[Senate Hearing 117-103]
[From the U.S. Government Publishing Office]


                                                       S. Hrg. 117-103

                  21ST CENTURY CAREGIVING: SUPPORTING
                      WORKERS, FAMILY CAREGIVERS,
                  SENIORS AND PEOPLE WITH DISABILITIES

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

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS


                             FIRST SESSION

                               __________

                             WASHINGTON, DC

                               __________

                             JUNE 17, 2021

                               __________

                           Serial No. 117-04

         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                    
46-223 PDF                 WASHINGTON : 2022                     
          
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                       SPECIAL COMMITTEE ON AGING

              ROBERT P. CASEY, JR., Pennsylvania, Chairman

KIRSTEN E. GILLIBRAND, New York      TIM SCOTT, South Carolina
RICHARD BLUMENTHAL, Connecticut      SUSAN M. COLLINS, Maine
ELIZABETH WARREN, Massachusetts      RICHARD BURR, North Carolina
JACKY ROSEN, Nevada                  MARCO RUBIO, Florida
MARK KELLY, Arizona                  MIKE BRAUN, Indiana
RAPHAEL WARNOCK, Georgia             RICK SCOTT, Florida
                                     MIKE LEE, Utah
                              ----------                              
                 Stacy Sanders, Majority Staff Director
                 Neri Martinez, Minority Staff Director
                         
                         
                         C  O  N  T  E  N  T  S

                              ----------                              


                                                                   Page

Opening Statement of Senator Robert P. Casey, Jr., Chairman......     1
Opening Statement of Senator Tim Scott, Ranking Member...........     2

                           PANEL OF WITNESSES

Ai-Jen Poo, Executive Director, National Domestic Workers 
  Alliance, Chicago, Illinois....................................     5
Stephanie Blunt, Executive Director, Trident Area Agency on 
  Aging, North Charleston, South Carolina........................     6
Brittany Williams, Homecare Worker, SEIU 775 Member, Seattle, 
  Washington.....................................................     8
Theo Braddy, Consultant and Former CEO, Center for Independent 
  Living of Central Pennsylvania, Harrisburg.....................     9

                                APPENDIX
                      Prepared Witness Statements

Ai-Jen Poo, Executive Director, National Domestic Workers 
  Alliance, Chicago, Illinois....................................    35
Stephanie Blunt, Executive Director, Trident Area Agency on 
  Aging, North Charleston, South Carolina........................    41
Brittany Williams, Homecare Worker, SEIU 775 Member, Seattle, 
  Washington.....................................................    45
Theo Braddy, Consultant and Former CEO, Center for Independent 
  Living of Central Pennsylvania, Harrisburg.....................    50

 
                  21ST CENTURY CAREGIVING: SUPPORTING
                      WORKERS, FAMILY CAREGIVERS,
                  SENIORS AND PEOPLE WITH DISABILITIES

                              ----------                              


                        THURSDAY, JUNE 17, 2021

                                       U.S. Senate,
                                Special Committee on Aging,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 9:34 a.m., via 
Webex, Hon. Robert P. Casey, Jr., Chairman of the Committee, 
presiding.
    Present: Senators Casey, Gillibrand, Blumenthal, Rosen, 
Kelly, Warnock, Tim Scott and Rick Scott

                 OPENING STATEMENT OF SENATOR 
                 ROBERT P. CASEY, JR., CHAIRMAN

    The Chairman. The Senate Special Committee on Aging will 
come to order.
    Today's hearing takes place as COVID-19 vaccination rates 
continue to climb and states across the country are opening up 
their economies. We can finally see the light at the end of 
this dark tunnel. Now we must learn from the devastation 
brought on by COVID-19.
    We know that the pandemic exposed long-standing challenges 
that American families confront each and every day. The 
pandemic highlighted the essential value of care, both that 
supported by a professional workforce and that of unpaid family 
caregivers.
    At today's hearing, our witnesses will speak about the 
caregiving economy, both paid and unpaid, and what is needed to 
ensure that seniors and people with disabilities have access to 
the supports that they need. Medicaid Home and Community-Based 
Services enable more than three-and-a-half million people to 
remain in their homes, to stay active in their communities and 
to lead independent lives. This assistance often includes help 
with activities of daily living, such as eating, bathing and 
managing medications.
    Too many Americans, likely millions more, are not able to 
access these services, placing significant financial and 
emotional strains on families. We know that almost 820,000 
Americans languish on wait lists for Medicaid Home and 
Community-Based Services, sometimes waiting for these services 
for years. That is one reason why President Biden proposed a 
historic $400 billion investment over 8 years in these 
essential services as part of the American Jobs Plan.
    Congress is currently debating the contours of legislation 
to invest in our infrastructure and fix our nation's long-
neglected roadways and bridges, just by way of example. 
Obviously, other parts to that bill as well. For millions of 
families across the country, but especially for women, their 
bridge to work might be a physical bridge, but it may also be 
the bridge of care, caregiving bridge, whether it is Home and 
Community-Based Services or whether it is childcare or other 
supports for the family.
    The President's proposed investment will make it possible 
for more Americans to receive high-quality services and 
supports. This investment will allow them to live in their own 
homes, participate in their communities, go to school and hold 
a job. It will help family members who are often the 
unrecognized and unpaid caregivers providing support every day.
    This investment is also about services, but it is 
definitively about jobs. We must turn these jobs into good 
quality family sustaining jobs. In Pennsylvania, for example, 
the median wage for a direct care worker is just $11.99 per 
hour, and many have fewer or no benefits, those in this 
workforce. As we will hear today, the majority of these workers 
are women and from communities of color. Among homecare 
workers, 62 percent are people of color. An investment in these 
essential workers is long overdue.
    A little over a month ago I spoke to Lisa Savage from 
Philadelphia. Lisa left her career of more than 20 years to be 
a homecare worker in order to support her son, Brandon, who was 
shot and left paralyzed while at home on a break from college. 
Lisa Savage said the following to me, ``as a homecare worker, 
we are essential. We are essential because we care for the 
elderly and we care for people with disabilities at home,'' 
Lisa is right. An investment in her, in her essential work, is 
critical. An investment in homecare workers across the country 
is long overdue.
    I look forward to hearing from our witnesses today about 
these important issues, but before we begin, I want to remind 
Committee members and witnesses to please keep your remarks and 
questions to 5 minutes. We have a countdown timer that can be 
viewed alongside the other participants' windows on Webex. 
Following opening remarks, Senators will ask their questions 
based on seniority, and I ask that members have their cameras 
turned on a few minutes prior to their questions.
    With these logistical notes, I turn to our Ranking Member, 
Senator Scott.

