans at ACL. I can reassure
you and everyone that we are actually not eliminating any
programs. We are not reducing staff. We are actually really
just striving to be better in what we do and how we do it.
Of course, I think any organization, public or private,
should regularly look at continuous quality improvement, and
while there is never a good time, I know ACL is a very young
operating division, just formed in 2012, so I believe this
season really was our first opportunity to really take a good
look at things and say, What can we do, again, in a way that is
the most effective for future stays?
You are correct, sir, and I also recognize that change
always creates anxiety, and that is probably the worst part of
any of those conversations, is the initial anxiety that
creates, but as we have been trying to do recently in messaging
with folks, again, no program is going away. We are not
reducing staff. Programmatically, nothing of significance will
interrupt the core mission that each and every day we plan to
fulfill.
Specifically to CCD, we are honored to meet pretty
regularly with CCD, as we actually do with most stakeholder
groups. In my 19 months here, I have met with over 350
different organizations, spoken at conferences, really tried to
lean in, plug in, to just get public feedback about every
possible way we can----
Senator Casey. I just want to interrupt. I am just running
out of time.
Mr. Robertson. Yes, sir.
Senator Casey. I just want to know, did you meet with or
consult with CCD about these organizational changes?
Mr. Robertson. Thank you, sir. Fair question. Just to be
honest, I have to tell you when it comes to restructuring,
reorganization conversations, we are not actually permitted to
get into that level of detail prior to the package being
approved through the formal process.
Senator Casey. The answer to my question is no. I take it
that is a no.
Mr. Robertson. That is correct, sir.
Senator Casey. Okay. The last one--and I know I am over
time, Madam Chairwoman. I just want to ask about another group.
The Leadership Council on Aging Organization, so-called LCAO,
is a member organization of 70 groups representing aging
networks, including AARP, the National Association of Area
Agencies on Aging, the National Council on Aging. Did you meet
with or consult with them prior to this change, proposed
change?
Mr. Robertson. Thank you, Senator. Again, just to be short
in answering your question, specific to reorganization
proposals, no, sir.
Senator Casey. Okay.
Mr. Robertson. Have we, of course, over the years been
involved in dialogs about better ways of serving their needs
and making them be supported and successful? Absolutely.
Senator Casey. Thanks. I might have a followup, but thanks
for the extra time.
The Chairman. Thank you.
Senator Rosen. Thank you. Thank you, Madam Chair and
Ranking Member Casey, for bringing such an important hearing to
us.
The Older Americans Act is so very important to us all, and
as a person who was a caregiver for my parents and in-laws for
many years, a lot of these issues I have experienced firsthand,
as well as so many of my friends.
Earlier this year, I visited the William Pennington Life
Center in Fallon, Nevada. It is a rural senior center, serves
over 70,000 meals in their congregant dining room. Now, mind
you, we only have 3 million people in the State of Nevada.
Northern Nevada is not the central population of our State, so
70,000 meals is a big deal. They deliver meals to over 200
homebound seniors each year.
Last year, I was able to join our Meals on Wheels
volunteers in Boulder City, southern Nevada by Hoover Dam, and
my own mother, when she became homebound due to illness,
received Meals on Wheels herself.
I know that I have seen firsthand what community groups are
delivering meals to frail seniors and the services that the OAA
provides are nothing short of spectacular, life-changing in so
many ways. My mother, I would say, ``You do not need those
meals.'' She goes, ``No. I want someone to feed me besides you
and come over and visit.'' And so it was a conversation for
other people and talking about other things. I say it as a joke
now. She is no longer with us, but it was really important to
her to have that.
Two home meal delivery programs in Nevada have reported
wait lists, the city of Henderson, Catholic Charities, and
there are more than 60 eligible individuals who have to be put
on a wait list, and throughout Nevada, nearly 600 older adults
are on wait lists, and so it is my understanding that we have
enough volunteers to deliver the food and do all of that. What
we do not have is the actual food, and seniors are going
hungry.
Secretary Robertson, we know an increase in funding is your
principal recommendation for addressing these wait lists. Do
you have other additional suggestions that maybe we can take
here?
Mr. Robertson. Absolutely. Thank you, Senator, and you are
absolutely right. The real bedrock program within the Older
Americans Act is a nutrition program, and like you, I have had
many professional and personal experiences where it just
reinforces for me that that is so much more than a meal.
Senator Rosen. Right.
Mr. Robertson. It is the ability to really do a wellness
check and to engage older adults, so you are absolutely
correct. We actually are funding innovation grants on the meals
side to really help drive conversations around what can we do
to make sure that that service is as efficient and as effective
as it can be. I did bring a couple of examples of some
innovation work that is happening around the meal program,
and----
Senator Rosen. Does this help our rural communities as
well? Because we have the urban area, of course, in southern
Nevada, Las Vegas, but when you drive across northern Nevada
and around rural Nevada, the distances are vast.
Mr. Robertson. Absolutely.
Senator Rosen. It is difficult, so they face some
challenges in rural communities as well.
Mr. Robertson. You are right, Senator. You know, food
insecurity exists everywhere, even in urban settings, but
undoubtedly, where conversations are the toughest is rural
service delivery. How do you make sure that those cost
variables balance out for those CBOs, and many of whom, as
Senator Casey was really referencing, that critical CBO network
and how frail some are in terms of fiscal resources, how do
they continue to serve people in rural parts of America?
You know, some of the options, for instance, I was briefed
on a situation in Texas where they are doing weekly deliveries,
which, again, is not the most preferred option, but it is an
efficient way of making sure seniors get food.
Senator Rosen. They are getting food. At least they have
the food.
Mr. Robertson. That is important. We also were talking
about in Missouri AAAs that are using kind of some technology
options to partner with local providers on making sure that
more----
Senator Rosen. Are you spreading the word amongst
organizations to let them know that people are trying different
things?
Mr. Robertson. Yes, ma'am, absolutely. As a matter of fact,
even if they are programs that we do not fund, we try to
amplify and share that message across the country, because I
think that struggle is common in every State. Most every State
has that same rural challenge, and I guess a bigger challenge
are a few States that face frontier issues where the distance
is so enormous that it is almost an impractical feat.
Senator Rosen. Right, very, very difficult.
Mr. Robertson. Absolutely, we do all we can to share that
information through just the public marketing work that we do
and how we push that message out.
Senator Rosen. Thank you. I have one other question. It is
my understanding on the ground from people in Nevada that
greater coordination between Federal agencies such as HUD and
the OAA programs, we could really work together. You talk about
amplifying and producing better results, and so tell me what
silos you see between Federal agencies and what suggestions you
might have for us to make things better for seniors, especially
affordable housing. We have lots of issues besides food
insecurity, so that would be hot, and the OAA perhaps.
