    [Senate Hearing 117-111]
    [From the U.S. Government Publishing Office]

                                                           S. Hrg. 117-111

                           LIVING YOUR BEST LIFE NOW:
                        ENJOYING YOUR GOLDEN YEARS WITH
                          PHYSICAL AND MENTAL VITALITY

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

                                    HEARING

                                   BEFORE THE

                           SPECIAL COMMITTEE ON AGING

                              UNITED STATES SENATE

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                           CHARLESTON, SOUTH CAROLINA

                                   __________

                               SEPTEMBER 8, 2021

                                   __________

                               Serial No. 117-07

             Printed for the use of the Special Committee on Aging

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                    __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    46-334 PDF                 WASHINGTON : 2022

    -----------------------------------------------------------------------------------

                           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 Tim Scott, Ranking Member...........     1

                               PANEL OF WITNESSES

    Connie D. Munn, Director, South Carolina Department on Aging,
      Columbia, South Carolina.......................................     5
    John M. Ciccone, M.D., FACC, ABIHM, Associate Chief Medical
      Officer, Roper St. Francis Healthcare, Mount Pleasant, South
      Carolina.......................................................     7
    Kesha L. Hayes, MA, LPN, Founder of Caring for Aging Beauties,
      Lugoff, South Carolina.........................................     9
    Connie Ross-Karl, Honorary Senior America, North Myrtle Beach,
      South Carolina.................................................    10
    Floyd Davidson Spence, Jr., Owner & Instructor of Lake Murray
      Fitness Cycle, LLC, Lexington, South Carolina..................    11
    Perry A. Bowers, DMIN, Founder & President of Focused Living
      Ministries, Columbia, South Carolina...........................    13

                                    APPENDIX
                          Prepared Witness Statements

    Connie D. Munn, Director, South Carolina Department on Aging,
      Columbia, South Carolina.......................................    31
    John M. Ciccone, M.D., FACC, ABIHM, Associate Chief Medical
      Officer, Roper St. Francis Healthcare, Mount Pleasant, South
      Carolina.......................................................    33
    Kesha L. Hayes, MA, LPN, Founder of Caring for Aging Beauties,
      Lugoff, South Carolina.........................................    36
    Connie Ross-Karl, Honorary Senior America, North Myrtle Beach,
      South Carolina.................................................    38
    Floyd Davidson Spence, Jr., Owner & Instructor of Lake Murray
      Fitness Cycle, LLC, Lexington, South Carolina..................    46
    Perry A. Bowers, DMIN, Founder & President of Focused Living
      Ministries, Columbia, South Carolina...........................    48

                           LIVING YOUR BEST LIFE NOW:
                        ENJOYING YOUR GOLDEN YEARS WITH
                          PHYSICAL AND MENTAL VITALITY

                                  ----------

                          WEDNESDAY, SEPTEMBER 8, 2021

                                           U.S. Senate,
                                    Special Committee on Aging,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 9:30 a.m., Waring
    Senior Center, Charleston, South Carolina, Hon. Tim Scott,
    Ranking Member, presiding.
        Present: Senator Tim Scott