                 OPENING STATEMENT OF SENATOR 
                   TIM SCOTT, RANKING MEMBER

    Senator Tim Scott. Thank you, Mr. Chairman, for holding 
another really important hearing for those of us who are all 
very concerned about our aging community and the way in which 
they age, the care that they receive.
    I had the good fortune, and still have the good fortune in 
many ways, to be raised by a single mom who was a caregiver. 
She spent 40-plus years as a nurse's assistant in hospitals 
caring for our elderly patients. Having an appreciation for the 
hard work, the struggle of caregivers is something that I grew 
up watching and experiencing.
    The truth is, Mr. Chairman, I think you and I will both 
agree that caregivers need to be celebrated today coming out of 
a pandemic in a way that we have never, ever celebrated them. 
Too often too many of them are working for too few dollars in 
their paychecks. Having been raised with my brother in that 
household, I will say that the one thing that I would never, 
ever change is the compassion and the sensitivity that my mom 
learned through being a caregiver.
    Made me a very different person and made my brother a 
better person, and frankly, it is that important part of 
caregiving that you cannot buy. You just cannot buy people who 
love and care for the patients as my mother did and so many 
others do today.
    We think about people that we know first, and I think about 
Claudia Bentley in my Charleston office and Kathy Crawford in 
my Charleston office who both are caregivers.
    Claudia's husband, Ed, suffers from Alzheimer's and she 
basically has at least two full-time jobs at the exact same 
time. Kathy has cared for two elderly aunts into their nineties 
in their home and then her mother-in-law, who passed away 
unfortunately just last week at 91 years old.
    Kathy and her husband moved the mother-in-law into the 
house so that they could provide high-level, high-quality care 
for the ones that they love the most. I think it is one of the 
best things we can do is take care of those that took care of 
us when we could not take care of ourselves.
    From 2008 to 2018, the population over 65 years of age grew 
from 39 million to 52 million. By 2060, that population will be 
95 million people. That is a lot of folks that will need a high 
level of care. My concern with the president's approach to this 
issue is just throwing money at the issue will not solve the 
problem of quality control. It will not solve the problem of 
family members being able to take care of their family members. 
We cannot use a one-size-fits-all plan.
    It is one of the reasons why I will release today a white 
paper, a discussion on a better way forward, a way that allows 
for us to look at the unique opportunities within family 
systems and our other apparatus to provide the type of unique 
programs and care provision that our seniors want and deserve.
    The truth is that having our seniors spend all their assets 
down to be eligible for Medicaid makes it very difficult for us 
to have intergenerational wealth created, especially in those 
communities where their net wealth is eight times lower than 
the rest of our country. We have to make sure that we focus our 
attention on programs that do not require us to see the 
resources depleted before you are even eligible for assistance. 
I think there is a better way, and our focus on that better way 
is going to be the focus of our attention on providing a 
flexible tailored program that allows for caregivers to be 
appreciated, celebrated and allows the family members who need 
the help the most to have access to resources that allow for 
their lives to be the best. I am a big believer that the latter 
range should be better than the former range, as we have 
learned in the Good Book.
    With that, Mr. Chairman, I look forward to hearing from our 
witnesses. I thank each and every one of you for being here 
today and I look forward to having a robust discussion on ways 
for us to improve the quality of the outcome of those we love 
the most.
    The Chairman. Ranking Member Scott, thank you for our 
opening. I will now turn to our witness introductions, and I 
will start and I will have the first, then I will turn to 
Ranking Member Scott for the second.
    Our first witness is Ai-jen Poo. Ai-jen is the cofounder 
and executive director of the National Domestic Workers 
Alliance. She is also the cofounder and director of Caring 
Across Generations, a coalition of organizations working to 
strengthen the caregiving infrastructure for America's 
families. She is a recognized expert in family and elder care 
and has been chosen by Time magazine as one of the 100 most 
influential people in the world and was a recipient of a 
MacArthur Genius Foundation--I am sorry, MacArthur Genius Award 
in 2014.
    Ranking Member Scott, I will turn to you for our second 
introductions.
    Senator Tim Scott. Thank you, Mr. Chairman. It is my 
pleasure to introduce today an individual who has, I will say--
I will stray briefly from my prepared remarks, but let me just 
say this first. Stephanie Blunt is a champion of people who 
need a little help, people who want to be independent, people 
who have passion for life, people who are still in the prime of 
time--in the prime of their lives.
    Stephanie, for the last 20 years, has literally dedicated 
so much of her life to helping seniors throughout the 
metropolitan Charleston area, as well as the State as a whole. 
She is the executive director of the Trident Area Agency on 
Aging, where she has worked, as I just said, for more than 20 
years. In her capacity, she provides oversight for Federal, 
State and private funds used for serving seniors and family 
caregivers.
    She also leads development of strategic and operational 
plans in support of the agency's mission. Stephanie's testimony 
today is based on her experience working with older Americans 
and their caregivers. We will hear about the pivotal work she 
has done to support our most valuable citizens.
    Stephanie, we appreciate your hard work, your dedication to 
the seniors in our State, in our low country. She has been in 
the nonprofit world from my days in the nonprofit world back in 
the early 2000's, so God bless your efforts and may you 
continue to have strength and good health.
    The Chairman. Thank you, Ranking Member Scott. I will now 
turn to our third witness, Brittany Williams.
    Brittany Williams, I want to say first of all, thank you to 
Brittany for being with us today, but also for being so patient 
as we navigated some technology challenges. I am glad you were 
able to be here by phone and we will be able to post your 
picture with the audio when it is your turn to testify, so we 
are grateful.
    Brittany is a professional homecare worker in Burien, 
Washington. She is a third-generation caregiver who began work 
as a homecare worker after watching her mother and her 
grandmother do the same work. She is also a member of Service 
Employees International Union, Local 775.
    Then finally, our fourth witness is Theo Braddy.
    Theo is someone I met a couple of months ago when we were 
talking about these issues in the midst of the pandemic. Theo 
is also a Pennsylvanian. I do not mind mentioning that. He is 
currently a consultant working in the area of disability and 
nonprofit management. For 31 years Theo was the CEO of the 
Center for Independent Living of Central Pennsylvania and also 
helped people with disabilities live where and how they wished. 
Theo is a person who has lived with a disability since he was 
15 years and has used Home and Community-Based Services for 
more than four decades. Theo, we are grateful that you are with 
us today.
    Before I start with our witness statements, I wanted to 
acknowledge Senator Rosen is with us. As I often mention during 
our hearings, we are going to have senators who will be in and 
out going to different hearings, but just we will wait for some 
to get back to do questions. I want to acknowledge those who 
are here early and then we will go from there, but let us turn 
to our first witness, Ai-jen Poo, for our first statement.

                    STATEMENT OF AI-JEN POO,

             EXECUTIVE DIRECTOR, NATIONAL DOMESTIC

              WORKERS ALLIANCE, CHICAGO, ILLINOIS

    Ms. Poo. Chairman Casey, Ranking Member Scott and 
distinguished members of the Committee, thank you for the 
opportunity to testify today. At Caring Across Generations and 
the National Domestic Workers Alliance, we have worked for over 
a decade to bring attention to the urgency of state and 
Medicaid Home and Community-Based Services for older adults and 
people with disabilities. We now have a once in a generation 
opportunity to invest, to build the 21st Century care 
infrastructure we need.
    Caregiving is personal to me. My own grandfather, who 
helped raise me, taking me to and from school, teaching me the 
values of hard work and respect for my elders, values that 
shaped who I am today, had to be placed in a nursing home 
against his wishes when he lost his vision and we could not 
find homecare assistance. He shared a room with six others, 
many who were crying in misery. He could not eat the food or 
sleep.
    The staff was overwhelmed with too many people to care for 
and he passed away after just a few months, fearful and a shell 
of himself. While this is my own story, it is certainly not 
unique. Eighty-eight percent of aging adults prefer to receive 
long-term services and supports in the home and community-based 
setting. These services are out of reach for too many.
    Across the United States nearly 820,000 older adults and 
people with disabilities are on waiting lists for Medicaid 
HCBS. People wait years, sometimes decades, for access to 
services. There are homecare deserts across the country, 
especially in rural communities, and we are facing an elder 
boom. By the year 2050, the population of people 65 and older 
will nearly double. With 10,000 people aging into retirement 
per day and living longer, there is an overwhelming demand for 
care in the home and in the community.
    To age at home, we need infrastructure, including a strong 
direct care workforce. From 2018 to 2028, the U.S. will need to 
fill over 4.4 million homecare job openings, making homecare 
one of the fastest growing occupations in our economy. The 
average annual income for a homecare worker is $17,200 per 
year. The median hourly wage only increased by a total of 91 
cents between 2009 and 2019. One in eight direct care workers 
lives in poverty and three--quarters earn less than a living 
wage in their states. This essential workforce of women, 
majority women of color workers who we are counting on to care 
for us, cannot care for their own families doing this work.
    The proposed investment of $400 billion for HCBS and the 
American Jobs Plan will jumpstart economic recovery in a number 
of ways. First, according to one estimate, the $400 billion 
would create nearly 800,000 new care jobs and over 1.1 million 
new jobs overall each year over 10 years, adding an estimated 
$40 billion in new income to American families every year.
    Second, it will raise wages and offer real economic 
security for the direct care workforce so they can sustain in 
the profession, work that cannot be outsourced or automated, 
and one that has faced legal exclusion from basic protections 
for generations because of the devaluing of caregiving and 
largely due to racism and sexism. This is a powerful way to 
directly create good jobs for women and women of color to be a 
part of our economic recovery.
    Third, by expanding access to services, the plan will allow 
for people with disabilities to live independently, to work and 
live full lives in the community.
    It will enable quality of life and better healthcare 
outcomes for older people, including people with chronic 
illnesses like Alzheimer's who want to live at home connected 
to friends and family. Expanding access to services and a 
strong workforce are interdependent goals that go hand and 
hand.
    Finally, it will support the 48 million family caregivers 
who are also majority women who have long struggled to manage 
work and caregiving. The pandemic pushed nearly four million 
women out of the workforce due to caregiving challenges. Our 
recovery must enable them to have the real choice to go back to 
work.
    The care economy is the foundation of the entire economy, 
from childcare to paid leave to HCBS. When we invest in care, 
we invest in opportunity for all. An investment of $400 billion 
in the American Jobs Plan and Home and Community-Based Services 
is an investment that cannot be shortchanged. Thank you so 
much.
    The Chairman. Thank you, Ms. Poo, for that testimony. 
Before we move to our second witness, I wanted to acknowledge 
as well Senator Blumenthal and Senator Rick Scott.
    Next we will have Stephanie Blunt. You may begin.