Mr. Robertson. You are absolutely right, Senator. I think
there are a lot of opportunities that still exist for Federal
coordination. I will tell you, and this is my own personal
claim, but I think we are a collaborating machine at ACL. We
are always looking for ways that we can partner with other
Federal agencies, both within HHS as a big Federal agency and
across the Federal Government, so you know, we are doing
things. When we talk about meals with USDA, certainly housing
with HUD, some of those conversations. I would draw as a couple
quick examples, though, where----
Senator Rosen. Do you have suggestions of how we can help
you create those--or do we need to help you in some ways create
those partnerships?
Mr. Robertson. Rather than prescribing it, I just love to
hear that you would continue to encourage it, resting assured
that we are all about that, and, you know, again, a couple
quick examples. I know when it comes to elder justice, one of
Chairman Collins' priorities, it really is a good day when we
have the Elder Justice Council, which we chair, 14 Federal
agencies that are all at the table really talking about what we
can do to move the needle in that area. I also think about the
work we do with veterans on the VA side and how that crosses
over so many of these conversations.
I would just say, Senator, that, you know, rest assured we
are going to walk right alongside you in championing really the
message of collaborating and working together, leveraging
resources and being more innovative in how services are
delivered. I would not have any prescriptive recommendations at
this point, but, again, maybe for QFRs or some way to followup,
if there was something specific you were looking for.
Senator Rosen. I think it is important that we get it
right. I appreciate the hearing because none of us are getting
any younger, so I would like to get it right before maybe we
need it.
Mr. Robertson. Absolutely.
Senator Rosen. Don't we all have some skin in the game in
this one, that is for sure.
Mr. Robertson. Absolutely.
Senator Rosen. Thank you.
The Chairman. Thank you, Senator.
Mr. Secretary, in the last Congress, we passed the RAISE
Family Caregivers Act, which I co-authored with Senator
Baldwin. Now, I know that the National Family Caregivers
Support Program has existed for nearly 20 years, but the RAISE
Family Caregivers Act comes directly out of hearings that we
have had, and it would create a new council. I am a little
disappointed that it has not been set up yet. Can you give us
some idea of when you expect that to happen?
Mr. Robertson. Chairman Collins, I am very happy to give
you an update and to reassure you that throughout the last 6
months or so, we have worked as expeditiously as possible to
get this up and running. We anticipate the first meeting
happening of that council this summer.
What I learned was how laborious a process it is to kind of
get these things stood up, so I am proud to say, though, that
at every juncture, as we kind of walked through that process,
we really were able to shrink timelines and push things
through.
I want to thank, of course, you and Senator Baldwin for
championing the conversation and Congress for providing that
authority in the appropriations. We again have been working
through that process. I was also pleased to see that we had
hundreds of nominations, folks that were willing to raise their
hand and say, ``Yes, I would like to be a part of the RAISE or
the SGRG Committee.''
We are in the process now of having now sent out the
invites for the people to serve, and we are getting their
responses back. They then go through that final vetting for
financials and all that sort of thing, but that is why I do
believe this summer we are on track to have that first meeting.
We have had a meeting with our internal Federal partners to
make sure that everybody is on the same page. We have got our
services contract aligned, so I hope to use that here very
soon, we will get off and running. As you well know, those
support the key things that we do at ACL. It is about
supporting caregivers. It is one of my pillars, and it has
absolutely from day one remained a priority. I want to thank
Senator Casey and so many others that just kept encouraging and
saying let us get this done. I just wanted to reassure you it
is a priority, and we are doing all that we can to push that
across the finish line and get those committees stood up. Like
you, we are excited to see what feedback we get and how we can
advance the conversation in America around caregivers.
The Chairman. I am very glad to hear that. In the State of
Maine, for example, in the past, I believe, 5 years, we have
seen a 24-percent increase in the number of grandparents who
are taking care of their grandchildren due, sadly, to the
opioid and heroin epidemic that is gripping our State, and they
have very different needs from other kinds of caregivers.
We also are seeing people who have been diagnosed with
early onset Alzheimer's disease, and the burden and difficulty
for their spouse or other child is also great.
There are so many, but the final category that I will
mention where we have worked very closely with former Senator
Elizabeth Dole is military caregivers, and a lot of these
families are going to be in the caregiving for a wounded
warrior for decades.
Mr. Robertson. Absolutely.
The Chairman. It is not just going to be the last few
years, so I think the caregiving picture in the United States
has really changed, and that is why we are very eager to get
this set up and be able to identify best practices, for
example.
Let me just ask one final question, and that is on elder
abuse, neglect, and exploitation. That is a principal
objective--preventing exploitation is a principal objective of
the Older Americans Act. It is right there in Title I where the
other objectives are listed, and yet our work on this Committee
has found that we are having a real epidemic in elder abuse as
well. The GAO estimates that seniors lose $3 billion a year to
unscrupulous individuals, to scams, and I think that is the tip
of the iceberg.
Mr. Robertson. I agree.
The Chairman. I think the problem is far bigger than that,
because particularly when it involves a family member, the
senior is very reluctant to report.
Just last month in Maine, a securities agent was sentenced
to 10 years in prison for defrauding two older widows out of
more than $3 million. That was one of the worst cases of
financial abuse that we have had, and in that case,
fortunately, the perpetrator was caught and brought to justice,
but in most cases, we know that does not happen. In fact, the
estimate is that only one out of every 25 cases is ever
reported.
What more through the Older Americans Act--and I know about
the Elder Justice Council, but what more can we do to raise
awareness so that seniors do not fall victim to these
relentless scams?
Mr. Robertson. You are right, Chairman Collins. It is so
heartbreaking to hear so many stories about abuse and
exploitation, even neglect that occurs and how we should be a
country free from that worry. People should not wake up in the
morning and wonder, ``Am I going to be abused, exploited, or
neglected today?''
You absolutely hit upon one of my pillars. Again, at ACL, I
have five elder justice, elder abuses. One, we are certainly
proud of the work again we are doing with the Elder Justice
Coordinating Council, which I have to point out the enormity of
all 14 agencies leaning in on this is unprecedented. We have
added a couple. We added USDA and also Bureau of Indian
Affairs, so we have a really comprehensive conversation
happening around all angles. You are right, though. The data is
scary. The direction that the trend line is going still does
not make us happy at all, but I think we are really starting to
see some return on a lot of the investment programmatically
that we are putting into the work around this space.
You know, the Older Americans Act, of course, calls out the
Ombudsman Program. We also, of course, are very honored to be
working as the Federal agency that helps fund Adult Protective
Services. I think really that answer is kind of an all-in
agreement that we have got to make this a priority. Does it
involve funding? Sure, absolutely. I think in just leaving a
conference this morning where I talked about this topic, I also
think part of how we eradicate elder justice is to make it a
personal issue and to really begin to make sure that household
by household we do what we can to make sure that people are
aware when they see or sense that something is happening afoul,
that they report that.