                    OPENING STATEMENT OF TIM SCOTT,
                             RANKING MEMBER

        Senator Tim Scott. Good morning everyone, and thank you for
    joining us for this Special Committee on Aging hearing as we
    discuss in our first field hearing some of the important issues
    around really living your best life now. It's an exciting
    topic, and I look forward to hearing from some of our really
    incredible guests that we have with us today. Thank you all for
    being here. I look forward to your comments, and I'm encouraged
    by the thoughts and the words that you've already spoken
    earlier today and look forward to having you address the public
    today.
        Good morning to everyone, and I want to welcome everyone
    who's joining us virtually. We decided because of COVID, with
    the higher level of activity, that perhaps the most important
    thing we could do to have a special hearing on aging is not to
    bring a bunch of folks into the room; and so I think that was
    the first decision made by my excellent staff. It was a good
    decision, and I certainly support it; and now I look forward to
    having an opportunity for us to discuss some of the really
    important issues that face South Carolina and, frankly, our
    nation as it relates to issues around aging.
        Focusing on living your best life now is something that,
    when I think about that topic, the first person that comes to
    my mind is my mother, Frances Scott, who has for the last 45
    years served in the capacity of the Roper St. Francis Bon
    Secours Healthcare System as a nurse's assistant; so she is
    someone who has really helped so many folks, over her four-plus
    decades, age gracefully. This is someone, of course my personal
    American hero, my mom, Frances Scott, but she has spent so much
    time teaching me valuable lessons about taking care of others
    when they can't take care of themselves. Something that's
    really embedded in our culture here in South Carolina is the
    fact that we do want to go the extra mile for those folks who
    have served us personally, individually, or corporately. As a
    State, we want to take care of those folks in our State who
    have done such a great job of helping others. The good news is
    we have innovation as a major part of who we are as South
    Carolinians, and that doesn't just mean from a healthcare
    perspective, sometimes it's financial security, dignity when it
    comes to aging; the importance of aging gracefully requires all
    of us to help each of us.
        South Carolina has had tremendous growth; since 2010, 11
    percent growth in our State. More than 5 million people, smart
    Americans, now call South Carolina their home. Interestingly
    enough, at the same time those South Carolinians over the age
    of 65, it's almost 1 out of 5, 18 percent of South Carolinians
    are over the age of 65. That's good news because we're living
    longer and people are making the decision to call South
    Carolina their home. From that distinction, the 18 percent of
    South Carolinians over the age of 65, South Carolina ranks
    among the top 10 with the highest percentage of people over the
    age of 65 in our country. Seniors from all across the nation
    are flocking to South Carolina. Maybe it's because of the
    history of our State and the fact that we focus so much on
    preservation; might be the beaches here down in the Lowcountry;
    the mountains in the Upstate; or it could be because of folks
    in Greenville and Spartanburg, according to the US News and
    World Report, some of the best places to live in all of
    America, right here in the Palmetto State.
        However, while we have much to celebrate as a State, we
    also have some challenges that we face as a State, and frankly
    as a Nation. Heart disease is the leading cause of death in
    South Carolina. Two out of five South Carolinians have high
    blood pressure. South Carolina also ranks 6th and 12th as it
    relates to adults with diabetes and obesity. Unfortunately,
    because of those challenges, our State is a part of the stroke
    belt.
        There's good news. South Carolina is emerging in the life
    sciences. Led by the Department of Commerce and other regional
    economic development partners, we have recruited over 800
    companies with over 43,000 life science professionals whose
    economic impact on the state is over $12 billion; but more
    importantly, it focuses our attention as a State on the
    importance of developing and evolving healthcare expertise so
    that our seniors have the opportunity to live life and to live
    it at their best right now. I'm very thankful to live in a
    State where we focus on outcomes.
        You know, many people have said that music and the arts are
    like the universal language, feeding the human spirit in the
    best of times and, frankly, even in the worst of times. One
    great example is the University of South Carolina's Congaree
    New Horizons Band, a band for people 50 and older. Yes, that
    means me too. Sara Coffman, a band member, emphasized the joy
    of being able to work with and see one another each week to
    make music together. Craig Plank agrees and adds that
    rehearsals are one of the ways to keep the mind sharp.
        I love the fact that we are engaging in really important
    initiatives and activities that allow the human spirit to
    continue to flourish in the best of years. Frankly, as I said
    earlier, the latter reign, according to those of us who follow
    scripture, should be better than the former reign. I believe
    that the best is yet to come for our seniors and think that
    it's a powerful opportunity for us to focus on that today.
        I am grateful for the assistance of Senator Mark Kelly from
    Arizona. He has joined me in introducing for the first time a
    resolution making September National Healthy Aging Month. It
    recognizes senior centers for their central services and
    activities that forge relationships, purpose, and well-being.
    Today nearly 11,000 senior centers serve more than 1 million
    seniors.
        I also want to thank at this time the Waring Senior Center
    and Roper St. Francis Healthcare System for being such great
    hosts today. Your center is a home away from home for so many
    seniors, and they're able to engage in music, in the arts,
    pickleball, book clubs, and even drum ball.
        Now, before we're done, Dr. Ciccone, I want to know what
    drum ball is.
        You need to know what it is too. Okay. We'll defer that for
    one of the questions 15 for the record.
        I will say that we sit in a place named for a former city
    council member, Louis Waring, who passed away just a couple of
    years ago. I will say, I knew Louis Waring. He was a prince of
    a fellow. He was the iron fist in a beautiful glove, literally.
    He was the kind of person who set the example. He spoke with
    wisdom and with grace. He was a powerful presence but always
    gracious. His son Keith is now a member of the Charleston City
    Council, as he was previously before he passed away; and so
    it's fitting to be in a place where someone with such wisdom
    and grace led his community in a powerful way. Now we have an
    opportunity to use this amazing facility to talk about graceful
    living.
        I want to get quickly to the introductions of our guests
    today, our witnesses. First of all I'll start with Connie Munn,
    the Director of South Carolina Department on Aging. Director
    Munn was confirmed last year by Governor McMaster as the first
    director of our Department on Aging for South Carolina.
    Director Munn has a background as a mental health counselor.
    She has been involved in aging issues since earning her
    master's of social work from the University of South Carolina,
    where she specializes in geriatrics. Ms. Munn, thank you so
    much for being a part of this discussion today, and we
    certainly look forward to your comments.
        Ms. Munn. Thank you.
        Senator Tim Scott. Dr. Ciccone. It is my pleasure to
    introduce a cardiologist and associate chief medical officer at
    Roper St. Francis Mount Pleasant Hospital. He is also the
    medical director of the Healthy Lifestyle Program, the region's
    only hospital based program designed to reduce cardiovascular
    risk and improve overall well-being. It serves more than 300
    participants a year, and over 70 percent of the participants
    are over age 55. As I discussed a little earlier, people are
    flocking to the State. Dr. Ciccone beat the masses, and you got
    here in 2012 I think it was.
        Dr. Ciccone. It was.
        Senator Tim Scott. Well, thank you for becoming a South
    Carolinian, and thank you for bringing your expertise to the
    discussion that we're having today.
        Dr. Ciccone. Thank you.
        Senator Tim Scott. Kesha Hayes, our next witness I want to
    introduce, is founder of Caring for Aging Beauties. I love
    that. I love that. Kesha is also the CEO and owner of
    Professional Development and Training Services, which trains
    caregivers to provide care for older Americans. Kesha founded
    Senior Service Day, an event which received a Governor's
    proclamation showing seniors how to live in an excited fashion,
    understand companionship, and social engagement. Kesha, I'm
    thrilled to have you with us today, and thank you so much for
    being a part of our discussion today.
        Now, the elegant Connie Ross-Karl is the one there with the
    sash on. Connie, Ms. Ross-Karl, got her start in pageants when
    she represented South Carolina in the Ms. Senior America
    Pageant in 2007. Today she coaches pageant contestants in many
    age groups and is a certified Miss America Judge. Ms. Ross-Karl
    described seniors as the backbone of our country. I could not
    agree more. She said, ``Ms. Senior America becomes a platform
    for women to assist other women and the senior population in
    general. When you put a crown and a sash on someone who's 60
    years or older, it literally changes their life and makes them
    the best they can be.'' Thank you for sharing your expertise
    and your passion today with all of us.
        Ms. Ross-Karl. Thank you.
        Senator Tim Scott. Floyd Spence, Jr., owner and instructor
    of Lake Murray Fitness Cycle, thank you for joining us today to
    talk about the importance of fitness and vitality as a part of
    this discussion today. Very important. David has been a sports
    and fitness enthusiast his entire life. He played football--I
    didn't know that--at the University of South Carolina. Go
    Gamecocks. I would say that the victory this weekend was not
    too bad of a start. What, 46 points?
        Mr. Spence. Forty-six.
        Senator Tim Scott. May we see more of that all year long.
        Mr. Spence. Thank you, sir.
        Senator Tim Scott. Yes, absolutely. I'm a little biased, I
    apologize, toward the Gamecocks.
        Now David leads fitness classes at gyms across the Midlands
    and is continuously searching for ways to help others train
    properly and remain active at any age. David is the eldest son
    of the late Congressman Floyd Spence who represented South
    Carolina's Second congressional District in Washington for more
    than 30 years. David shared that his father set an amazing
    example for him to not only remain active throughout his life
    but also to devote his life to serving and helping others.
    David, I'm thrilled to have you with us today.
        Mr. Spence. Thank you, sir.
        Senator Tim Scott. Thank you for a lifetime of service.
        Mr. Spence. Thank you, sir. My pleasure.
        Senator Tim Scott. Thank you. Perry Bowers, our last
    witness, founder and president of Focused Living Ministries. As
    a man of family myself, I am certainly thankful that you are
    part of this panel; and we recognize the important role that
    faith plays in our lives and, frankly, even in aging
    gracefully. I think it's a really important part and key
    ingredient to a life well served, a life well lived I should
    say. I'm proud to have Perry as a part of our Palmetto State
    and thankful for your ministry and the work that you've done.
    One of the favorite scriptures that I have is Proverbs 29:18
    that says without a vision people perish or cast off restraint.
    One of the things I love about your presence and your focus is
    you are helping others find their own vision at times, and that
    is such an important ingredient into a purpose driven life,
    which in my opinion is one of the best ways to have your latter
    days be better than your former days, and that's an important
    part.
        Before we enter into witness testimony, I will say that, as
    I said before he arrived, this is the building center named for
    Mr. Louis Waring, and I mentioned that his son Keith Waring was
    a member of city council. Keith has been kind enough to join
    us. Keith, will you say hello to everyone.
        Mr. Waring. Hello everyone.
        Senator Tim Scott. Thank you for being here, Keith.
        Mr. Waring. Thank you for being here.
        Senator Tim Scott. Absolutely. Ms. Munn, do you want to
    start us off?