       STATEMENT OF STEPHANIE BLUNT, EXECUTIVE DIRECTOR,

                 TRIDENT AREA AGENCY ON AGING,

                NORTH CHARLESTON, SOUTH CAROLINA

    Ms. Blunt. Chairman Casey, Ranking Member Scott, members of 
the Senate Special Committee on Aging, it has been an honor to 
serve in the South Carolina aging network for the past 20-plus 
years, both at the local service provider level and at the Area 
Agency on Aging level.
    Trident Area Agency on Aging is one of 10 area agencies on 
aging in the State of South Carolina designated by the South 
Carolina Department on Aging. Since our organization was formed 
in 1991, we have worked with both the public and private 
sectors to develop a cost-effective approach to long-term care 
services. We serve as the resource connection for seniors, 
adults with disabilities, family caregivers and professionals.
    I lead a staff of over 15 who have daily contact with 
seniors and their families. Annually, our staff and volunteers 
serve over 12,000 seniors and 1,500 family caregivers. It is my 
responsibility to work within budgets, adhere to regulations, 
follow policies and procedures, but at the end of the day, it 
is about making all of those factors connect with the people 
who need our assistance on a daily basis.
    Since 1965, the Older Americans Act has been a solid 
foundation for aging services throughout our country, and my 
years of experience have taught me how to cobble together 
Federal, State and local resources to meet the needs of a very 
growing and diverse aging population. States, regions and 
counties are all different, and it is a waste of resources to 
collect needs assessment data year after year and not be able 
to really offer the services and supports that will prevent 
seniors from going into the hospital or seeking long-term care 
placement.
    While the Older Americans Act is designed with some local 
flexibility, there are still restrictions on which sets of 
funds we can use to fund which services, and that presents a 
challenge, so Area Agencies on Aging, we need flexibility at 
the local level so that we can determine how those funds are to 
be spent, and spend those funds how seniors need them.
    Since 2001, our Area Agency on Aging has offered through 
the Older Americans Act the National Family Caregivers Support 
Program Services. We have seen first-hand the challenges that 
many caregivers are facing, particularly the working family 
caregiver. Our staff receive calls from stressed out family 
caregivers on a daily basis who are trying to juggle their 
full-time employment, as well as their families and their 
caregiving responsibilities.
    Through the Family Caregiver Support Program, we are able 
to provide information, connect caregivers to resources, offer 
education, like dementia education, and also respite services. 
The respite that we do provide is helpful to so many 
caregivers, as it gives them a break. In South Carolina, the 
average respite assistance is valued at about $2,000 annually. 
We are providing about 90 hours of assistance per year. While 
this is very beneficial to so many caregivers, it does not meet 
the ongoing needs of the working family caregiver.
    Our country's affordable healthcare options, you know, they 
are difficult--you know, our long-term care assistance is 
fragmented and so families are seeking affordable care options. 
In addition, we need more investment in more fiscally 
responsible home and community-based service options.
    The lack of workforce in the homecare industry continues to 
be a barrier in providing respite services and homecare 
services. You know, we rely heavily on these direct homecare 
workers to perform light housekeeping, help with personal care 
and also provide their meal preparation, because we want to 
have these services in place because we want to keep seniors 
out of long-term care placement. Unfortunately, hiring these 
direct care workers is a challenge.
    In my region, I surveyed some of our providers and the pay 
is anywhere from 10 to 17 dollars an hour, but that $17 an hour 
is not the norm, because that is based on the years of 
experience in the field, the certifications they have and the 
level of care that they are providing. We really need to 
increase compensation for these direct care workers--they are 
so essential to our system--and enhance the rates for 
community-based service providers who are funding--who are 
employing these individuals.
    I just again want to thank you for the opportunity to speak 
with you this morning and just allowing me to share my 
experience on serving older adults, people with disabilities 
and also our most important family caregivers.
    Thank you.
    The Chairman. Ms. Blunt, thanks for your statement. We will 
turn next to our third statement from Brittany Williams. Ms. 
Williams, you may begin.

   STATEMENT OF BRITTANY WILLIAMS, HOMECARE WORKER, SEIU 775 
                   MEMBER, SEATTLE WASHINGTON

    Ms. Williams. Good morning, and thank you, Chairman Casey, 
Ranking Member Scott, and members of the Aging Committee. My 
name is Brittany Williams. I live in Burien, Washington. I am a 
homecare worker and proud member of SEIU 775. We represent over 
45,000 in-home caregivers in Washington and Montana.
    Homecare workers have helped seniors and people with 
disabilities live with dignity and independently in their 
homes. I currently take care of three clients, providing 
essential life-sustaining care, such as bathing, cooking meals, 
cleaning, helping them go to the bathroom, running errands, and 
anything else they may need throughout the day.
    Caregivers is not just a job for me. It is in my genes. I 
grew up watching my grandmother and my mom doing the same work. 
While I was in school learning my ABCs from my teachers, I also 
learned an invaluable lesson of compassion and care from my mom 
and grandma. Even as a child I could see that care is essential 
and it is giving life work that I am blessed and proud to do.
    This job is hard. I always say that homecare workers are 
the maintainers of life, but we can barely survive ourselves. 
That is the way it has always been for homecare workers. Black 
women like me have been caring for this nation for centuries, 
but due to the long history of racism and sexism, our work has 
been labeled as unskilled women's work, and that narrative has 
been used to devalue us and hold us back.
    Homecare is one of the lowest paying jobs in the country 
and where many lack access to benefits. I am a single mom of 
two amazing children, but I worry about letting them down. My 
family has to budget every penny and save wherever we can for 
an emergency. I struggle to meet our basic needs like paying 
our bills, putting food on the table. I simply cannot afford to 
give my children some of the opportunities their peers have.
    If things were not bad enough already, the COVID-19 
pandemic ran us into the ground. Everything that I thought was 
secure the pandemic took away. It took away the security of 
having a safe place for my children to learn.
    It took away the security of working in the hours to earn 
what I need to provide for my family, and it took away the 
security of having a roof over my head. I became exhausted and 
angry at the injustice of it all. A global pandemic, economic 
turmoil, and on top of all of that, the racial violence.
    I stayed strong and I did what I had to, but I would be 
lying if I said I was not scared for my life and the lives of 
my family and clients each and every day. Thank God for my 
union, SEIU 775. Together we have won higher wages, better 
benefits. Now Washington homecare jobs are among the best in 
the Nation. The victories are bittersweet because not every 
homecare worker is in my position. Like my mom down in 
Arkansas, she does not have a union and she earns just $11 an 
hour.
    We need to fill nearly five million homecare jobs by 2028. 
The low quality of these jobs force people out of the industry 
and leave shifts unfulfilled and clients without caregivers. 
Our country needs a care wakeup call and that is why we support 
the American Jobs Plan. This investment in care will be 
lifechanging. It could transform homecare jobs into family 
sustained union careers so we can build the workforce we need 
to meet the growing demand for care.
    This investment will help build back a more inclusive 
recovery, lifting millions of women, black women, women of 
color, immigrants out of poverty and at the same point in our 
lives. We all will need this kind of care at some time. It is 
not fun to think about, but everyone deserves the comfort of 
knowing a skilled and dedicated caregiver will be there when 
the time comes. If you or your family member suddenly needs 
homecare tomorrow, are you confident you will be able to get 
the resources and services you need? Are you confident that 
your constituents could do the same?
    I suggest you do not wait to find out. Care cannot wait and 
neither should Congress. Thank you.
    The Chairman. Ms. Williams, thank you for your statement.
    Now we will turn to our fourth witness, Theo Braddy.