You are right. It is difficult because so many perpetrators
are family members, so it is a matter really of making it a
human rights, a human dignity sort of conversation to say that
sort of behavior cannot be tolerated. We as the Federal
Government and Federal programs are ready to aid families all
across the country in addressing that.
The Chairman. Thank you.
Senator Casey. Thank you, Chairman Collins. For the record,
I wanted to put two concerns on the record in light of my last
question.
Mr. Robertson. Yes, sir.
Senator Casey. I just have one question/request. The two
concerns--and these concerns we may add to them as we go
further into the detail of this reorganization, but one is--and
I will just state it as a concern, and we can talk about it
later, but one is: What happens to regional offices? That is
something I would want to know more about.
Mr. Robertson. Yes, sir.
Senator Casey. Then also there is among many
administrations, as you know, in an organization like this,
right now we have the Administration on Intellectual and
Developmental Disabilities. I am told or as I can read here in
the proposal that that would be renamed to an office as opposed
to an administration. I am concerned that that is a downgrade.
That is something we can walk through.
Here is my question or my request. Would you meet with me
and the members of my office that work on these issues very
soon, in the next week or two, if that is possible?
Mr. Robertson. Senator, we would be happy to sit down with
members of your team and talk through some of these changes. I
am happy to address both of those that you just referenced
specifically and even beyond that should you have any other
questions, sir.
Senator Casey. Thanks very much.
Mr. Robertson. Absolutely.
The Chairman. Thank you, Senator.
Senator Hawley. Thank you, Madam Chair, and thank you for
calling this important hearing.
I want to start by doing a little bit of bragging on the
Area Aging Agencies in Missouri whom I am awfully proud of and
just put in the record some of the great work that they have
been doing. Last year, they delivered almost 6 million meals to
seniors across my State and served over 2 million congregate
meals. They have also provided over 30,000 seniors with
information and assistance services, given over 15,000 seniors
transportation to medical appointments or errands, and helped
to involve 7,000 of our elders in recreation programs, and
these Area Aging Agencies, backed, of course, by OAA resources,
are really an essential part of our community fabric in
Missouri, and I am very, very grateful for their hard work.
Let me just mention one other thing, the exciting
innovations happening in Missouri. In west-central Missouri,
which is where I grew up, a Care Connection for Aging Services,
based in Warrensburg, has been providing services in 13 rural
counties for 45 years, and they recently pioneered a program
called ``Seniors Fit and Fun,'' which I think is great. It was
recognized with an Aging Achievement Award by the National
Association of Area Agencies on Aging, and this activity, what
they did is they used a fair concept with vendors leading
interactive health activities for those who attended rather
than just setting up tables, and also educated seniors on
Medicare preventative care benefits. It has been a very
effective way to improve health by encouraging seniors to stay
active. It has been a big hit, and, again, I am very proud of
all the work that they are doing.
With that, Mr. Secretary, let me ask you this: I was hoping
that you might elaborate on the point that you make in your
written testimony about value-based care and how OAA programs
can help address the social determinants and components of
health. What part do you think does OAA play in helping us move
to a value-based system?, and how are you incorporating aging
networks into the overall health care system to achieve value-
based care?
Mr. Robertson. Well, thank you, Senator, and thank you for
bragging on your Missouri programs. I think that is wonderful.
You probably have some listeners whose chests are sticking out
right now. That is great.
We did have a slightly earlier conversation around, again,
just the value of this conversation for social determinants and
how we are overdue as a country to talk through what does it
mean to really better integrate the social services side of all
these services that are offered to Americans throughout every
community into that higher-cost health care conversation, so it
is one of Secretary Azar's four priorities about transforming
health care, and really in some of his more recent
conversation, he has talked about, hey, we need to better use
the aging and disability networks, because the social
determinants work they do, as we all know, often can fend off
higher costs, and when we think about one example after
another, you know, a $4.50 meal can sometimes keep a person out
of a nursing home, or a very low cost home modification can
really, again, enable someone to stay in their community, so
all those things have tremendous value.
Like you, I am very proud of our network. All across the
country, we have nearly 22,000 CBOs who are working every day
to sort of continually get better at what they do. In some
cases, they are expanding into more of that health care space
and doing some really creative things around payment models.
That is not something yet we have prescribed or necessarily
offered directly at the Federal level, although I am really
proud of the conversations we are having with CMS, because the
key driver behind a lot of that is going to be Medicare and
Medicaid, and some of the innovations that they are interested
in, the conversations they are having, and I am just convinced
that our network is primed and ready to really take that next
step and to really begin to better appreciate payment models of
how those lower costs in the setting that we all prefer, how
those services delivered can really, again, hold off higher
costs that Americans, as all of us managing budgets, would be
appreciative of.
Senator Hawley. Thank you very much.
Thank you, Madam Chair.
The Chairman. Thank you, Senator.
Thank you very much, Mr. Secretary. We look forward to
working further with you as we put together the reauthorization
and hope that we can count on your office for technical
assistance as well as for policy guidance.
Mr. Robertson. Absolutely. Thank you, Chairman Collins.
Thank you.
The Chairman. Thank you.
I would now like to turn to our second panel of witnesses,
and while I am giving them a moment to get settled, I will
introduce them.
Our first witness on the second panel is Richard Prudom,
the secretary of the Department of Elder Affairs in Florida.
The secretary has served with this department since 2011 and in
various roles in the government of Florida for more than 30
years, so he brings a wealth of information to us.
I am particularly pleased that our second witness is
Laurence Gross, the chief executive officer of the Southern
Maine Agency on Aging. Mr. Gross has been with the Southern
Maine Agency on Aging for 41 years, all but the first 5 years
of its existence. During his tenure he has championed efforts
to address social isolation among our seniors and to pursue
innovations to expand the reach of core programs, so we are
delighted to have you with us today.
Finally, I will turn to our Ranking Member to introduce our
witness from the Commonwealth of Pennsylvania.
Senator Casey. Thanks, Chairman Collins. I am pleased to
introduce Faith Lewis from Simpson, Pennsylvania. We live in
the same region, and Faith and I were together recently talking
about many of these issues.
Faith is a mother, a grandmother, and, it is hard to
believe, a great grandmother. We do not have many great-
grandmothers testify in front of the Senate, so this might be a
first, so Faith, we are grateful you made the trip here to do
this and to tell us what we need to know about a lot of these
issues that you confront every day.
Faith is a caregiver for her 5-year-old great-
granddaughter, Xziylan--is that how you pronounce it? I want to
make sure I did that right, and Faith's sister, Lois, and
Xziylan made the trip from northeastern Pennsylvania to be here
today and, I am told, are watching today's hearing on
television, so we want to say hello to both of them and thank
them for being here and coming all the way to Washington.
