[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

=======================================================================

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                     ONE HUNDRED SIXTEENTH CONGRESS


                             FIRST SESSION

                               __________

                             WASHINGTON, DC

                               __________

                              MAY 8, 2019

                               __________

                           Serial No. 116-06

         Printed for the use of the Special Committee on Aging
         
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        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
                              ----------                              
            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

                              ----------                              


                         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; andThird, 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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