            STATEMENT OF THEO BRADDY, CONSULTANT AND

          FORMER CEO, CENTER FOR INDEPENDENT LIVING OF

         CENTRAL PENNSYLVANIA, HARRISBURG, PENNSYLVANIA

    Mr. Braddy. Again, first of all, I would like to thank you, 
Chairman Casey and Ranking Member Scott and members of the 
Special Committee on Aging, for inviting me to share.
    I would also like to thank all the panelists, but I 
certainly would like to thank the young lady that just spoke, 
the homecare worker. I feel your pain.
    My name is Theo Braddy and I became a person with a 
disability at the age of 15 after breaking my neck playing high 
school football in Wadley, Georgia. I am originally from 
Georgia and I am 61 years old. I retired early in 2019 after 
working 31 years as the CEO of the Center for Independent 
Living of Central Pennsylvania. Our mission is to eliminate and 
prevent barriers that are faced by people with disabilities on 
a day-to-day basis.
    I am married. I have a 28-year-old daughter and a 23--year-
old son. I now work part time as a consultant. Most importantly 
and assuredly, for this hearing I am a user of Home and 
Community-Based Services. That is very important. I have used 
Home and Community-Based Services for over three decades. As I 
share my story, Senators, please understand that this is not 
only my story, but it is a story that has lived out for 
millions of people cross this country, including the young lady 
who just spoke, the homecare worker.
    Disability, what we do not know is when it can happen. It 
happened to me playing high school football, a game I. It 
happened to Christopher Reeve riding a horse. What we do know 
for sure, that life will change when it does. You will be faced 
by all types of new barriers in life, and that turning point 
was at age 15, 46 years ago. At age 15, my life changed. I 
became paralyzed from the neck down and I could not do anything 
for myself.
    Now, I usually do not talk about this, but for the purpose 
of this virtual meeting, I need to really describe to you that 
my disability is significant. I am paralyzed from the neck 
down. I virtually cannot do anything for myself. I have spent 
46 years in a wheelchair, and if I could spin around and pull 
myself through these earphones I would show you, because you 
need to know my situation.
    I cannot move my fingers. I do not have any dexterity. I do 
not have any triceps and muscles. I have biceps, but I have 
very little movement. I cannot get in and out of bed. I cannot 
dress myself. I cannot undress myself. I cannot even bathe 
myself.
    Life changed for me. It became what I refer to as a maze of 
confusion. I ended up in a nursing home. The young lady that 
said something about the crying and misery, I remember when I 
was 15 years old not being able to sleep because people were 
just crying all night long. The weight of all of this came on 
my family because I spent that time, a year in a nursing home. 
When I came home from rehab, we were dirt poor. My mom could 
not help me with anything, so the only option was for me to go 
into a nursing home, and I spent a year in a nursing home. That 
crying and that misery, it haunted me.
    Fortunately, like most people with disabilities, my family 
came in and my brothers and sisters, they brought me to 
Pennsylvania. I ended up on the third floor in an apartment 
building, looking out a window for weeks at a time waiting for 
my brothers to come over and carry me down three flights of 
stairs and getting back up again. That went on for a long, long 
time.
    I have no way of explaining how it feels not to be able to 
do anything for yourself anymore, having to depend on family 
members, of the kindness of strangers. Sometimes strangers are 
not kind. I remember one time when I was trying to put money 
into a parking meter and a stranger came by. I was waiting on 
someone to come by to help me put the money in and he looked at 
me as I asked him to help, and he said, I did not have time for 
that, and he kept on walking.
    We cannot always depend on the kindness of strangers. Home 
and Community-Based Services changed all of that. It started 
when I received attendant care services. I said this many times 
before. People with disabilities do not want to be taken care 
of. They want--they do not want to be seen as objects of 
charity. We want to contribute.
    HCB Services, especially attendant care services, did that 
for me. I call it the great equalizer. There are many times 
throughout my 31 years of work when I had to depend on 
attendants to drive me back and forth to my many meetings 
because they were just too far or just too painful for me.
    Being provided with attendant care gave me back my 
independence and my ability to live life fully again. Once I 
started receiving Home and Community-Based Services, I enrolled 
in Edinboro University and received my earned bachelor's 
degree, then I moved to Philadelphia, Temple University, and 
received my master's degree in social work, with Honors. This 
was done based on one time a OVR counselor telling me I was not 
college material when I told him I wanted to go to college. In 
undergraduate school for the first time in my life I was able 
to move off campus and live by myself and use attendant care 
services. That is something all students want to do.
    Shortly after finishing my MSW, I worked with a small group 
of Central Pennsylvanians, people who wanted to apply for a 
grant to establish what was a major thing at the time, Center 
for Independent Living. Once that grant was approved, I became 
the director for 31 years, like I said.
    I have taught as adjunct professor at Millersville 
University, at Temple University as well, and lectured all over 
the country. I have been appointed to serve on boards by three 
different Governors, and as a result, I have impacted many 
lives for the better. All along the way, my different 
attendants helped me get in and out of bed, went with me as I 
needed, not 24/7, but just as I needed.
    This is what attendant care is all about. This is what Home 
and Community-Based Services is all about. This is what I want 
you to take away, Senators. Do not miss this. All the time.
    The Chairman. Sorry, I am just going to--just want to jump 
in. We are over time by more than 2 minutes.
    Mr. Braddy. Oh, I am so sorry. I am so sorry.
    The Chairman. I just wanted to make sure we can get to our 
questions. I hate to cut you off.
    Mr. Braddy. No, that is fine. That is fine.
    The Chairman. We might be able to develop more of it during 
questions.
    The Chairman. I know that we are juggling senators who are 
in and out, so I am going to concede my question time to 
Senator Blumenthal.
    Senator Blumenthal. Thank you so much, Senator Casey. I am 
so grateful to you for having this hearing and for your 
championing this cause of home and community-based care. You 
have been just such a steadfast advocate.
    I really want to thank this panel. You know, we hear from a 
lot of witnesses. I have four hearings and meetings this 
morning. A lot of it happens at the same time, but sometimes a 
panel really cuts through to your heart, and this panel, Mr. 
Braddy, thank you so much for that really eloquent testimony. 
Thank you to Ms. Williams.
    You know, SEIU, we owe that union so much because they 
really help protect the homecare workers in a way that Congress 
has failed to do.
    You are right, and I am quoting you, ``Care cannot wait,'' 
and neither should Congress, and that is why many of us feel 
like Senator Casey, that this kind of Home and Community-Based 
Service should be part of our infrastructure and it has to be a 
part of what we do.
    In Connecticut, we have 500,000 family caregivers. Let me 
repeat, 500,000 family caregivers in a State with a population 
of about three a half million people. That is a sizable part of 
our whole population. They are people who are families taking 
care of members of their families. They are people like Ms. 
Williams working professionally. They are people like the 
attendant who is taking care of Mr. Braddy. They have been 
going through unprecedented stress, anxiety, hardship, physical 
labor, so this kind of lost wages, missed opportunities, 
unparalleled stress, cries out for action for the sake of the 
people who they care for, as well as themselves.
    Let me ask Ms. Poo, you have spoken a bit about the impact 
of unpaid caregiving on families, mentally, physically, 
financially, and Mr. Braddy, you have shared your experience 
receiving care from family members before HCBS.
    Maybe I can ask you, how important is the unpaid--the 
support that we provide unpaid caregivers, the tools, the 
training, the support they need? I just want to mention that I 
have introduced today the Alzheimer's Research and Caregiver 
Trust Fund Act, which Americans would be able to donate to 
through their annual tax returns. The donation would then be 
directed toward NIH and the Administration of Community Living 
to support and train caregivers. I think we have coming 
together different ideas.
    Let me ask you, Ms. Poo, how important are the tools and 
training to the caregiver, the family caregivers?
    Ms. Poo. Thank you for the question, Senator. It is 
absolutely essential that we support our family caregivers. 
Frankly, care in America is an all-hands on deck situation. We 
need to support our family caregivers.
    We need to support our professional caregivers. Frankly, 
there will be a lot of family friends and neighbor care that we 
will rely on as well. It is often posited as an either/or, and 
in fact, we need to support all, a strong workforce and 
families.
    We know that almost 20 percent of family caregivers have 
quit their jobs because of caregiving, and 70 percent of family 
caregivers are forced to make work adjustments, like cutting 
back on hours or turning down a promotion. All of this can 
result in lost wages, diminished Social Security earnings, 
jeopardizing the overall economic stability of families and 
communities, so we do need to support family caregivers.
    I also want to highlight the sandwich generation, those who 
are both raising young children and managing care for aging 
loved ones or loved one with disabilities. They are in a 
particularly difficult position. Really do need support.
    Senator Blumenthal. What percentage have been forced to 
leave their jobs?
    Ms. Poo. Twenty percent, sir.
    Senator Blumenthal. Twenty percent and 70 percent adjusting 
their work schedules. You know, my time has expired. I really 
would thank you, Senator Casey. You have been very, very 
gracious. Again, thank you for having this hearing.
    The Chairman. Thank you, Senator Blumenthal. I know we are 
joined as well by Senator Kelly. I will turn to Ranking Member 
Scott, but I do want to make reference to the fact that we have 
had some technical issues, so we are trying to work them out, 
but I want to turn to Ranking Member Scott for his questions.
    Senator Tim Scott. Thank you, Mr. Chairman. You seem to be 
handling the technical issues seamlessly. Most of us cannot 
tell, so thank you for your hard work behind the scenes.
    Ms. Blunt, once again, just thank you for your dedication 
to caregiving throughout South Carolina, and specifically in 
the low country. I know that you recognize that by the year 
2030, our small State will have 1.8 million South Carolinians 
who are probably going to need a higher level of care than they 
currently do right now.
    Can you tell us how your partnerships with local businesses 
and community leaders benefit seniors? One of the challenges 
that we have is that sometimes this one-size--fits-all says 
that the government is the only solution. Certainly, has to 
play a significant role, but it cannot be the only way forward. 
We are going to have to have community leaders and partnerships 
that provide some bridge to our seniors.
    Can you talk just for a few minutes about--however long you 
want on that topic.
    Ms. Blunt. Thank you, Senator Scott. Sure. I tell you, 
partnerships are vital and essential to the Area Agency on 
Aging services, and the Old Americans Act provides that 
framework for us to engage in those partnerships, and that is 
so critical. For instance, let me just give you an example. You 
know, we receive on a daily basis intakes and provide 
assessments for seniors who are reaching out to us for 
services, like home-delivered meals. Well, it does no good to 
end a call knowing that a senior is hungry and saying, okay, I 
will put you on a waiting list for services.
    We are able to operate a food pantry here, and that is 
because we have local partnerships in our community with 