Faith is one of 11 million people who benefit from the
Older Americans Act each year. She attends a grandparents
support group at her local Area Agency on Aging, and she also
receives resources through the National Family Caregiver
Support Program to help with some of the costs of caring for
her great-granddaughter, who is watching her on television now,
so Faith, thank you for being with us today. We look forward to
your testimony.
The Chairman. Thank you very much, and we will start with
Secretary Prudom.
STATEMENT OF RICHARD PRUDOM, SECRETARY,
DEPARTMENT OF ELDER AFFAIRS, TALLAHASSEE, FLORIDA
Mr. Prudom. Chair Collins, Senator Casey, members of the
Committee, thank you for the opportunity to be here today to
discuss the importance of the Older Americans Act and what we
are doing in Florida to meet the needs of our growing senior
population.
I was honored to be recently appointed Secretary by
Governor Ron DeSantis. The Governor has taken bold actions and
shown great leadership on issues affecting Florida seniors,
including Alzheimer's disease and related dementias and also
making Florida an age-friendly State. The Governor has charged
me with working to improve the lives of older Floridians--a
responsibility I do not take lightly--and it is my pleasure to
work with him in service to our 5.5 million seniors.
The Department of Elder Affairs serves as the State Unit on
Aging for Florida and oversees more than $330 million in State
and Federal funding, including more than $112 million in
funding from the Older Americans Act. We partner with 11 Area
Agencies on Aging, over 50 lead agencies, and many direct
service providers across Florida to keep seniors in their own
homes and communities as they age. It is our mission to keep
our older residents healthy, safe, and independent for as long
as possible.
Florida has the highest population percentage of 65-plus in
the Nation. In fact, our senior population of 5.5 million
outnumbers the senior populations of 20 other States combined.
In the next decade, this senior population will increase by
more than 38 percent to 7.6 million.
There are challenges in promoting the health and well-being
of this growing and increasingly diverse older adult
population. Population aging, especially when the Baby Boomers
reach ages 85 and older, signals a likely surge in the use of
long-term-care services, so clearly, Florida's aging network is
tasked with an important challenge: to ensure that we are
meeting and will continue to meet the needs of our frail
elders.
The major focus of our programs is to provide home and
community-based services as an intervention for those elders
who are at risk of being placed into a long-term-care facility
because of their degree of frailty. As the Older Americans Act
is a primary mechanism for these services, it should be
considered the foundation for this aging-in-place concept,
which is not only preferred by older Floridians, but the higher
costs associated with nursing home placement are avoided.
For the last fiscal year, Florida received nearly $106
million in OAA Title III funds and served approximately 200,000
clients throughout the State. The OAA services most utilized by
Florida's seniors and their caregivers were transportation,
meals, medication management assistance, and respite for
caregivers.
Before I highlight a couple of these programs, I do want to
stress to the Committee that we do not take these funds for
granted, recognizing they are provided by taxpayers and are
essential to the overall health of Florida families. We
consider the funding an investment in the future of Florida,
being ever mindful of both the societal and economic returns on
that investment.
We consistently seek innovative ways to deliver services
and explore additional funding sources to supplement and
complement those services. Many of these are fully highlighted
in my written statement.
In the last fiscal year, we provided nearly 11 million
meals in Florida, and more than half--over or 6.3 million--were
served through OAA. As we have heard today already, a meal is
more than just a meal to those who receive it. Home-delivered
and congregate meals are also an opportunity for socialization
and engagement, which helps combat another critical issue
facing our elders: loneliness and social isolation.
Medication management is a highly utilized OAA service in
Florida, and, Chairman, you mentioned about the opioid crisis,
and, obviously, this is something in line with that. Studies
show that the inappropriate management of medication has been
proven to be one of the highest indicators of nursing home
placement, so this 3D program is essentially helping us to
achieve our goals of help seniors age in place.
In the last fiscal year, Florida received nearly $15
million in funding for caregiver support, serving more than
91,000 family caregivers. Respite is one of the most important
services offered because it is vital that our caregivers are
healthy and can continue to provide care. Many caregivers face
burnout, illness, exhaustion, and financial distress, so it is
crucial that we support their well-being and health.
The Older Americans Act also provides more than $1.6
million to help fund the Ombudsman Program, which Secretary
Robertson alluded to earlier on. It is a statewide volunteer-
based program that works to protect, defend, and advocate on
behalf of those living in long-term-care facilities. It also
helps fund our abuse prevention coordinators through whom we
educate the public on preventing abuse, neglect, and
exploitation as well as on how to report abuse.
Before I close, I would like to give you an example of a
recent innovation that we introduced. Last August, in
consultation with the ACL, we initiated a Disaster Recovery
Reserve, a DRR, which obligates the State's 11 AAAs to
designate a predetermined amount of Older Americans Act funds
to serve elders affected by a disaster. It is important to note
that the DRR funds would not be used if a disaster did not
occur.
In October 2018, Hurricane Michael hit the Florida
Panhandle as a Category 5 hurricane. The DRR innovation allowed
us to transfer designated funds to AAAs that housed those
affected counties, thereby providing additional services to
older adults after the storm. We are repeating the DRR this
year as well and obviously hope that we do not have to use
them. I shared this innovation with my counterparts from 13
other States at the ACL meeting in Atlanta last week.
As I said at the beginning of my testimony, there are
challenges in promoting the health and well-being of Florida's
growing and increasingly diverse older population, but I share
Governor DeSantis' vision for Florida to be a place where
seniors are not just living but living well. An aging
population is an opportunity to use our social and
technological ingenuity to develop solutions to our changing
needs that can move us all forward. The Older Americans Act is
essential to our ability to meet those challenges; in that
regard, it is the major vehicle we use in Florida to support
and protect Floridians as they age in place--helping, among
other things, to improve senior nutrition, support family
caregivers, advance elder justice, and helping older adults to
age well in their communities. These are all essential pieces
that enable current and future seniors to live and live well,
which is our ultimate goal in Florida.
Thank you, and I am available to answer any questions.
The Chairman. Thank you very much.
Mr. Gross.
STATEMENT OF LAURENCE W. GROSS,
CHIEF EXECUTIVE OFFICER, SOUTHERN
MAINE AGENCY ON AGING, SCARBOROUGH, MAINE
Mr. Gross. Senator Collins, Senator Casey, members of the
Special Committee on Aging, I am Laurence Gross. For 41 years,
it has been my honor to serve older adults at Southern Maine
Agency on Aging, the past 36 years as chief executive officer.
Our service area includes Maine's largest city and one-third of
the State's elder population living in 2,000 square miles of
suburban and isolated rural settings. SMAA staff and volunteers
touch the lives of more than 20,000 people annually. I want to
thank Senator Collins for inviting me to speak with you today.
During my tenure at SMAA, I have seen the Older Americans
Act evolve to become a solid foundation for the future of aging
services in this Nation. Today I will share my experience as a
veteran on the front line of the act's evolution in the
``oldest'' State in the Nation.