                 STATEMENT OF CONNIE D. MUNN, DIRECTOR,

                  SOUTH CAROLINA DEPARTMENT OF AGING,
                        COLUMBIA, SOUTH CAROLINA

        Ms. Munn. Yes, sir. Good morning. I'm Connie Munn, and I
    serve as the Director of the South Carolina Department on
    Aging. It is an honor to be with all of you today. Senator
    Scott, I want to especially thank you for hosting this field
    hearing highlighting all of the great progress we are making
    together as a team here in South Carolina with regard to health
    and vibrant aging.
        Throughout the pandemic the strength of the Aging Network
    in South Carolina has been tested and truly showcased. Regional
    and community partners all across the State have come together
    in a time of great need, a true testament to the dedication and
    devotion to those who have a desire to help others when most in
    need. While the threat to an older adult's health and well-
    being has been intensified during the pandemic, longstanding
    partnerships as well as new connections have been vital to the
    continuation of services for our most vulnerable population.
        At the start of the COVID-19 pandemic the South Carolina
    Department on Aging and the Aging Network immediately observed
    barriers that seniors faced regarding nutrition, and we began
    to encourage the use of additional nutritional supports to fill
    the gap, such as providing bags of groceries or assisting with
    enrollment in the Supplemental Nutrition Assistance Program,
    better known as the SNAP benefits.
        One such example is when a senior called the Trident Area
    Agency on Aging because she desperately needed food. She was
    caring for her husband, who was a disabled veteran and also
    going through cancer treatments at a VA facility. This
    particular senior did not drive and had to walk to get her
    food, so the Area Agency on Aging was able to provide her some
    food from their pantry and connect her with Lowcountry Street
    Grocery to provide a weekly delivery of eggs and fresh produce
    to an area which was deemed a food desert.
        This is just one example which illustrates that in order to
    promote healthy, active, and independent lifestyles, community
    support and services must be provided from a holistic approach.
    To live a fruitful life all dimensions must be assessed, and
    supports should be tailored to the unique needs of the
    individual. This is why a multitude of evidence based
    programing is offered in South Carolina to enrich the lives of
    older adults, to improve their health and well-being, and to
    reduce disease and injury. The majority of these programs are
    funded through the Older Americans Act and are directly
    implemented by our Aging Network by certified and trained
    individuals. Additionally, programing is provided in
    collaboration with other State agencies and university systems
    utilizing alternate funding sources.
        Some examples of our evidence-based programs that are
    provided in South Carolina include Powerful Tools For
    Caregivers, which is a caregiver support program; falls
    prevention resources, such as Fit & Strong and Enhance Fitness;
    and Clemson University has partnered with the Administration
    for Community Living on a grant to reduce fall risk in rural,
    older South Carolinians. We know diabetes and arthritis are
    chronic diseases that affect our older South Carolinians, and
    so to combat diseases we offer the Diabetes Self-Management
    Program and an Arthritis Foundation Aquatic Program. The
    Trident Area Agency on Aging offers a unique program which
    highlights a partnership between community and clinical
    linkages Roper St. Francis Hospital System for the delivery of
    the Enhance Fitness Program.
        The Department on Aging established a social isolation and
    loneliness task force which led to developing supports and
    resources for those older adults most at risk, which were the
    rural, minority, and homebound individuals. Some of the
    projects in progress include Senior Kits, which offers take-
    home kits for adults to enhance emotional, mental, and physical
    wellness; and an iPad loan program, which is a partnership we
    have with South Carolina Assistive Technology to offer seniors
    iPads to take home.
        The Department on Aging has been able to form various
    partnerships with Federal and State agencies as well as non-
    profits. One of those is the Housing and Urban Development in-
    home modification grant. Our agency just received a $1.1
    million grant that will encourage vibrant aging and lifestyle
    by funding minor home repair to seniors in 29 counties
    throughout South Carolina. By utilizing an in-home occupational
    therapist and the regional assessors in the Area Agencies on
    Aging we know that this will be a successful project to keep
    our older South Carolinians active and improve their quality of
    life.
        In closing, I would like to reiterate that the South
    Carolina Department on Aging recognizes that wellness is a
    multidimensional measure of overall health, integrating the
    mind, the body, and the spirit. Regardless of the social,
    economic, or environmental conditions, all older adults have
    the right to health and wellness services. While the Older
    Americans Act provides many direct programs and services, we
    feel like the Department on Aging aims to bridge the gap with
    those entities who do the same or similar work. We believe that
    this task is best accomplished by coordination, cooperation,
    and collaboration by partnering with other State agencies, non-
    profits, health systems, and higher education institutions to
    provide positive change for South Carolina's older adults.
        Senator Scott, I again thank you for the opportunity to
    present my testimony today, and I look forward to answering any
    questions or concerns you may have.
        Senator Tim Scott. Thank you, ma'am. Dr. Ciccone.