private businesses and our Lowcountry Food Bank. We can provide 
seniors with basic food to get them through until we are able 
to connect them with SNAP resources or give them additive 
services.
    Another partnership I just want to highlight, you know, 
even with the city of Charleston, the Mayor's Office on Aging, 
you know, I cannot--you know, this past Tuesday was World Elder 
Abuse Awareness Day and, you know, we highlighted elder abuse 
awareness because that is a huge issue in our communities. You 
know, we want to make sure that we are training. You know, 
through our partnership it was a grant that we received, and we 
were able to train police officers on how to investigate elder 
abuse.
    Those partnerships are so, so, so very, very critical. I 
can talk about them all day long. Again, you know, it is us 
pulling together. No one entity can do it by themselves, and it 
really takes all of us working together to meet the needs of a 
growing and diverse aging population.
    Senator Tim Scott. Well, Ms. Blunt, you bring up another 
question for me. In your testimony you talk about the 
frustration of trying to manage multiple funding streams and 
programs that all focus on caregiving for senior Americans. How 
can Congress play a role in fixing this convoluted system, as 
well intended as it is, is really inefficient in its delivery 
system in meeting the needs at the user level?
    Ms. Blunt. Sure. The Older Americans Act, while it does 
provide some flexibility, you know, we do find that it is--you 
know, we have fragmented services, you know. Like in South 
Carolina, we try to partner--we work with our Medicaid agency. 
You know, the Area Agencies manage the Older Americans Act 
services and, of course, the Department of Health and Human 
Services manages the Medicaid waiver program.
    You know, we want to avoid duplication, so it is so 
important that we are working together to make sure that we are 
maximizing all of our resources in our community. With regards 
to the Older Americans Act, for instance, with home delivered 
meals, as I discussed, you know, we have a growing waiting list 
for home delivered meals in our region. Sometimes the money is 
given to us in, you know, two parts, two subparts of the Older 
Americans Act.
    Being able to maximum--you know, transfer--you know, to 
increase transfer capacity rather than having people sit on a 
waiting list, you know, we should be able to provide services 
if the money is there. We should be able to help people and get 
them off the waiting list. Like I said, no senior should be 
hungry in our community.
    Senator Tim Scott. Yes, ma'am. Well, I know I am about out 
of time, so I will make a statement as opposed to asking a 
question and you can just shake your head if you agree or 
disagree. In South Carolina, and I think around the country, 
the truth of the matter is that as you wrestle with the streams 
of resources that may or may not be available, that is one 
convoluted system itself. According to a survey, 77 percent of 
respondents in South Carolina were unaware of GetCareSC 
website, which would allow for a site that aggregates the 
information that can help caregivers and the folks that they 
care for understand what is available.
    Ms. Blunt.
    Senator Tim Scott. Knowledge is power. We simply need to 
also make sure that we have a strong marketing network to help 
people understand what is even available in some instances.
    Thank you, Mr. Chairman.
    The Chairman. Thank you, Ranking Member Scott. I will have 
a round of question--or I will take my round of questions now. 
I wanted to go back to Theo Braddy.
    Theo, I did not want to cut you off earlier, but yours, 
like so many stories we are hearing today, is a compelling 
story about the benefits of Home and Community-Based Services 
as a leader in this field. In your testimony you talk about how 
[audio disruption] about your reference in both the written and 
the statement you made earlier about when you were on that 
third floor in an apartment building looking out a window for 
weeks at a time waiting for your brothers to come over and 
physically carry you down three flights of stairs--so you have 
seen it up close.
    Mr. Braddy. Senator, you are cutting out. I missed that 
question.
    The Chairman. Can you hear me now?
    Mr. Braddy. I can hear you now.
    The Chairman. Okay. I was saying you are both an expert in 
the area, but also a consumer of the services. My question is, 
do we need to expand Home and Community-Based Services, and do 
homecare workers need better wages and benefits, in your 
opinion?
    Mr. Braddy. Yes. Yes, sir. Yes, sir. Again, I apologize for 
extending my time there. I got a little carried away, so I 
definitely apologize for that. Yes, it is really about time. We 
have talked about this for a while. It is about time for us to 
recognize that homecare workers, attendant care workers, 
personal care workers, whatever you want to call them, are 
valued in this community here for families. We definitely need 
to increase their rate so we can make it more available.
    Even more so, Senator, and Committee members, in this 
COVID-19 period, where we are already seeing a shortage of 
homecare workers who are not vaccinated and sometimes choose to 
be not vaccinated. I have already experiencedb people not being 
able to get services because of that. Yes, we need to increase 
that hourly rate immediately.
    The Chairman. Thanks very much for your insights. I wanted 
to turn to Ms. Williams. We know that homecare workers are 
essential. We have all said that today in one way or another. 
We also know, and you know personally, that it is demanding 
work. Too often workers like you who have provided this kind of 
care do not see their work valued the way it should be. In many 
parts of the country, the homecare workforce is characterized 
by, unfortunately, low wages, limited access to benefits and 
very, very high turnover, and that is not good for anybody.
    This occupation is among the fastest growing in the United 
States as the aging population is steadily increasing demands 
for services. In order to meet the demand for services, we need 
to ensure that the workforce exists to provide that care and 
that these are good jobs that pay middle-class wages.
    Ms. Williams, how important is it that we turn care work 
into a stabile middle-class career for homecare workers across 
the country?
    Ms. Williams. Thank you for that question. I really want to 
say like, you know, investing in caregiving is an investment in 
our community. When we have those strong and stabile homecare 
careers, we are literally making a way for those family members 
who would have not been able to work, whether they are your 
doctors, your lawyers, your garbage workers, your teachers, 
your firefighters, police officers.
    We are allowing them the ability to go out and work. At the 
same time, we are allowing those consumers, our clients, the 
ability to still have dignity throughout their lives.
    We want to make sure that we are making it a career instead 
of a job, so that the future people that will come into this 
field will have something to look forward to. It also causes an 
interest into what would be a door opening toward the medical 
field. Once you feel that compassion and that love and you see 
that smile on a person's face after a day of work, that might 
have been draining on the caregiver, but it was fulfilling for 
the client. It becomes an awe moment of, okay.
    To look at your paycheck at the end of the 2-week period 
and see that my family is taken care of, I was able to put back 
into my community because I was able to buy a home, I was able 
to put back into my community because I was able to go to the 
grocer, or I was able to pay my bills, that is why it is 
essential to make it a career, middle--class field.
    The Chairman. Thanks very much for bringing your personal 
experience to this. I know my time period is over by way of the 
clock, but I know we are juggling both senators coming in and 
out and also some senators trying to connect and they are 
having some technical difficulties. I can turn to Ranking 
Member Scott again or I can --
    Senator Tim Scott. Yes, sir.
    The Chairman [continuing]. ask a couple more questions.
    Senator Tim Scott. Happy to ask a question.
    The Chairman. Okay.
    Senator Tim Scott. Mr. Chairman. I did not give Ms. Blunt 
an opportunity to talk about the GetCareSC and the importance 
of having a portal where people can go and get information in 
one site.
    Ms. Blunt, as opposed to asking you to nod because I was 
running out of time--I apologize--now we have more time.
    I will go back to you with the really important question 
about the dissemination of information that is critical for our 
seniors and their healthcare providers to have access to. I 
think that survey is right that 77 percent of respondents were 
unaware of the fact that there was a place that they could go 
to get more information. That seems to be a really important 
part of this puzzle.
    Would you speak about the importance of having that one-
stop shopping for this really important issue?
    Ms. Blunt. Absolutely, yes. Thank you for the question. You 
know, first of all, sometimes family caregivers do not even 
know they can ask for help, so it is important to have a 
resource for them that they can access very easily at their 
leisure. Again, like I said, they are juggling so much. They 
are juggling their family and their full-time employment and 
the caregiving responsibilities, so we need to kind of meet 
them where they are.
    I know we have also worked outreach, I will tell you, is so 
important, and we have been working on an educational platform. 
Thanks to--you know, we have our national Association of Area 
Agency on Aging that, you know, promotes best practices 
throughout the country. We are connected and trying to get 
together an educational platform for our family caregivers, so 
again, they can access that portal and get quality training, 
accurate training. It is so important that they give accurate 
information so that they can provide better care for their 
loved ones and access and connect with the resources in the 
community.
    Again, we are trying to think differently, think of new 
ways and innovative ways to serve our seniors, partnering with 
organizations to do even more outreach and since the pandemic. 
We were able to master this virtual platform, but I will tell 
you, I think the challenge in that has been connectivity, 
because in our rural areas not all of our seniors and family 
caregivers have access, you know, to broadband. That kind of 
makes it a challenge for us.
    Again, we are happy to start to get back out in our 
communities now, partner with our faith-based organizations and 
to continue promoting GetCareSC and all of the services that 
are provided at the Area Agency on Aging level.
    Senator Tim Scott. Ms. Blunt, you just raised another 
really important point that I was not going to ask about, but 
it seems like this is a really important part of the 
conversation, innovation and technology. There is no doubt that 
a Harris poll suggests that 8 out of 10 Americans really like, 
love telemedicine, virtual medicine.
    I am thinking back to a different day when my mom, as I 
have already said, spent 40-plus years--she is still working, 
but no longer the nurse's assistant that she was. Forty-plus 
years as a nurse's assistant providing care, and then her aging 
parents needed care and so my mother and my aunt both had to 
take care of my grandmother in her home and then later my 
grandfather in his home.
    Truth be told, getting the loved one to the doctor, in 
fact, it is getting off work, doing split shifts at work so you 
can work 4 hours in the day, take 3 hours in the afternoon, you 
go to doctor's appointment, you come in later, telemedicine 
really could provide a higher quality of experience for the 
caregiver and the patient. Any thoughts on that from an 
innovative standpoint?
    I will say that I visited Salley, South Carolina, my 
grandfather's hometown. Broadband, high-speed broadband is an 
issue, so certainly connection issues is something we need to 
work on as well. Telemedicine seems to reduce the burden on the 
caregiver and increases the quality for the patient.
    Ms. Blunt. It sure can and, you know, like you said, brings 
in the family caregiver, because sometimes you have family 
caregivers in multiple states who want to be involved in what 
is going on with mom and dad. Yes, absolutely bringing families 
together so they can help to coordinate care and coordinate not 
only the services, but of course, their healthcare. It is so, 