Maine is the ``canary in the coal mine'' when it comes to
the field of aging in America. Of necessity, Maine has built a
national reputation as a laboratory for innovation, testing,
and proving policies and practices that will serve our country
well in the decades to come. I am proud of the many national
awards SMAA has received in recognition of our contributions to
Maine's legacy, most recently as the first recipient of the
Business Innovation Award from the John A. Hartford Foundation.
SMAA offers the core of OAA services: home-delivered and
community-based meals; information and assistance; family
caregiver support, training, and respite; Medicare counseling;
fraud prevention; and health promotion activities. We operate a
day center for adults with dementia, the Sam L. Cohen Center,
where I was delighted to host Senator Collins after it opened
in 2016. Our 600-plus volunteers provide invaluable human
capital resource: nearly 4,000 hours of program services
annually.
Senior nutrition programs are a hallmark of the OAA.
However, by the early 2000's our traditional congregate dining
model was languishing. Flat funding, rising inflation, and
demographic shifts of interest had reduced participation and
increased operating costs. Our clientele was ``aging out'' to
home-delivered meals. In response, we made the strategic
decision to replace our legacy delivery design with a voucher
model. We called the program ``As You Like It.'' Initially set
in a hospital cafeteria, As You Like It offered our diners menu
choices in an attractive multigenerational setting that was
open 7 days a week. The program was an instant hit. We soon
expanded to other local hospital and college cafeterias and
eventually to a network of small restaurants.
In its first 5 years, As You Like It grew our congregate
program by 55 percent and increased the number of diners from
rural areas by 61 percent while increasing the number of people
and meals served per dollar of funding.
SMAA then restructured our home-delivered meals program to
increase its relevance to the changing needs of our clients. We
introduced flash-frozen meals, a dramatic transformation. Flash
freezing greatly increased the nutritional density and quality
of our meals, reduced waste, and changed our meal delivery
paradigm to allow evening and weekend meals. We now offer a
variety of menu choices: vegetarian, gluten-free, pureed,
renal, and traditional comfort foods every day, very different
from the one-size-fits-all single item menus of the past.
Consumers loved the change because it offered them choice and
convenience. A serendipitous benefit was the ability of our
meal delivery volunteers to conduct informal wellness checks
and spend more time with clients for whom they were often the
only visitor of the day.
Using the updated menu and delivery options, we rebranded
our home-delivered offerings as ``Simply Delivered Meals'' and
conducted a pilot study within a 4-year Medicare demonstration
designed to reduce hospital readmission rates of high-risk
patients. We provided a week of Simply Delivered Meals to
patients when they left the hospital and documented a 38-
percent reduction in readmission rates and a 387-percent return
on investment from avoided readmissions. Our results were peer-
reviewed and published in the American Journal of Managed Care
in 2018.
These two examples show how the Older Americans Act can
become a new platform for addressing what medicine calls the
``social determinants of health.'' Poor nutrition, lifestyle
choices, limited access to safe funding and isolation,
exacerbate most chronic health conditions, but are nearly
impossible for the medical community to influence alone. Area
Agencies on Aging are ready to help.
As SMAA has shown, a nimble and innovative AAA can make a
quantifiable difference in both quality of life and cost of
care.
I conclude with several recommendations to modernize the
Older Americans Act, really strengthen the Older Americans
Act:First, I would encourage you to explicitly encourage State
and Agencies on Aging to leverage Older Americans Act funds
through private-pay and contractual relationships with health
care;Second, modify the act to increase the value in adding
cost-and revenue-sharing options beyond individual client
donations; andThird, increase funding. Older Americans Act
funding has woefully lagged growth in the aging population. At
SMAA, after inflation, we receive less Older Americans Act
funding today than we did in 2010. Please increase funding to a
level that restores the service capacity we have lost in the
past decade. Then index authorizations to keep up with the
growth of the older population and inflation.
In 3 months, I will be retiring from my position at the
Southern Maine Agency on Aging. I have had a fulfilling career
with many unique opportunities and satisfying achievements
thanks to the Older Americans Act. Testifying to this Committee
and sharing my insights with you is a wonderful capstone. Thank
you very much.
The Chairman. Thank you very much for all those years of
service. I can somehow envision you as going from your paid
position now to being a volunteer delivering some of those
meals.
Mr. Gross. That might just happen.
The Chairman. Ms. Lewis, welcome.
STATEMENT OF FAITH LEWIS,
GREAT-GRANDPARENT, SIMPSON, PENNSYLVANIA
Ms. Lewis. Chairman Collins and Mr. Casey, I want thank you
for inviting me today on behalf of the grandparents raising
their grandchildren across the country.
I am currently caring for a 5-year-old. Her name is
Xziylan, and she is quite the child. She loves to run, and, you
know, a 5-year-old is no small defeat, but she is a good kid.
She loves to eat. She is a fruit eater. She is a vegetable
eater, and when we go shopping, I let her pick out the stuff
that she wants, and her favorite is watermelon. I never knew a
kid that liked watermelon so much. She loves to go to the park,
and for Christmas she got her bike, so she cannot wait for the
really nice weather to come so she is able to go outside and do
what she wants to do--play--well, of course, with help.
It is important to me that Xziylan is a happy child.
Xziylan's mom has been in prison on drug-related charges for
the past 3 years, and if I did not step up to help, my
daughter, Xziylan's grandmother, would have taken her, and she
has two already of her daughter's children, and it would be
very hard for her to take care of three, so my son helps a
little bit, my neighbor, and yes, my sister, Lois, she helps
me, too.
I have strong support. It is very important. Every couple
weeks I go out to dance, an old great-grandma out there
dancing. I go to Wilkes-Barre with my friends, and we just--I
am not a drinker, so we go out just to dance and have a little
fun and laugh and joke around.
I rely on my Social Security check to make ends meet. Some
months are harder than others, but, you know, I have been
watching children since I was 13 years old, when my Mom died,
so I figure out how much really what to spend. I used to go
shopping, too, for her. I get $35 each month in food stamps,
but with a kid who likes to eat such healthy food, it does not
stretch very far. Sometimes I go to the food pantry in St. Rose
in Carbondale. Sometimes, you know, that helps. I bought a new
car, but I do drive Xziylan back and forth to school, and with
the cost of the car, and our housing is $500, the insurance is
expensive, I have insurance, and I do buy her some clothing
when needed. She is starting to grow. She went from a binky to
a little girl.
Last year, I joined a grandparents support group called
``Parents a Second Time.'' It is run by the Lackawanna County
Area Agency on Aging. It meets regularly, and if the support
group did not exist, I would not have anyone to talk to who
would understand what is the meaning of caring for a child in
the golden years. The issue that we discuss most often is the
financial strain of raising our grandchildren.