                   STATEMENT OF JOHN M. CICCONE, MD,

             FACC, ABIHM, ASSOCIATE CHIEF MEDICAL OFFICER,

                     ROPER ST. FRANCIS HEALTHCARE,

                     MOUNT PLEASANT, SOUTH CAROLINA

        Dr. Ciccone. Good morning. Thank you, Senator Scott, and
    thank you to Roper St. Francis for the opportunity to testify
    today about such an important problem, aging in our population.
    I expected to come away from today with learning some new
    things from my other panelists, but I didn't expect to really
    understand what drum ball was, but I did Google it, and it's
    quite interesting.
        Senator Tim Scott. Excellent.
        Dr. Ciccone. The world's population is aging as a
    consequence of increasing longevity and decreased fertility. It
    is estimated that in 2015 the percentage of the world's
    population age 65 and older was 9 percent or 617 million
    persons. That population is projected to rise to 1 billion
    persons by 2030 and 1.6 billion by 2050. Growth in the under 20
    year old population is anticipated to be flat and moderately
    increasing over the next 30 years.
        Europe is currently the oldest region with 17.4 percent of
    the population aged 65 and older and anticipated to encompass
    25 percent of the population of the world by 2050. North
    America will retain its position as the second oldest region
    with projection of 21.4 percent aged 65 and older by 2050. In
    comparison, the same demographic is projected to triple in size
    in Asia, Latin America and the Caribbean, the fastest growing
    aging population. Africa will have a significant rise in the
    older population but will remain relatively younger due to high
    fertility rates.
        Allow me to address some specific challenges. Heart disease
    and stroke are the leading causes of death in the US
    population, accounting for one third of the deaths in the US
    every year. The cost is staggering with direct costs of $214
    billion and a further cost of $138 billion due to lost job
    productivity. The noneconomic costs further emphasize the
    magnitude of the problem.
        Cancer is the second leading cause of death in the US,
    accounting for nearly 600,000 deaths annually. As of 2020 the
    cost to the healthcare system was approximately $174 billion.
        Diabetes affects more than 34.2 million Americans with
    another 88 million having prediabetes, the precursor to type 2
    diabetes, and is directly linked to diet and obesity. Diabetes
    leads to chronic heart and cerebrovascular disease, kidney
    failure, and blindness, which negatively affect quality of life
    and cause an estimated $327 billion in direct costs and lost
    job productivity.
        Obesity is an endemic, affecting 19 percent children and 42
    percent of adults. Obesity is directly linked to heart disease,
    diabetes, and some cancers at a cost of $147 billion annually.
        Arthritis affects 1 in 4 adults in the US. It is a leading
    cause of work disability and a common cause of chronic pain,
    incurring a total cost to the healthcare system of $304 billion
    as of 2013, $164 billion in lost earnings alone.
        Alzheimer's disease affects 5.7 million Americans and is
    the sixth leading cause of death in all adults and the fifth
    leading cause of death in the age 65 or older population. It is
    estimated that the costs associated with treatment will be
    between $379 billion and $500 billion by 2050.
        The anticipated rise in healthcare costs due to the aging
    population is not sustainable. Appropriate strategies to
    decrease the incidence of chronic diseases and the associated
    costs to the healthcare system are critical if we are to
    sustain appropriate access to our population. Even a decrease
    in incidence of chronic diseases by 10 percent would result in
    savings of greater than $100 billion to the healthcare system.
    Using primary and secondary prevention strategies relying
    primarily upon lifestyle changes are extremely cost effective
    and will improve quality of life for the aging population.
    Improved education to the at-risk population in particular can
    further enhance the positive impact of costs upon the
    healthcare system.
        The 21st Century Cures Act mandates that patients have
    unfettered access to their medical records. Navigating through
    the maze of lab and imaging reports and physician notes is a
    daunting task for patients. Providing an organized approach to
    this information with patient approved secure access to medical
    records to all providers involved in the care of the patient
    and using artificial intelligence to improve patient medical
    literacy will be an adjunct to cost effective management.
        Remote patient monitoring of patients with chronic diseases
    and the development of virtual care paradigms will further
    enhance the ability of healthcare providers to extend and
    improve care to the at-risk population, concentrating efforts
    to the high cost patient using population health.
        Healthcare expenditures will continue to rise as the
    population ages due to environmental factors as well as the
    development of chronic diseases as part of the aging process.
    Many of these diseases can be prevented or modified by early
    intervention using lifestyle measures and appropriate
    introduction of medications which prevent end organ damage. An
    appropriate exercise regimen tailored to the patient further
    enhances the comprehensive approach to the patient.
        The Healthy Lifestyle Program at Roper St. Francis is an
    example of a cardiometabolic program aimed at reducing risk for
    chronic disease, normalizing metabolic abnormalities,
    decreasing the need for medications, and improving overall
    fitness and functionality of the patient. Fine tuning the diet
    and setting goals for fitness are essential to this approach.
    Patients meet with a dietician regularly and adjust diet to a
    more balanced and healthy plan. Regularly scheduled small group
    exercise sessions with homework assignments on non-gym days
    improve fitness, overall metabolic abnormalities, and improve
    functionality, particularly in those patients previously
    limited by orthopedic issues. The program creates structure and
    accountability for patients whose greatest barriers
    historically have been nonadherence to diet and exercise.
        I'm sorry about running over time, but thank you for the
    opportunity again.
        Senator Tim Scott. Thank you.

           STATEMENT OF KESHA L. HAYES, MA, LPN, FOUNDER OF
           CARING FOR AGING BEAUTIES, LUGOFF, SOUTH CAROLINA

        Ms. Hayes. Good morning everyone, and thank you so much,
    Senator Scott, for allowing me to be here, and thank you so
    much to the amazing Special Committee on Aging staff and all
    that you are doing for our older adults in South Carolina.
    Aging is inevitable, but it shouldn't be miserable. Some say
    aging in place, but I tend to say aging in grace. We just never
    know if the place that someone is aging in happens to be a good
    space.
        All over the world there is an elderly man or woman that
    fought for us to be in a room. They actually fought for me to
    be here sitting in this seat, and, yes, I get emotional about
    that because we are caring for those that once cared for us.
    Aging beauty, that has nothing to do with gender but everything
    to do with grace and wisdom. Actually, the definition of an
    aging beauty is a person with exemplary wisdom who should be
    valued and celebrated daily. Some of us have lost sight of the
    honor that an aging beauty should be shown, and we should never
    do that. When we speak of older adults, we should think of
    someone that's not dying, not someone helpless, but someone who
    made sacrifices for us to operate like we are today.
        I was wondering why I fell in love with aging beauties, and
    I remember sitting under an oak tree in front of my
    grandparents' house, and I would listen to all the wisdom that
    they would be talking about until it was time for me to leave
    because it was those conversations that, you know, children
    couldn't be a part of. I wanted to do something special for
    older adults, so I began the path of first thinking that I
    would train healthcare professionals so that they can properly
    care for those who cared for us; and in doing so we would
    provide them with a rewarding career so that they can be self-
    sufficient, get off unemployment, and then provide care to our
    greatest generation in a proper fashion because aging beauties
    do deserve to be taken care of properly.
        Then that wasn't enough, so I decided that we would show
    special recognition to aging beauties by creating a day to show
    social engagement and companionship. A third of seniors are
    lonely, feel abandoned, they are depressed, and we needed to
    show them that we care about them; so we created senior service
    day, a proclaimed day in South Carolina that allows everyone in
    the State to go and show honor and love by doing special
    activities, games, or even just dropping things off on
    someone's porch.
        Caring for Aging Beauties, our nonprofit, was then birthed;
    and now we provide The Care Lab, a place where family members
    who are caring for loved ones can come and learn technical
    skills for free, but they also connect with other family
    members in the same situation and receive peer support.
    Actually, the students that are trained in our healthcare
    school, they are the ones that are doing the training of these
    family caregivers, so they're giving back before they even
    start the workforce.
        The Senior and Caregiver Expo provides a way for all
    entities to come together and provide the resources for seniors
    in one place so that they can know exactly what's out there for
    them, and it provides fun, fellowship, self-care, food, and
    lots of music. We have birthday clubs, pen pal programs,
    monthly activities, and we call this the Connecting Generations
    Program. It's very important that intergenerational programing
    is necessary and that it's promoted so that we can have a
    strong sense of community and connect generations.
        As one of our participants, Mary Brevard, shared, ``Aging
    is not lost youth but a new stage of opportunity and
    strength.'' The beauty of a woman is not in a facial mole, but
    true beauty in a woman is reflected in her soul. It is the
    caring that she lovingly gives, the passion that she knows.
    Aging beauty of a woman with passing years only grows. Thank
    you.
        Senator Tim Scott. Thank you very much, ma'am.
        Ms. Ross-Karl.