so very important. We just need to make sure whatever platform 
we are using is user friendly.
    Senator Tim Scott. Yes, ma'am.
    Ms. Blunt. Senior priority, that they are able to again 
access it and just making sure--you know, specifically 
transportation, that is a whole other topic. Again, it would be 
important because some of these seniors lack transportation.
    Senator Tim Scott. Yes, ma'am.
    Ms. Blunt. No one wants to go down that rabbit hole, but--
    Senator Tim Scott. Mr. Chairman, I am just going to propose 
that Ms. Blunt identified you, sir. That is a rabbit hole that 
we need to go down at some point. I served on the United Way 
Board of Directors for the Tri-County area and I will say that 
we spent a lot of time working on programs and projects to help 
seniors make it to their doctor's appointments, but also 
getting your hair done. I mean, there are a lot of things. The 
quality of life experience itself is limited by transportation.
    There are some fairly creative ways to help seniors be able 
to afford and have access to ride-sharing services and/or make 
the whole process easier for seniors. It is something that we 
do not always think about, especially in cities in the south 
where transit is not an option, honestly, for most seniors. You 
have to have a creative, innovative way of providing that 
resource and the time to do it, to get to and from.
    Thank you, Mr. Chairman. I went over by a minute or so.
    The Chairman. That is quite all right. We are doing a lot 
of juggling. Ranking Member Scott, thanks very much.
    I will start with more questions. I might be interrupted if 
we have a senator that is connected. We have had some senators 
having difficulty connecting, but if they are-if they do get 
connected, I will interrupt my questions.
    I wanted to turn to Ai-jen Poo for a question regarding the 
workforce. Again, we keep coming back to this issue of who is 
doing this work because it is so important to highlight. We 
know that the workforce that provides these services, Home and 
Community-Based Services, are majority women. That does not 
surprise anyone, but also a majority of women of color, or 
workers of color, more broadly.
    This has been the case for far too long. We know that 
family caregiving responsibilities have more frequently fallen 
to women, often pulling them out of the labor force more often 
than men. Can you speak about the importance of investing in 
these services from a different perspective here for the 
purposes of this question, from the perspective of gender 
equity, but also racial equity?
    Ms. Poo. Yes, Mr. Chairman. Thank you for the question. 
Raising the pay for homecare workers would disproportionately 
benefit women, who make up 9 of 10 workers in the homecare 
workforce. It would also benefit the 63 percent of homecare 
workers that are black, Latinx, Asian American and Native 
American. According to the Groundwork collective, 68 percent of 
black and Latinx caregivers said that family caregiving 
responsibilities impacted their ability to work, 10 percentage 
points higher than white caregivers.
    Women of color already face obstacles in accessing higher 
paying jobs and quality jobs, including occupational 
segregation and discrimination. Also, investing in HCBS would 
increase women's labor market participation, which is a key 
factor in a healthy economy. Millions of women, as I mentioned 
earlier, were forced out of the labor market in 2020, in large 
part due to family caregiving responsibilities, and as a 
result, we have the lowest female labor participation rates 
since 1988. These investments would really support black women 
and other women of color who were among those hardest hit 
through the pandemic.
    The Chairman. Ms. Poo, thank you for your response to that. 
I am going to turn back to Theo Braddy. Theo, in your 
testimony, you talked about how when you first became paralyzed 
in that football injury that you had, all of the caregiving 
responsibilities fell to your family, which is, I think, a 
reality for many American families. They go through similar 
experiences when a loved one develops a disability or an older 
relative needs more assistance.
    While some family members are able to provide these 
services, others cannot and it often places significant 
financial burdens on families as individuals to give up their 
job or work reduced hours to provide care. I have heard just in 
the last couple of months folks in Pennsylvania and throughout 
the country where that is the reality. They have had to give up 
a career, as many of you have experienced yourselves.
    Can you say more about how expanding these services can 
benefit family caregivers, which is in the--as we heard 
testimony earlier today, is in the tens of millions? How can 
these services benefit the family caregiver but also all family 
members general?
    Mr. Braddy. Yes, a couple things, Senator. One is the need 
for respite care, right? Often family members are just 
completely overburdened and need someone to come in and provide 
that service. Another thing I have seen, especially in the 
rural areas, there is a need for family members to become paid 
attendants, and because there is no other service available in 
that area in regard to agency attendant care, whatever. It is 
important for those family members to be recognized as 
legitimate homecare attendants and get paid for their services, 
and I have seen that quite often because it is unavailable.
    It is very important into how essential is family members 
to provide attendant care services to their members who are 
disabled, and we do not always recognize the importance of 
that.
    The Chairman. Theo, thank you very much for that response. 
I know we are still juggling a little bit. I know that Senator 
Warnock was, I think, connected, Senator Rick Scott as well. I 
will ask another question.
    Senator Tim Scott. Mr. Chairman, I have a question, sir, if 
you want me to go with a question.
    The Chairman. Yes. Yes.
    Senator Tim Scott. Thank you, Mr. Chairman.
    The Chairman. Ranking Member Scott, thank you.
    Senator Tim Scott. Yes, sir. I know you have your hands 
full, and I am happy to try to lighten a little bit of that 
load, because Ms. Blunt has not answered enough questions for 
me yet, so I have questions for her. I see Mr. Braddy over 
there laughing like he is talking like a South Carolinian. She 
is gifted and I am blessed to have her as our witness.
    You served on a task force for South Carolina on long--term 
care. Now, I will say that this issue is talked about a lot 
because she is my American hero. I have spent several years in 
the industry selling long-term care policies, so this issue for 
me is something that I have personally thought about for 20-
plus years, maybe 25 years or so, having been in the industry 
as a pup. I was only two years old when I started, by the way, 
and literally have spent some time thinking about what can make 
aging gracefully better.
    You served on that 2014 State task force on long--term 
care. What has changed? What recommendations would you suggest 
that we as a committee, as a Congress and as a nation embrace 
or at least consider?
    Ms. Blunt. It was a privilege working on that long--term 
care task force, and we still, you know, are meeting today, 
because that process was like a strategic planning process 
around long-term care in the State of South Carolina. The first 
step was actually getting all the stakeholders, getting us all 
to the table and actually just talking, and getting us to work 
together with regards to policy and program development.
    At the end of the day, we do cross--we do cross, so it is 
important that we come together. The right hand should know 
what the left hand is doing so that we can work together and at 
the end of the day provide a seamless transition of services 
for our seniors.
    What came out of that, as you alluded to, with SC or--
earlier, prior to it being GetCareSC, we had South Carolina 
Access, and that is because people were looking for that one-
stop shop that you referred to. As a result of that task force 
coming together, that is how we eventually got to having 
GetCareSC and, you know, started to put together marketing 
behind it and educating our community about long--term care 
services--many other things have come out of it, partnerships.
    You know, we at the Area Agency, we are working with our 
Alzheimer's Association. We are working with AARP. We are just 
working with a lot of organizations who are our stakeholders, 
who we rely on to help us think differently. You know, 
oftentimes, you know, we have been thinking one way for so 
long, but that may not work right now. We need to--we need to 
change our thinking, again, bring us together, having us talk 
and having us collaborate.
    The workforce issue, you know, that has been--you know, 
especially with the homecare we have been talking about, our 
paid professional direct care workers, that has been an issue 
that we are trying to tackle. You know, like I said, we came up 
with 30 recommendations. I will tell you, the real work came 
when you had to prioritize those recommendations, even of great 
consensus. Again, just bringing down those barriers and us 
talking and working through this complex homecare system in our 
State.
    Senator Tim Scott. Thank you, Ms. Blunt. I will say that 
when I was selling the long-term care policies--and I do think 
we should spend some time at some point talking about the 
importance of helping those who can afford the long-term care 
policies and things that they can do that hopefully prevent the 
Medicaid depletion of your resources is an important part of 
the consideration, making it easier to digest, whether it is 
using the 125 platforms that allows for these policies to be 
tax deductible or something that actually encourages people to 
make a decision about long--term care assistance when they are 
in their forties, when it is pennies on the dollar, versus 
their sixties, when the expense is exorbitant.
    I did not sell any policies in people, of course, in their 
sixties because it is just too expensive. In your forties, 
early fifties, this is the affordable alternative that keeps 
you at home or makes you the decisionmaker and not someone 
else, so that is a really important part of the equation, that 
we should find a way to encourage a public/private partnership.
    I will say that when you think about those days, the 
activities of daily living, the five to seven activities of 
daily living that trigger your care is really important for us 
to assess how we deliver on the promise of high-quality care 
assistance in any form or fashion, and I think that is the 
important part of the formula that we still have to work 
through.
    Mr. Chairman, I know that my time is down to zero-plus 
three, so I will turn it back over to you, sir, and happy to 
ask another question if we have members that are waiting.
    The Chairman. I have to tell you, Ranking Member Scott has 
been on the button in his timing today. I was going to give him 
another minute or two or five, but now one thing I have 
learned--and I see Senator Warnock, if he is ready for 
questions, we can turn to him.
    One thing I have been informed about is these technological 
challenges today are not only the Aging community. This is a 
Senate-wide internet issue, so we are going to have--we might 
have some Senators that can connect by way of audio only, but 
if Senator Warnock is able to connect by audio, I will turn to 
him next, if we can see him.
    Senator Warnock. Well, thank you very much, Mr. Chairman. I 
am glad to be here and glad I could get on the internet to 
address the issues facing our caregiving economy. I have long 
been a big supporter of Medicaid, Medicaid expansion, Medicaid 
as the primary source of coverage for long-term services and 
supports in the United States, accounting for 52 percent of all 
spending on long--term care nationwide.
    The majority of the spending goes toward the Home and 
Community-Based Services program, HCBS, which typically 
involves assistance with activities of daily living like 
cooking, bathing, other types of housework. These critical 
services enable aging individuals and people with disabilities 
to remain in their own homes, to stay active in their 
communities, to lead independent lives instead of moving to 
institutional settings, as most Americans would prefer to 
receive service and supports at home.
    Ms. Poo, as you know, unlike nursing homecare, state 
Medicaid programs are not required to cover HCBS care at home, 
which means the kind of at-home care Medicaid recipients can 
get from this program varies from State to State. Can you speak 