The National Family Caregiver Support Program helps because
I get reimbursed some of the costs of raising Xziylan. It helps
me afford clothing that fits her, and she is growing. Next
year, she is going to go to kindergarten, so I will have to buy
her uniforms, and it helps me pay for a membership to the YMCA
for the activities that she wants to go to. They will reimburse
me when I go, and they are helping me with the YMCA.
I think it would be good if more grandparents raising
grandchildren would be served through the program. Every little
bit helps, and on behalf of the grandparents who cannot get the
help like I can, I would like to thank Senator Casey and
Senator Collins for trying to help make sure that more
grandparents raising grandchildren can participate in the
program.
My grandchild is not the only person who got caught up in
the opioid crisis. There are many more, and even more people
who are unable to care for their children because of sickness
or accidents. Grandparents and even great-grandparents like me
are the next line of support. I hope that the National Family
Caregiver Support Program will be able to help all older
caregivers, and I hope that you continue to improve all of the
programs funded by the Older Americans Act so that my Area
Agency on Aging will continue to be around for me and my
family.
Again, Chairman Collins and Mr. Casey, thank you for the
opportunity to testify before the Committee, and I look forward
to answering any questions.
The Chairman. Thank you very much, and how fortunate your
little great-granddaughter is that you were able to step up and
take care of her and raise her. I think it is wonderful that
you do so, but also it is really saintly of you to do so. She
is a lucky little girl. Thank you.
Mr. Gross, let me start my questions with you. First, I am
so impressed with the innovations that you came up with, the As
You Like It program, which gave the opportunity for seniors to
have more choice and also addresses the isolation problem by
bringing them out of their homes, and yet rather than having
one set meal at a congregate eating place, they are going to
even restaurants, so I love also the choice and convenience of
your Simply Delivered Foods program.
Let me ask you, was it difficult to get--did you have to
get permission to establish these programs from the Federal
Government? Or is there flexibility in the law? Or did you just
go ahead and do it?
Mr. Gross. Thank you, Senator Collins, for that question.
Let me say I live in the gray area, and I sort of do not ask
for permission but maybe beg forgiveness as an operating
approach, and so if the law provides an opportunity to provide
a straight answer or answer the question with a straight face,
I will make an effort to try to bend the rules, so yes, we just
went ahead and did it.
I will say that we initially did get some pushback from the
regional office of the Administration on Aging at that time,
even though the concept of the Simply Delivered program and the
As You Like It program was built into the long-range plan of
the Older Americans Act of increasing more meals served per
million dollars of Older Americans Act funding, so we just went
ahead and did it, and we got some pushback. We had to defend
ourselves a little bit about not discriminating against rural
communities and that type of thing, but the data that we
collected documented that the program was actually what people
were looking for, and we were able to make it available to
them.
The Chairman. That is overwhelmingly the case from the
statistics that you have given us, and you are treating seniors
as they want to be treated, and I think what you are doing is
wonderful, and I want to make sure as we put in the
reauthorization bill that we specifically provide the kind of
flexibility so that you can pursue those kinds of alternatives
to better serve your clientele, and I just think both of those
programs are really terrific.
I am impressed by the data that you provided us showing
that the Simply Delivered Meals given to patients upon
discharge from a hospital reduced hospital readmissions by more
than a third. That is truly extraordinary. Could you describe
on an individual level what impact this had not only in keeping
a patient from being readmitted to the hospital but on their
lives?
Mr. Gross. Yes, thank you again, Senator Collins. What we
heard from people, particularly around the Simply Delivered
Meals program, were a couple things. One, people went to the
hospital, did not expect to come home and find their food in
the refrigerator was no longer edible. We heard from caregivers
comments like, ``I never realized how much trouble it was going
to be to take care of my spouse when I went home.'' ``The meals
were such a wonderful relief for me. It was one less thing that
I had to keep track of, one less thing that I had to do when I
brought my family member home.''
Those are the kinds of comments that we saw that were
really unexpected but really point to the quality-of-life
considerations in addition to the cost savings that come from
reducing readmissions.
The Chairman. My final question for you has to do with the
issue of co-pays. I did not word my question as well as I
should have with the Assistant Secretary, but, in fact, haven't
you implemented some cost-sharing programs that allow
individuals who are on the waiting list to be able to purchase
your foods until they qualify because of coming up on the
waiting list?
Mr. Gross. Yes, that is what we did do. We basically
offered our Simply Delivered Meals as an alternative to the
traditional home-delivered program but for people who can
afford to pay them, and so by allowing them to pay privately,
they can sort of receive meals, as you said, until their name
comes to the top of the list. That is another area that may be
a little bit gray in the Older Americans Act under past--it
depends on who is in the State Unit on Aging, but in the past,
there has been concerns about mixing private-pay dollars in a
donation-only program, and there were some prohibitions about
using--leveraging your Older Americans Act funds with those
private-pay dollars.
We found that, again, we are kind of forced into the
corner. We have 250 people on our waiting list right now, and
when we take them off, we find that many have gone to higher
levels of care or in cases died before we could get to them.
They had been on the list since January of this year, so this
is one way that we can at least make it available for some
people to get off and get nutrition they need.
The Chairman. That makes all the sense in the world. If
there is a waiting list and people have the ability to pay and
you can produce the food for them, why not do it so that they
are not in a situation where they are not getting the nutrition
that they need, which is going to worsen their health problems?
So I really commend you for that as well.
Mr. Gross. Thank you. I should also mention that there is a
slight profit in providing that meal, which then allows us to
put the money back in to help other people come off the waiting
list sooner.
The Chairman. That is great. Thank you.
Senator Casey. Thanks very much.
Faith, I will start with you. I really appreciate your
testimony both in terms of helping us better understand the
benefits of programs like the National Family Caregiver Support
Program, but also for giving us an insight into the reality of
your own experience. It is very helpful for us.
I was noting in your testimony one brief sentence in, I
guess, your fourth paragraph where you talked about the work
you are doing and the work others in your family are doing, and
you said, ``We help each other out.'' A simple statement but so
important when we talk about what you are doing and what a lot
of families are doing around the country. We are told that 2.6
million children--just imagine that, 2.6 million children--are
being raised by grandparents or other extended family or
friends across the country, and obviously, you know that a big
share of that are grandparents, and in your case a great-
grandparent.
The role of coming a full-time caregiver comes
unexpectedly, and that is probably an understatement. For some,
we have heard so many stories it happens literally in the
middle of the night. Most grandparents do not even know where
to turn for help. Senator Collins and I got legislation passed
last year to provide a resource to give grandparents
information. We still have a long way to go on that and other
priorities.
It is not just an action you take as a grandparent. It is
an act of love, and your act of love saves our Government a lot
of money, so we must continue to support in a much more robust
way grandparents who take on this role because they want to
help someone that they care about.
I wanted to ask you, Faith, about the Caregiver Support
Program, if you can tell us how that helps you in the difficult
task that you have.