            STATEMENT OF CONNIE ROSS-KARL, HONORARY SENIOR
              AMERICA, NORTH MYRTLE BEACH, SOUTH CAROLINA

        Ms. Ross-Karl. Good morning, Chairman Scott, fellow
    participants and invited guests. Thank you for the honor of
    speaking to you today as the Senior America State Administrator
    for South Carolina and an Honorary Senior American, I am proud
    to introduce you to a 42-year-old anomaly of a national
    movement of thousands of women, whose founder, Dr. Al Mott, is
    still a participant, along with his wife Elizabeth, to share my
    knowledge and experiences in anecdotes about successful aging
    and to capture how the enthusiasm for life that being a queen
    at the age of elegance, 60 or older, dispels some of the
    misconceptions of aging.
        The Senior America Pageant recognizes physical fitness, of
    course, and seeks to emphasize that fitness comes in many
    shapes and sizes and that true beauty is a matter of insight as
    well as eyesight. The pageant emphasizes that if you're
    interested in staying healthy as you age, you need to highlight
    both your workout muscles as well as your creative ones.
    Ongoing research suggests that creativity may be a key to
    healthy aging. By giving women 60 years of age and older an
    opportunity to display their inner beauty, talents, and
    elegance, the pageant honors the achievement of senior women
    and motivates and encourages them to utilize their full
    potential to share their positive outlook with others.
        Senior America contestants also benefit from important
    friendships they have developed by competing, friendships that
    last really to the end of our lives. Through social capital and
    its bridging affect into different unique worlds seniors can
    enjoy better physical, mental, and emotional well-being. When
    grandma's happy, everybody's happy. Helping each other may be
    as simple as straightening a crown or as complicated as staying
    up all night putting ice on the face of a queen who has fallen
    but still has to escort on the red carpet the next day, give
    out awards, and perform on a television show that's being
    broadcast for 11 million people. I was the fallen queen. Ida
    Brinkley, 2010, was my diligent nurse.
        Falls, such as breaking a leg or a hip, are our real
    nemesis and happen sometimes at really important events. One of
    my sisters from 2007 fell at the national pageant, broke her
    hip, and was in recovery for more than 2 years.
        Today Fran Owens is president of our national alumni
    association. We watch out for each other and help each other
    get through just about anything. Bernadette Dudek lost her
    husband, the love of her life, more than a decade ago when she
    was living in New Jersey. The New Jersey Senior America
    organization embraced her and encouraged her to be a
    participant. She was a finalist that year in the national
    pageant in 2009 and competed in the national pageant 10 years
    later representing South Carolina, as she now lives in Fort
    Mill. We uplift one another to be the best we can be from
    inspiring others recovering from injury and illness to things
    as simple as good vision and dental health. We share our
    poignant moments, from spending time with Jon Bon Jovi and
    learning how to mashed potato from Dee Dee Sharp.
        I wore my Senior America banner when I climbed the Great
    Wall of China. I wore it when I walked with my family behind
    the caisson carrying the remains of my World War II parents who
    have been laid to rest in Arlington; and was later swarmed by a
    wonderful group of South Carolina students, all of us visiting
    the Iwo Jima monument. They saw my banner, and they all wanted
    pictures.
        Finally, the Ms. Senior America Pageant is designed not
    only to enrich the lives of seniors but to tap their energy to
    enrich the lives of others. It is dedicated to diversity and
    spotlighting the positive aspects of aging. The organization
    encourages queens to have personal platforms and offers a
    local, State, and national stage for that. One example is
    Marlisa K. Small's Bold and Beautiful Wigs for Cancer, which
    gives a free, high-quality wig to men, women, and children in
    treatment for cancer. Her charity went from a local charity to
    a national charity in conjunction with her year as Ms. Senior
    South Carolina in 2018. Raquel Welch learned about Marlisa and
    giving away Raquel's wigs and donated a stunning personal gown
    to Marlisa to auction at her fundraising gala. It brought
    $10,000.
        I would like to close with this thought, pageants are not
    finite at any age. We are more than queens of the old people.
    There are many women deserving of recognition, and participants
    truly do represent a cross-section of America. Ranking Member
    Scott, thank you for hosting this hearing today, and I look
    forward to what is to come in the hearing; and on behalf of the
    age of elegance, we women thank you.
        Senator Tim Scott. Thank you so much, ma'am.
        Mr. Spence.