to how this patchwork leads to gaps in coverage across the 
states?
    Ms. Poo. Yes. Thank you for the question, Senator. The fact 
that Home and Community-Based Services, unlike facility-based 
care, is optional and not mandatory, it means that states can 
cap how many people they serve and limit the types of services 
offered, and this leads to some states having long waiting 
lists and families not being able to get the full array of 
supports and services that they need.
    Even if they get pulled off the wait list, they may still 
not get the services that they need, and that, in addition to 
variation in pay and protections for workers that provide Home 
and Community-Based Services, leads to a system that is 
complicated to navigate, leaves many waiting with nothing, and 
some without what they need. In Georgia, for example, there are 
8,000 people on waiting lists for this very reason, Senator.
    Senator Warnock. It is an issue I have been working on for 
a while and continue to work on. Can you speak about what 
Medicaid expansion in Georgia and in the other 11 states that 
have yet to expand Medicaid, what would Medicaid expansion mean 
to providers and how would that benefit homecare workers?
    Ms. Poo. It is incredibly essential. It is so well 
documented that Medicaid expansion will improve access to 
healthcare, health outcomes, increased financial security due 
to the reduction and share of health costs that will improve 
economic mobility because it is easier to go to work or to look 
for work.
    For example, adults in Ohio and Michigan recorded that the 
coverage by Medicaid expansion made it easier for them look for 
work or go to work. Sixteen percent of homecare workers lack 
health insurance. Forty-three percent rely on public healthcare 
coverage, most commonly through Medicaid and Medicaid 
expansion. Medicaid expansion under the Affordable Care Act 
would benefit more homecare workers, providers who rely on 
Medicaid for their health insurance.
    Senator Warnock. Providing care would actually enable 
people to work, which is an interesting observation, where we 
can have folks putting the work requirements as a basis for 
getting the care, and you are saying getting the care actually 
enables people to work; is that correct?
    Ms. Poo. Absolutely. That is right, Senator.
    Senator Warnock. Thank you so much.
    The Chairman. Thank you, Senator Warnock. I want to give 
people a sense of where we are headed next. We are going--we 
are alternating, obviously, from one side to the other. I am 
told that Senator Braun might be available, at least by audio. 
If he is not, I will turn to Senator Rick Scott and then 
Senator Gillibrand.
    Senator Braun, are you connected or not? Okay, does not 
sound like it. Senator Rick Scott will be next.
    Senator Rick Scott. Thank you. Thank you, Chairman.
    First, I want to thank Ranking Member Tim Scott for his 
report on Home and Community-Based Services reform with a focus 
on self-directed care models. We have that in Florida, but we 
call it the participant directed option.
    When I was the Governor of Florida, I finished about two 
and a half years ago, we made a series of reforms to our 
Medicaid program and provided more Home and Community-Based 
services and benefits to our Medicaid enrollees.
    We went statewide with our Medicaid managed care plans.
    As part of what we--that we were able to add additional 
benefits, such as home delivery of meals, housing assistance, 
which may include rent, utilities, grocery assistance and 
cellular service. We were able to help people maintain their 
health and safety before they got sick to go to the hospital 
without the constraints of what is or is not traditional 
covered services, and we were able to empower our enrollee 
members to receive care from an approved home health agency or 
from a friend, neighbor, family member or other trusted 
caregiver. I look forward to working with the Committee and I 
want to thank again, Ranking Member Scott and this Committee on 
replicating this across the country.
    My first question is for Ms. Blunt. How can we work to make 
government more efficient? Beneficiaries receiving homecare are 
typically dual eligible with Medicare and Medicaid. My 
experience is these programs do not talk to each other. For 
example, a neglectful attendant might a cost beneficiary to go 
to the hospital. These Medicaid costs are absorbed by Medicare. 
The Medicare program does not necessarily share this 
information with the Medicaid program and we lose part of the 
feedback loop on care and measuring quality, or in this case, 
substandard quality.
    How can we better integrate these services so we can detect 
substandard care? How can we better measure service quality and 
outcomes? How do you make sure we get a good return on our tax 
dollars? Would you consider inadequate coordination of care to 
be a big problem and perhaps maybe the biggest problem in 
effective management for Medicare, Medicaid and other Americans 
Act programs?
    Ms. Blunt. Thank you so much, Senator Scott, for that 
question. You know, it is one of the frustrating things that we 
see on the local level is, you know, we do not have the 
ability--it all starts with our data systems, being able to 
track data, systems being able to talk to each other.
    If we have the ability to--you know, when we do intakes and 
we are doing initial client assessments, you know, if we have 
the ability to collect that baseline data and then be able to 
report on the progress, report on what we are doing, identify 
and show the changes that we are making, then I think we will 
have a better system in place overall. You alluded to, yes, the 
system. The long-term care system is fragmented, and that 
presents a challenge, because, you know, we are not able to 
talk to each other.
    We want to make sure that we are utilizing our resources as 
efficiently as possible and not double serving someone or 
duplicating services and efforts. We want to utilize our tax 
dollars as efficiently as possible, but it all starts with our 
data systems.
    I know that is a challenge for us here in our state because 
we can show outputs all day long. We can show the number of 
meals we provided and the amount of transportation we provided, 
but we really need to be able to show what difference our 
services are making and how we are keeping people out of 
hospitals and how we are delaying long-term care placement.
    Senator Rick Scott. Thank you. Ms. Blunt, one of the 
challenges of caring for our seniors and any vulnerable 
population is the potential of abuse and neglect by caregivers, 
our personal attendants, and the fear of the patient, of 
speaking up. Abuse can have physical signs, but neglect could 
be an attendant who shows up and does subminimal effort, which 
may be, as you know, harder to detect, but it has the potential 
to put the beneficiary into eventually a health crisis, or a 
new wheelchair ramp that looks usable, but not--you know, might 
not be up to code.
    Can you speak to how we can protect our seniors from any 
particular harm and building accountability and how you handle 
these challenges in your area?
    Ms. Blunt. Certainly. You know, it is about training and 
educating the community, making this issue making--raising 
awareness to this issue. Again, we just celebrated World Elder 
Abuse Awareness Day on June 15th, and we partnered with the 
city of Charleston and the Medical University of South Carolina 
Center on Aging to really promote elder abuse awareness. Again, 
it comes down to the training. We were able to partner with the 
city of Charleston and train police officers on investigating 
allegations of abuse. It is so important that we all come 
together, because it is such a huge and complex issue.
    Senator Rick Scott. Thank you. My last question, Ms. Blunt, 
is with Medicaid homecare being a single-payer government-
dominated market, ensuring the buyer is getting a good value 
for the money can be pretty challenging. In Florida we have 
worked to address this by tying choice to the patient, by 
allowing them to direct where their Medicaid dollars go and 
give them the ability to hire and fire their personal caregiver 
if they wish.
    What are some of the ways you think a State can evaluate 
the quality of homecare services, and what are you doing in 
your state?
    Ms. Blunt. What we are doing--okay, so what we are doing in 
our State is we are--you know, it is about talking to the 
individual, you know, making sure we are doing the monitoring, 
that ongoing monitoring, and speaking with the senior, making 
sure that they are getting the care. You know, it is about 
quality assurance monitoring and making sure that everything 
lines up. We do not reimburse--and then with Older Americans 
Act funds, we do not reimburse if we do not have all of the 
documentation in place. We do not reimburse if we cannot 
confirm that the services were received by the senior, so that 
is just briefly, you know, kind of what we are doing here in 
our office.
    Senator Rick Scott. Thank you. Thank you, Mr. Chairman.
    The Chairman. Thank you, Senator Scott. Senator Gillibrand.
    Senator Gillibrand. Thank you, Mr. Chairman. Ai-jen, thank 
you so much for your testimony and for your leadership. I am 
extremely grateful for all the work that you have been doing 
for communities in New York and across the country. We know 
that paid leave, paid family medical leave, is a crucial 
necessity for workers and for families, especially when a 
family member has a health issue.
    We know that a national paid leave plan would positively 
boost the economy, as workers spend their wage replacement 
income that they earned, leading to further job creation and 
labor income for workers in various goods and service sectors. 
Widespread and active paid leave disproportionally affects 
women of color and lower income workers who are less likely 
than other workers to receive paid leave benefits from their 
employer.
    Do you agree that national paid family and medical leave 
plans, such as the one proposed by President Biden, is 
America's Family Plan and My Family Act, helps address the 
overwhelming growing demand for caregiving support and long--
term care?
    Ms. Poo. I absolutely do agree, Senator, and thank you for 
your leadership on this issue. It is so essential for the 48 
million working family caregivers who work full time and spend 
more than 20 hours a week caring for aging loved ones or loved 
ones with disabilities. They need the ability to have time and 
take leave to care for the people that they love when they need 
to, for the care workforce, the essential workers who have been 
keeping us all safe taking care of the people that we love. As 
homecare workers, as domestic workers, they need paid leave in 
order to take care of their families so that our caregivers can 
care for those that they love too. That is absolutely 
essential, essential, and a structure.
    Senator Gillibrand. Thank you. Thank you very much.
    When it comes to family caregiving, how else can we provide 
the financial support that they need? I co-sponsored the Social 
Security Caregivers Act, which would create a credit that could 
be used, added to an individual's earnings to calculate their 
future Social Security benefits. I also have the idea of making 
full-time caregivers eligible for their own Social Security 
payments and checks.
    Are these two ideas that you support? Do you have other 
ideas that we could consider and perhaps legislate?
    Ms. Poo. Absolutely. I support both of those ideas, and I 
also want to note that investing $400 billion in Medicaid Home 
and Community-Based Services is also supportive of family 
caregivers who need respite care and who need support. 
Oftentimes, care for the aging and people with disabilities is 
an all-hands-on deck situation and requires both family members 
and homecare workers, and I certainly support expanding access 
to respite care of all sorts, additional cash assistance to 
cover the cost of caregiving and more assistance in navigating 
all of these programs and services.
    Senator Gillibrand. Thank you. That is extremely helpful. 
For Mr. Braddy, how do the diverse needs of the population that 
depend on Home and Community-Based Services, including older 
adults and people with disabilities, impact the need for 
availability of a wide range of home and community-based 
services, and does our care infrastructure workforce meet all 
the needs of all the people with disabilities? Are people 
falling through the cracks?
    Mr. Braddy. Yes, Senator, so many people are falling 
through the cracks. I think it is important for us to also look 