Ms. Lewis. I was trying to get other people to come to the
Caregiver Program, but I am out there like pushing, and now I
just go to the programs, and what I do is--I am a little
startled on the question now. You have to ask me that later.
Senator Casey. Well, I know you indicated in your
testimony, you talked about the fact that because you have
these opportunities you are able to share ideas with others.
Ms. Lewis. Well, right now the Area on Aging----
Senator Casey. The Area Agency?
Ms. Lewis. Yes, in Scranton, Rebecca Munley, she and Jason,
they help set up programs where we do not have to pay. They pay
it for us and set the program up, which I already took Xziylan
to two of them, one at Nay Aug Park and one at the Ritz in
Scranton, which was very nice, and they set that one up in the
Ritz. You could drop your children off and go for like 3 hours
and go to dinner or shopping or something, but I did not do
that because I will not leave her alone. I did not know--it was
more for a couple, but she said she was still invited, and she
enjoyed it. She painted butterflies, and they are hanging--
everyone painted butterflies, and they are going to hang them
in the courthouse of Scranton.
Senator Casey. That is great.
Ms. Lewis. Which I thought is going to be very nice.
Senator Casey, It does give you a little respite, a little
break?
Ms. Lewis. Yes. They are the nicest people I ever met, and
all the people in the group really talk about them and say how
nice they are. They are very helpful to everyone, and they do
not look down at no one. They are very nice, and I think that
is nice, so we all have issues, but we all seem to talk about
it and try to see if we could get together and figure out
something.
Senator Casey. Well, you have given us a lot to reflect on
in terms of the value of these programs, and I know that in
addition to the fact that you have got a substantial
responsibility, it also is a responsibility that brings you a
lot of joy, and that is also inspiring for us, so thanks.
Ms. Lewis. I listened to these people here about the aging,
and I think, wow, am I lucky or what that I am able to take
care of the children and help my daughter out, too. She helps
me, like I said, and I help her, so it works out.
Senator Casey. Faith, thanks very much.
Ms. Lewis. Thank you.
Senator Casey. Sorry I am over time a little.
The Chairman. You are fine.
Senator Blumenthal. Thank you, Madam Chair, and thank you
for having this hearing. Thank you to our witnesses for being
here today and for your good work, all of you, on behalf of our
aging Americans.
I am a strong supporter of the Older Americans Act, and we
most certainly need to reauthorize it. I am from Connecticut
where our population is composed of about 575,000 people who
are seniors, about 16 percent of our population. We are growing
older, like the rest of America, and a lot of the discussion so
far has been about nutrition and meals and about, Ms. Lewis,
how you take care of your great-granddaughter, which is really
an inspiring story.
I want to ask you about taking care of the seniors in
protecting them from elder abuse, which is one of the key
objectives of the Older Americans Act. To what extent do you
think this problem is rising in frequency and severity? Let me
ask all of you.
Mr. Prudom. I will go first, if that is OK, Senator, but
that is a really great question, and yes, we are seeing an
increase in that, obviously with the aging demographics we are
seeing in Florida. People do not understand that even--I
mentioned earlier about the number of elder adults moving to
Florida. Not all of those are in need. A lot of them actually
have a lot of disposable income. Someone at the University of
Florida calculated a net economic impact of retirees in
Florida, they contributed $2,900 more to the economy than in
consuming public services, and people over the age of 50 are
driving the longevity economy, so we are seeing older adults
who actually have substantial resources, and they are becoming
obviously economic contributors to their local economies.
Unfortunately, as they get older, we are seeing some of the
vulnerabilities exhibit themselves, and people come and prey on
them, and it is unfortunate, because I was talking to law
enforcement and some of the prosecutors, and they say they are
adequately resourced for things like murder and for drugs, but
for things like abuse, neglect, and exploitation, it is not
quite as cool, it is not quite as sexy, it is not quite as--it
is more detached from that, and so, you know, we have been
talking in Florida about how do we really address this, not
only as a State but as a Nation, and I think the secret lies
with communities. The Older Americans Act was ahead of its time
in considering the value of communities in addressing the needs
of their citizens, and I think a lot of emphasis needs to be
put on this at the community level where everyone gets to the
table and says, ``What is important for our citizens to live in
our community, to be protected from this?''
We hear a lot of stories about the bad guys that are caught
and are put away, but the damage has been done, and that is the
bad thing. A lot of people--we are not talking---it may not be
a certain amount, but the actual act of exploiting someone has
a terrible physical health cost, and many times they will die
within 18 months of that trauma.
Senator Blumenthal. It is an emotional consequence.
Mr. Prudom. Most definitely, sir, and I think that is what
communities need to step up, and we can help them both on the
State and Federal level in equipping them to being proactive
and preventing this from happening in the first place, and I
think right now there are too many silos out there, and I think
those silos could be broken down by having communities step up
and demand better for their own citizens and have them at the
table to assist in that discussion.
Senator Blumenthal. Thank you.
Mr. Gross?
Mr. Gross. Thank you, Senator. In addition to the comments
that Secretary Prudom has made, I would highlight the
importance of keeping family members out of the checkbook. We
have a program that we developed at the Agency on Aging that we
call ``Money Minders,'' which uses bonded volunteers to go in
and help people once or twice a month to sort of sort through
their bills and pay their bills that need to be paid, help them
to organize their finances.
The client still makes the choices as to how to spend the
money, but they preserve their privacy, they make choices that
they want to make, and our volunteers are there just to kind of
help them understand what the consequences might be if they
make this very big donation, let us say, but they have a rent
check that is due next week that they will not have the cash to
cover that, so that is one example.
I think you might also want to look at some of the work
that we have done in Maine actually around what is prosecutable
in terms of intent and what levels or degree of evidence that
needs to be done. There is some presumptions in the law that
something that is--that improvident transfers are a problem,
and, again, Maine is sort of the canary in the coal mine. We
are the oldest State. We have done a lot of work in those areas
to try to identify that.
I would also say that one of the things we have heard from
some prosecutors is that they are reluctant to bring elder
abuse criminal proceedings because the reliability of the
witness is always at question, and it is very difficult
sometimes to convict a person who does not remember the facts
and does not have all their faculties around them, and so in
some cases, there is a higher priority to chase convictions
that are easier to get than they are with the resources that
are applied to prosecuting elder crime.
Senator Blumenthal. Some of the victims may be reluctant to
come forward out of shame or embarrassment or because the
crimes are committed against them by relatives or caregivers
whose affection means a lot to them.
Mr. Gross. Absolutely, and there is also the threat of
saying, ``If you do something like that, you know, you are
going to have to go into a nursing home, and I am not going to
be able to support you.'' That psychological abuse is just as
important as physical or financial abuse.
Senator Blumenthal. Good points. I am out of time. Thank
you very much.