                STATEMENT OF FLOYD DAVIDSON SPENCE, JR.,

                   OWNER & INSTRUCTOR OF LAKE MURRAY
             FITNESS CYCLE, LLC, LEXINGTON, SOUTH CAROLINA

        Mr. Spence. Good morning, Ranking Member Scott,
    distinguished panel, and guests. I am honored and blessed to
    share how my life's journey has allowed me the opportunity to
    positively affect the lives of others through what I call my
    ``Five to Stay Alive'' foundation principles: Faith, family,
    friends, freedom and fitness. They are values Momma and Daddy
    held so dearly and shared with me and my three brothers.
        Beginning some 68 years ago--okay, do the math--my life was
    active from the start. My dad, Floyd Spence, and mom, Lu
    Spence, moved to Lake Murray outside of Lexington, South
    Carolina, when I was about 3 years old. Dad helped build our
    home, so learning about physical activity was just a natural
    part of growing up.
        I started playing baseball and football as soon as I was
    old enough to play Little League, Dixie Youth Baseball, and
    Youth Football. I was fortunate enough to enjoy some success,
    and my dad, along with some great coaches, mentors, and
    friends, gave me some wonderful advice: If you want to excel in
    sports, you should train well and consistently, don't settle
    into just one sport, set yourself up for success by not
    drinking, not smoking, and not doing drugs. To a kid of eight
    to ten years of age, I believe that advice was gold. For the
    remainder of my life I have followed it.
        God's plan has led me to Nautilus Sports Medical and
    Fitness, then St. Andrews Fitness, Gold's Gym, MUV Fitness,
    Lake Murray Fitness Cycle, Dynamic Health and Fitness, and
    Crunch Fitness, where I was responsible for instructing classes
    and training people of all ages, needs and interests. My
    journey is filled with ordinary people who have done
    extraordinary and miraculous things because they made a
    commitment to themselves to live life active and well. My
    active life, my early decisions, and even my injuries and
    challenges, were all part of the Master's plan, not only for me
    but for my dad.
        My dad developed COPD in his 50's, and by 60 he was living
    with 5 percent total lung function, on oxygen 24 hours a day,
    and in a wheelchair much of the time. He was given finally 2
    months to live. Upon receiving this diagnosis, Dad was leaving
    the hospital when a doctor just happened to mention to him,
    hey, here's an experimental double lung transplant program
    going on in the hot bed of medical technology, Jackson,
    Mississippi. My dad decided to give them a call. They invited
    him down, and he received the invitation but no promises of
    what they could do. During the ten years of the progressive
    lung disease, dad rode a Shwinn Airdyne bike to strengthen his
    heart, maintain as much lung function as he possibly could, and
    build body strength and endurance for the challenge that lay
    ahead. That was my dad.
        Dad arrived in Mississippi and walked into the hospital
    with his portable oxygen tank and cannula, smiling and shaking
    hands and thanking folks for seeing him. They were shocked
    because this was not that old man in a wheelchair on oxygen
    near the end of his life they expected. He passed all
    qualifications and was accepted into that program.
        Six months later not only did dad survive the transplant
    and two subsequent rejection episodes, he rehabbed, recovered,
    and returned to South Carolina in September 1988 and was
    reelected to his tenth term as the Second District Congressman
    from South Carolina. Dad literally owed this miracle of new
    live to his Lord and Savior, Jesus Christ, and to the love of a
    family who selflessly made their 19-year-old son's lungs
    available for transplant after he lost his life in a motorcycle
    accident. God bless them.
        My dad would face another challenge in 1999-2000 when his
    kidneys failed. I was blessed to donate one of my kidneys to my
    dad. I always thought the gift of organ donation could save and
    improve a life, but to donate to my own dad meant more than I
    could ever explain. I certainly understood that in all my years
    of staying faithful, training, staying fit, avoiding those
    things that weren't conducive to a healthy life, which I
    thought were to live well and play well in sports, right, I was
    actually being prepared to give my dad the healthiest,
    strongest kidney possible. Amazing. The transplant went
    flawlessly, and dad returned to Congress when they reconvened
    without missing a vote. I returned to work and playing baseball
    less than 2 weeks later.
        Throughout dad's life and mine we held close to those
    ``Five to Stay Alive'' foundation principles. I placed the name
    on these principles because that's what they meant and still
    mean to me, faith, family, friends, freedom and fitness. In
    closing I'd like to say thank you to Senator Scott, to this
    distinguished panel, to all those guests that are visiting with
    us today virtually, and to tell you thank you for all you're
    doing for us because aging starts at birth, folks. Be fit, be
    active, be well, age well. Thank you and God bless.
        Senator Tim Scott. Thank you, sir.
        Dr. Bowers.