at some of the most difficult things in regard to support 
services, such as transportation that is affordable, accessible 
transportation. That is very key.
    All thing--only thing, assisted technology and technology 
is lacking. People with disabilities benefit strongly with 
assisted technology. Often durable medical equipment is not 
provided. There is often caps to that by insurance, Medicaid 
and often insurance companies. They practice the thing of not 
medically necessary. Example is twice my insurance company 
denied me and said my power wheelchair was not medically a 
necessity, and obviously it is, right? I had to protest just to 
get my motorized wheelchair.
    Those are the kinds of things that often fall through the 
crack that unfortunately people are not aware, and a family 
member would go in their own pocket to provide durable medical 
equipment for their child because that is what they do. They 
take care of their children with disabilities. Any parent would 
do that. They just do not know how to fight insurance 
companies.
    Senator Gillibrand. Well, thank you so much. Thank you all 
for your testimony today. I am very grateful for your 
leadership. Thank you, Mr. Chairman.
    The Chairman. Thank you, Senator Gillibrand. We will turn 
next to Senator Rosen.
    Senator Rosen. Thank you, Chair Casey and Ranking Member 
Scott for holding what I consider such an important hearing, so 
heartfelt. All the witnesses, thank you for your work and 
everything that you do.
    As many of my colleagues know, I stepped away from my 
career as a computer programmer to take care of my aging 
parents and my in-laws. I was lucky enough to have them live 
nearby and they all got old and ill and began their journeys on 
that road about the same time. This issue is very personal to 
me, because I lived through it, in just the same way that so 
many Americans, they just take on that responsibility for 
caring for a loved one when they have to.
    It is not always something that you can plan for. It 
sometimes just happens and you have to deal with it and do the 
best you can. I recently had the opportunity to meet with SEIU 
homecare workers in Las Vegas, of course, hear directly about 
the work they do and the challenges they face. In Nevada and 
across the country our homecare workers, of course, are 
overworked, underpaid and under appreciated for the critical 
work they do. I want to tell you, in my experience so many of 
those workers, those folks who were there for me in assisted 
living, in nursing homes and hospitals and homecare, all of it, 
they were angels to my loved ones and to me and to my family, 
and I appreciated what they do. Given these challenges, the 
right to organize, it is so important for healthcare workers. I 
am grateful to SEIU for all the work you are doing in Nevada.
    Ms. Williams, can you tell me about your experience as an 
SEIU homecare worker, about the importance of your union 
benefits and the protections you have in a profession that is 
unfortunately undervalued. I thank you, for the families that 
you are taking care of.
    Ms. Williams. Thank you. First, I just want to thank 
Ranking Member Scott for bringing attention to the different 
portals that different states do have where the clients and the 
caregivers can connect directly.
    I am blessed with a union, and a lot of times we overlook 
the simple things. As I was listening to you all, that I have 
come to, you know, expect, because I receive this from my 
union, I receive and have won, you know, retirement and health 
benefits and wage increases, and the list goes on and on. When 
you are having amazing people like Senator Scott's mom in other 
states doing the same job, or my mom in Arkansas doing the same 
job but they are not being valued, it is heartbreaking. It is 
heartbreaking because we are the maintainers of life.
    When we are maintaining that life--like I said earlier, we 
were giving the ability for the rest of society to continue 
forward. For a lot of our clients, some of them are able to 
work or continue forward what they were doing because now they 
have that extra balance to rebalance them from where they were, 
normal people given an unexpected new norm, and that 
caregivers, that missing fourth wheel of their car that comes 
in and basically rebalancing everything. When you are giving 
that fourth wheel enough air to do his job properly, a union, 
it makes the ride for all of us even smoother.
    Senator Rosen. Thank you. Speaking of smooth rides, I want 
to talk about incorporating palliative care into a healthcare--
into caregiving plans, because I dealt with this with my 
mother, who had terminal cancer, lung cancer, and she needed 
palliative care. It would not be curative, but it would remove 
some of her pain. The challenges I had I launched a bipartisan 
comprehensive care caucus to raise the benefits of palliative 
care overall. Ms. Blunt, as an executive director of an Area 
Agency on Aging, are any of your caregivers trained in 
palliative care and how do you collaborate in that space?
    Ms. Blunt. Sure. Thank you for that question, Senator. Yes, 
our caregivers are trained in palliative care. We work--in 
South Carolina, we work with DHEC--licensed agencies, and so 
they have to ensure that training requirements are met. At the 
Area Agency on Aging level, we do collaborate with hospice 
organizations, because we have several in our community that 
are doing really, really good work. They have partnered with us 
and provide that training and conducting that outreach and just 
making sure that these services and the caregivers even know 
that that is an option, a service that they may be accessing.
    Senator Rosen. Well, I just--again, my time is up, Mr. 
Chairman. I just want to really thank you and Ranking Member 
for having this hearing, for recognizing that this is an issue 
that touches every family at some time in their life and the 
people that they love, and we just need to be sure that we 
support everyone the best we can. Thank you.
    The Chairman. I want to thank Senator Tim Scott. Thank you.
    The Chairman. I want to thank Senator Rosen. Ranking Member 
Scott, I know I was going to try to connect--I was going to try 
to connect, or see if we could connect with Senator Braun. I 
know he has been trying to connect Senator Tim Scott. He has.
    The Chairman [continuing]. in terms of audio. Is that what 
do we know about that?
    Senator Tim Scott. No, not so far. I know that my staff has 
been reaching out to his and we have not had any success so 
far. Mary, I do not know that we have Senator Braun available 
at this point technology.
    [Pause.]
    Senator Tim Scott. He is unable to connect, sir.
    The Chairman. Well, Ranking Member Scott, I think I will 
turn to closing.
    Senator Tim Scott. Okay.
    The Chairman. If it is okay.
    Senator Tim Scott. Yes, sir.
    The Chairman. Well, thanks very much. I just have a couple 
of comments and then I will turn to the Ranking Member for his 
closing comments. Coming out of the devastation of this 
pandemic, we have had a lot of challenges, obviously, for 
families. I think one thing that is in my judgment an 
obligation for those of us in the House and the Senate is to do 
everything we can to bring about not just change in light of 
this pandemic, but transformative change, both for families 
facing these challenges that we have talked about today, as 
well as the workforce.
    The American Jobs Plan includes, as I mentioned earlier, a 
historic investment in what I think is a Great American idea, 
Home and Community-Based Services, which a lot of Americans 
receive already, but a lot more do not, unless we make this 
investment. This investment will ensure that older adults and 
people with disabilities are able to receive the services they 
need to remain independent and to be active members of their 
communities. We must make this investment to strengthen and 
fairly compensate a critical workforce that has been neglected 
for far too long. I think the pandemic, as it did on a number 
of fronts, highlighted that lack of investment and highlighted 
the essential nature of the work done by those caregivers.
    I look forward to working with all of our colleagues to 
advance the policies we have talked about today. I do want to 
thank in particular our witnesses, Ai-jen Poo, Stephanie Blunt, 
Brittany Williams and Theo Braddy.
    Now I will turn to Ranking Member Scott for his closing 
comments.
    Senator Tim Scott. Thank you, Mr. Chairman, and thank you 
for handling with grace the challenges from a technological 
standpoint that the Committee was faced with today. For most of 
us it seemed to be a very small, recognizing your hard work 
behind the scenes. I realize it was infinitely more than a 
small challenge, but you handled it quite well.
    Thank you to each of the witnesses who invested their time, 
and frankly, to those who have had really challenging yet 
inspirational stories. Thank you, sir, for your amazing 
testimony, and frankly, your life's journey that tells us that 
all things are still possible, no matter the challenges. 
Whether it is a football accident at 15 years old, it is just a 
powerful story that we all benefit from hearing.
    Ms. Williams, thank you so much for recognizing my mom and 
her sacrificial service to other. One of the reasons why I 
think I am a United States Senator today is because I had such 
a wonderful model that I was able to follow from a very early 
age.
    I will say this, that Chairman Casey and I probably 
disagree on a lot of issues, but the way that he handles 
himself makes me so proud to be the Ranking Member on this 
Committee. While we may not see the same solution, we typically 
see the same problem. The beauty of America is that we can take 
different paths to the same problem and hopefully open eyes 
that we are all in this together.
    I would say that the American Jobs Plan is a Federal 
Government-centric approach to solving needs that I 
consistently disagree with. I see the same need, but I think 
that the community and the local solutions are consistently 
better for the patient and the caregiver. While we will 
disagree on some of the solutions, I do think the importance of 
agreeing on the problem should not be overlooked or 
understated.
    Patients and families want flexibility for patient--
centered, self-directed care, not government-directed 
bureaucracy. That is really the most important point for me. In 
fact, we believe that the Federal Government spending more in 
this area is an important consideration, and frankly, an 
important resource. We would want it to be directed to local 
organizations to provide the highest level of care.
    There is a reason why the things that we care about most 
are not in Washington. They are in our own houses, our 
families. To the extent that we can provide more resources, 
more information, more collaboration from the local level up 
and not from the Federal Government down, we believe will 
provide the highest continuum of life and care.
    Mr. Chairman, I thank you for this hearing. I think each 
panelist for your expertise in providing what we needed to 
hear. I do think that we will find better solutions when we are 
working together for those solutions, even though we may 
disagree on how to get there. Mr. Chairman, I yield back the 
balance of my time.
    The Chairman. Ranking Member Scott, thanks for your 
statement and thanks for working with us on this hearing. I 
think we can both commend and salute our staff on my side, 
represented by Stacy Sanders, who had to do the really hard 
work on the, not just the hearing, but on the technological 
issues. We are grateful for their work and others who helped us 
get through the challenge we had.
    I also want to thank the Ranking Member for sharing not 
only his thoughts and his views on these issues, but sharing 
his mom's story. It just shows that so many Americans have had 
these experiences, and we need to benefit and learn from all of 
those stories.
    Again, we want to thank our witnesses for contributing both 
their time and their expertise. If any senators have additional 
questions for the witnesses or statements to be added to the 
record, the hearing record will be kept open for 7 days until 
next Thursday, June 24th.
    Thanks, everyone, for participating today. This concludes 
our hearing.
    [Whereupon, at 11:18 a.m., the Committee was adjourned.]    
      
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                                APPENDIX
     
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                      Prepared Witness Statements

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