The Chairman. Thank you, Senator, for bringing up that
issue. We have held, as you know, a lot of hearings on senior
scams, and I am proud that Maine led the Nation in passing the
Senior$afe Act, which we were able--Claire McCaskill and I
working together were able to get enacted on the Federal level,
and the Department of Justice is also paying much more
attention to this issue than ever before, which I think is
progress, and I think our Committee can take some credit for
that.
Senator Blumenthal. I know you have had a number of
hearings on this issue. The folks from Maine and Pennsylvania
and Ms. Lewis should know that you have really been a leader,
and I thank you.
The Chairman. Thank you, and thank you for your work.
Secretary Prudom, across the Nation, and especially in
Maine and in Florida, age-friendly communities are starting to
emerge as a natural solution to isolation. We held a hearing on
this issue as well and found that sometimes very small changes
can make a huge difference, such as the timing of traffic
lights to allow people more time to cross the street, curb cuts
to allow people to not have to step up, restaurants giving
senior citizen discounts on a certain day of the week.
Would it be valuable for the Older Americans Act to
recognize and support age-friendly communities? Because right
now they are not recognized in the act, I think because it has
really been only in the last few years that we are starting to
see this development. What suggestions would you have?
Mr. Prudom. Thank you for that question, Chairman. My
suggestion is to do exactly what you just said. I really think
this age-friendly initiative is going to be part of the future.
We are proud to be the fourth State that has just embraced the
age-friendly designation, but it is more than that. It is about
livable communities, livable for all, so we can all live and
live well, and I think that is the important thing, and you are
right, Senator. They actually address the social determinants
of health.
The beauty about this initiative, it is community-owned,
initiated, and driven, and the success lies up to the community
because they know what is important to their citizens, whether
it is, like you said, for the older citizens being able to
cross the street safely to go to a restaurant or to go and
visit somebody or whatever. Each community needs to address
that separately. Then you understand what is important to that
community and to get together to address how that should be
done.
You talked earlier on about housing, you know, appropriate
and affordable housing. That is an important thing that needs
to be addressed at the community level.
I think the exciting thing about this age-friendly
initiative is that, you know, as a State, we are embracing
that, and with the Older Americans Act to further encourage
communities to embrace the social determinants of health and
help their communities become livable communities is the right
way to go.
A lot of times when I talk about this, I tell people there
are both societal benefits and economic benefits from becoming
a livable community. You talked about the fact of
socialization. If you create a community where people are no
longer socially isolated and they are interacting with each
other as human beings, all of a sudden--as you said, the 15
cigarettes a day--people who are not socially isolated are
incurring or can incur more physical and mental health
expenditures. The older adults as well in our communities, they
volunteer. You mentioned that earlier on. That is huge in our
State. Last year, it was 200 million hours the older adults
volunteered. At 15 bucks an hour, that is $3 billion in cost
avoidance. If you create a community where older adults want to
go and live, they will volunteer, and that pays things back.
It is really important, I think, for communities to
understand the value of this. It is not some sort of Sociology
101 exercise. It actually makes economic sense, too, and I
think once people understand that--and the main thing is they
define this on their own terms. They decide how they want to
become livable. They decide what their social determinants of
health care, which ones to adopt and which ones that do not
really matter to them anymore, but I think the big ones are
what you mentioned: transportation and housing and outdoor
parks and buildings. I think those are the big ones that we are
sort of seeing where you can make the most--get the most bang
for your buck.
I think, you know, Chairman, I think that would be great to
encourage communities by placing incentive in the Older
Americans Act to do that, ma'am.
The Chairman. Thank you very much. That was very helpful.
Senator Casey.
Senator Casey. I do not have any additional questions. I
just want to thank our witnesses. Mr. Secretary, you have given
us a lot to think about, and if the State of Maine is the
canary in the coal mine on some of these issues, Florida and
Pennsylvania are not far behind, and I know you are wrestling
with them every day, so I appreciate the work you are doing and
the public service.
Mr. Gross, you are, I know, at the end of your career. I am
sure you have a second one lined up somehow, but we hope it is
in this field or something related, and we are grateful you are
here for this testimony, and, Faith, thank you for bringing
your story here. It is critically important that we hear from
people who are actually in the trenches every day and working
on these issues and, in your case, as a great-grandparent, so
thanks very much.
The Chairman. Thank you very much, Senator Casey.
I, too, want to thank all of our witnesses for your very
valuable testimony today. You have helped us better understand
the extraordinary benefits of the Older Americans Act, and as
we start to write the reauthorization bill, the input that you
have given us is extraordinarily helpful. That feedback will
help us produce a bill that will even better serve our older
Americans in every State and also our tribal communities as
well.
We do need to modernize the act to reflect the changing
demographics of this country and great new ideas that are out
there. At the same time, we want to make sure that we preserve
the core programs that support nutrition, wellness, caregivers,
elder justice, and really focus on the social determinants of
health that can change the trajectory of aging for older
adults.
I applaud the work that you are all doing, each in your own
way, whether it is on the family level, the regional level, or
the State level. I am very grateful for that. As we soon will
surpass half a century of success, we celebrate the Older
Americans Act, and we look forward to writing an even stronger,
better law, and we will be in touch with you as we do so.
I want to also thank the staff of the Committee, which has
worked very hard on this issue. Senator Casey, any final
remarks?
Senator Casey. Just a few closing comments. Thank you,
Chairman Collins, for the hearing. It is very important to have
this hearing as we do this, engage in this reauthorization
work. As we heard today, the Older Americans Act is critical to
helping seniors age in place, age in their homes and in their
communities. We heard that more grandparents are raising
grandchildren, as we know, and that those grandparents who have
access to Older Americans Act programming and that
multigenerational engagement should be expanded to help combat
isolation.
We learned that it is crucial to show how the act creates a
significant return on investment in terms of savings for both
Medicare and Medicaid, and based on the testimony and answers
to our questions, I hope that we are able to make these key
improvements, and I am sure we will be able to, as well as
other ideas to the law this year as we reauthorize the Older
Americans Act.
I look forward to continuing to work with Chairman Collins,
our colleagues on this Committee, and those on the Health,
Education, Labor, and Pensions Committee. We are, obviously,
members of both Committees, and that is in furtherance of the
goal, which is a strong reauthorization of the Older Americans
Act that supports our aging loved ones.
Faith, let me just say the last words about you. It is a
pretty remarkable story that that 13-year-old who lost her Mom
is now a great-grandmother raising a 5-year-old. That is a
great American story. Thanks.
The Chairman. It is indeed.
Committee members will have until Friday, May 17th, to
submit questions for the record. If we get any, we will pass
them along to you. Again, my sincere gratitude to each of you
for being here today. You added immensely to our understanding.
This hearing is now adjourned.
[Whereupon, at 4:40 p.m., the Committee was adjourned.]
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APPENDIX
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Prepared Witness Statements
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