                  STATEMENT OF PERRY A. BOWERS, DMIN,

           FOUNDER & PRESIDENT OF FOCUSED LIVING MINISTRIES,

                        COLUMBIA, SOUTH CAROLINA

        Dr. Bowers, Thank you, Senator Scott, for allowing me the
    honor of discussing the role of prayer, faith, and spirituality
    in aging vibrantly and graciously. I'm thrilled to have been
    married to my beautiful bride for 46 years. We are 68 and 70
    respectively and together have two daughters and six
    grandchildren. I entered the University of Maryland to become
    the world's greatest architect; however, God had other plans
    and has called me to build through the lives of men rather than
    building structures. For 30 years I've been the founding
    president of Focused Living Ministries, which teaches men to
    become husbands and fathers and servant leaders that God has
    called them to be.
        I understand that there are many diverse deeply held faiths
    represented today and online, so I will limit my remarks to the
    God of the Bible and His Son, Jesus Christ, whom I have
    personally experienced and whom I serve.
        God created us with a unity of body, mind, and spirit; but
    the soul is often neglected, yet it should be the most
    important. The spiritual life shapes aging in three vital ways.
        The first way a faith in God promotes vibrant aging is by
    declaring a person's value. We live in a culture and a society
    where value is based on performance, productivity, position,
    and possessions; but with age we gradually lose each of these.
    My 94-year-old father served 26 years in the Navy. Until 75,
    faith and prayer were not very high priorities in his life. He
    performed well as a doctor, was productive with many
    activities, and chaired many prestigious boards. These good
    things would eventually slip away as he ages. Late in life he
    discovered the importance of knowing God, not just knowing
    about God. His new faith taught him that he was created in
    God's image and is valued as a father values his children,
    apart from their performance. This has been the greatest factor
    to help him age with joy, peace, and patience, rather than
    becoming critical, complaining, or pining for past years.
    Understanding that we are created in God's image secures our
    dignity and worth, even as our bodies fade, mental faculties
    decline, and abilities diminish.
        Secondly, worship of, prayer to, and faith in Christ
    dramatically impacts aging by giving purpose. God wired us for
    eternity with a desire to invest in something that will outlive
    us. After retirement the older men with whom I serve crave to
    become involved in something greater than themselves. They
    claim that no matter how fun the game of golf or how satisfying
    it is to travel, serving others is far more fulfilling. Richard
    Butler is 81 and was a successful Blue Cross/Blue Shield
    executive. Several years ago he began a relationship with Jesus
    Christ, choosing to be fulfilled with God's purpose rather than
    fill his life with things that don't matter. Like a tireless
    border collie, he now serves as a school teacher, mentoring
    those who need remedial help, is his church's fix-anything
    handyman, and shepherds young men when they drift off course.
    He understands that a man wrapped up in himself makes a very
    small package.
        Lastly, a secure hope in the living God causes fearless
    aging. One out of one dies, and the process of aging often
    creates much anxiety. God invites us to put our faith in his
    sure character rather than fearing circumstances by placing
    hope in Christ rather than the hype of a philosophy. Those I
    serve reason that if Jesus historically lived, died, actually
    rose from the dead physically as he promised, and presented
    himself alive with overwhelming evidence, then there is real
    hope beyond the grave, and that evaporates fear.
        My 66-year-old brother Kenny married Kathy, raising three
    children while battling cancer until she died. He later married
    Rachel, who also died from cancer. Actually talking to Jesus in
    prayer every day about the crushing adversity of life has
    caused Kenny to overcome the fear of death which often rips
    through his heart as he ages alone. Prayer has shaped him into
    the most joyous, encouraging, positive man on the planet.
    Prayer gives him the right perspective and a proper focus on
    God's character rather than circumstances. No wonder he walks
    seven miles a day praying for countless people who face tragedy
    which only God can turn to triumph.
        A God given value that brings dignity, an eternal purpose
    which yields a fulfilled rather than just a filled life, and a
    secure hope in eternally physical life beyond the grave are
    just three of the real benefits of aging well that come from an
    authentic relationship with God. Thank you for listening to my
    heart.
        Senator Tim Scott. Thank you, Dr. Bowers.
        We'll now enter into the question and answer part of this
    hearing for the next 15, 20 minutes, hopefully. I will say that
    we had an opportunity to of course inform the public that we
    were having this hearing, and so we had some input on some of
    the questions from the public to some extent. One of the
    questions that started, Connie, was about the impact of the
    inflationary effect on our economy; and for seniors living off
    of a fixed income, the increasing prices are having a real
    negative impact on their fixed income. The question that we
    were going to ask is what resources are available through South
    Carolina Department on Aging that address the needs of those on
    fixed incomes, and what are your plans for expanding access to
    those resources. I think sometimes the knowledge of what's
    available is really important, so having you as a part of this
    panel is really helpful. Thank you for being here, and we'll
    give you a few minutes to answer the question about access.
        Ms. Munn. Thank you, Senator Scott. Yes, one of the
    resources that we have available, I think education is key.
        Senator Tim Scott. Yes, ma'am.
        Ms. Munn. I just want to say, first of all, it's been a
    pleasure being here this morning to hear what everyone has to
    say, and I look forward to working with everyone around the
    table to bring more resources.
        We have on our website, the Department on Aging, it's
    called Get Care SC, and that is a resource that's web based,
    but it has all of the resources that are available; over 350
    are listed on that web base. It's very easy for someone to go
    in, a family member, a loved one, to put your ZIP code in, and
    then that way it will take you to the services. Several of the
    services listed are like medication, medical equipment,
    transportation, help with daily tasks; and if you type in that,
    it will bring up the resources. It's governmental, private,
    nonprofit, all types of resources are available there, and so
    that's a resource that we have.
        Also the Area Agencies on Aging have an information,
    referral and assistance specialist; and that is someone that,
    if you call in to the area agency or call our office, we can
    connect you, and they can connect you with resources that are
    available. No matter what the income level is, we can help you
    with those resources.
        Senator Tim Scott. Excellent. Thank you, ma'am. One of the
    things, during your opening statement, you mentioned food
    security, food insecurity, and it's such an important part of
    what seniors wrestle with; and not necessarily a question, more
    so a comment, but just thinking about the importance of the
    issue of food security, energy security, and medicine. Too
    often when the economy gets tight and inflation goes up, our
    seniors are trying to figure out what they can ration, and
    sometimes they ration their medicine, sometimes they ration
    their food, sometimes they have to ration the energy.
        The importance of your role and the site that you've
    mentioned, I want you to mention it one more time, please, is
    incredibly important to folks on a fixed income. We can't take
    for granted that everyone knows where to go to get all the
    information that is available. Sometimes we have to reinforce
    those points because when I travel around and see some of the
    food kitchens or some of the activities around providing
    resources to our seniors, it would be helpful to have a portal;
    and, frankly, you just named a place where you can find out
    about 350 different opportunities for assistance. While we
    certainly live in the most prosperous country on earth, there's
    no doubt that there are too many folks who are still trying to
    make it paycheck to paycheck or Social Security check to Social
    Security check. If you would once again mention your site so
    that we could have that, please.
        Ms. Munn. It's www.getcaresc.com.
        Senator Tim Scott. Thank you very much.
        Ms. Munn. Thank you.
        Senator Tim Scott. That's really important.
        Dr. Ciccone, you know you're next. I thank you for, A,
    taking the time to look up drum ball and B, if you want to tell
    me what it is, I'm happy to listen.
        Dr. Ciccone. According to Google, it is a way for people
    who don't have a lot of mobility to incorporate yoga balls and
    drum sticks with an instructor who leads them in a rhythm
    session, encouraging mental acuity, to follow the rhythm, to
    follow the music, and also get some aerobic exercise in there
    using upper body.
        Senator Tim Scott. You did excellent research.
        Dr. Ciccone. I've been motivated.
        Senator Tim Scott. Mr. Spence, I look forward to your
    answer for drum ball next. What other kinds of activities such
    as walking, playing pickle ball, or even playing with the
    grandkids, can be substituted to improve your health as you get
    older; how can we get our seniors more active? I heard that as
    a theme around the table, to be honest.
        Dr. Ciccone. Well, a lot of the seniors have access to
    local services and access to a pool, so swimming is a total
    body exercise.
        Senator Tim Scott. Yes, sir.
        Dr. Ciccone. It's also safe for patients with orthopedic
    problems because they float; they don't fall. They avoid
    fractures. There's no stress on the joints. In the Healthy
    Lifestyles program we concentrate a lot upon reestablishing
    balance, which is a big problem in seniors. As they become more
    balanced, bicycling or stationary bike becomes important. It
    gives you a great workout. Using an elliptical trainer, the
    cross trainers where you're using upper body and gliding on
    that is very low impact to the joints. Many of the seniors do
    have orthopedic issues, and strengthening the muscles around
    the involved joint creates greater functionality and mobility.
    We've observed this many times in our patients. We had an older
    woman. She was I believe 82. She was an avid gardener. She
    couldn't garden anymore, and when she finished the program she
    was back in the garden, and she could take care of herself and
    do the things that really gave her joy.
        Senator Tim Scott. That's awesome. As a member of the
    senate, I hate compound questions. I really do. I'm going to
    ask one anyway. You said something, at least in the notes I
    wrote down during your opening statement, prevention,
    prevention, prevention, is what I continued to hear in your
    comments. The importance of prevention can't be overemphasized,
    and would you just talk for a minute or so about the importance
    of how we prevent things from happening as opposed to dealing
    with them after they happen? You talked about the metabolic
    rate and the impact, as it slows you grow so to speak.
        Dr. Ciccone. Yes.
        Senator Tim Scott. Are there some things that we can do to
    prevent us from having the conversations that we oftentimes
    have with our physicians?
        Dr. Ciccone. Yes. Thank you. Let me give you some personal
    experience.
        Senator Tim Scott. Yes, sir.
        Dr. Ciccone. I trained as an interventional cardiologist,
    as the guy that did stenting and other important things. I was
    one of the first board certified and fellowship trained
    cardiologists in the United States doing those procedures, and
    I had the unfortunate opportunity to do an emergency
    angioplasty on a young friend of mine, 37 years of age. He got
    through it. He was having an acute heart attack, and I came in
    and stented him, and I committed to prevention at that point.
    My partners at that time did not embrace prevention, and I was
    lobbying to have a prevention part of our practice. That was a
    Saturday night, and on Monday morning I came in and I said, I'm
    going to start this program, realizing that prevention is more
    important that intervention in some regards.
        There are many diseases that affect us as we progress
    through life that are completely preventable, heart disease
    being one of them; not completely preventable, but certainly we
    can observe major impacts in the incidence of the disease, the
    morbidities that are associated, the loss of function, the loss
    of jobs. Prevention is not that hard to do. It involves
    education, which is going to be very, very important going
    forward, and I alluded to that in my opening remarks.
        Senator Tim Scott. Yes.
        Dr. Ciccone. As well as addressing metabolic issues that
    are budding but not fully developed that will, addressed early,
    prevent end organ damage such as strokes and heart attacks,
    peripheral arterial disease, kidney failure. That's why
    prevention is a powerful tool, and it's very cost effective
    because it doesn't require a lot of heavy lifting on the
    patient's part, and it usually does not require a lot of
    medication.
        Senator Tim Scott. It sounds like the ounce of prevention
    and the pound of cure.
        Dr. Ciccone. It's more like a ton of cure.
        Senator Tim Scott. Ton of cure. Thank you for that. Let me
    write that down real quick here. I say that because, when I
    think about your opening statement, it really focused, at least
    in me, a sense of urgency of doing what I can do now to either
    extend healthy living or to prevent some of the challenges that
    you talked about. Thank you for allowing me to ask you what I
    hate, which is a compound question because I can never remember
    the seconds part of the question.
        Ms. Hayes, Ms. Kesha, one of the things I saw in your work
    is to really engage people where they are and your willingness
    to bring people together, and you have something, the Annual
    Senior and Caregiver Expo.
        Ms. Hayes. Yes.
        Senator Tim Scott. You also in your comments, you talked
    about the importance of intergenerational communion, so to
    speak.
        Ms. Hayes. Right.
        Senator Tim Scott. Gathering your grandparents, your
    parents, your kids, and maybe, frankly, your mentees maybe; not
    just within the family, but maybe even outside the family. Will
    you talk a little bit about the expo as well as the importance
    of what we learn from the generations that went before us
    because you were elegant in your presentation about the
    importance of not forgetting that the wisdom that has been
    given to you, you may have the opportunity and the
    responsibility of taking care of those wisdom givers.
        Ms. Hayes. Right.
        Senator Tim Scott. At the same time there's a generation
    that is maybe younger than we are that can help feed in energy
    and vitality into that senior who provided us with wise counsel
    when we desperately needed it. Another compound question. I
    apologize for being a hypocrite on the compound questions, but
    at the end of the day I'd love to hear your perspective.
        Ms. Hayes. Thank you. At the Senior and Caregiver Expo this
    is a time when we have so many different resources, maybe 50 or
    more entities that come, and they are able to be in one place
    because it's so hard for seniors to actually get transportation
    to go to different places to learn about the resources that are
    available; and most of them aren't tech savvy to go on the
    computer and really learn and experiment. This is a place where
    they can come in and go to each table, learn about the things
    that are there for them; but then also the caregivers are there
    too, and we are providing a conversation between the older
    adults and the caregivers. I think the exchange is phenomenal
    because now they get to talk about things that might be
    affecting them as far as proper care, and then they also get to
    learn about each other.
        The intergenerational program is so important because the
    knowledge that's exchanged from one generation to the next, it
    eliminates the stereotypes and the biases that we have for each
    other. You know, older adults might have some things that they
    might be saying about young adults, and vice versa. Also it's
    just the community awareness that it brings when they are able
    to have that social connectedness. Then the health benefits for
    the older adults that get to be involved with younger people
    just makes them more vibrant, and their self-esteem, knowing
    that someone is looking up to them and hearing things about
    their past is just phenomenal, and I think it does so much good
    for both.
        Senator Tim Scott. One final question for you, as we
    transition to my left. You talk a lot about promoting
    companionship and the necessity of purpose.
        Ms. Hayes. Yes.
        Senator Tim Scott. As we age gracefully. Will you talk a
    little bit about purpose as we transition to the left there.
        Ms. Hayes. Yes. Thank you. Great question. You know,
    getting older is something that is going to happen, and the
    purpose of that should be for us to not see the older adult as
    if they are someone that's a burden to us, but really someone
    that we can learn from. Then it's our job as a community to
    make sure that they are contributing in so many different ways
    in our world. As seniors are living longer, they are investing
    in small businesses; they're also investing in the workplace.
        There's so much we can do to promote and elevate them,
    making sure that they are part of the economic growth and the
    sustainability in that and creating opportunities for them to
    age--well, to have age friendly environments, and I think all
    of those things show purpose for them. Even when we talk about
    some ways to promote healthy aging, we're also talking about
    improving their mobility and transportation, having access to
    healthcare, making sure that mobile clinics and different teams
    are going to them in the underserved population. That's why the
    federally qualified health centers are so important and the
    funding for that is necessary. We work with those individuals
    who help our seniors take care of their diabetes and their
    hypertension, and that's so important.
        Then the affordable community living and housing is
    important for them to be able to stay with someone where
    they're not alone in their four walls. Social engagement and
    companionship, it's a matter of life or death for them. If
    you're sitting in four walls and you're not talking to anyone
    and no one's visiting you, who wants to take their diabetic
    medication; who wants to live? Because they feel like no one
    cares about them and they have no reason to live, so it's our
    job to give them that reason.
        Senator Tim Scott. That is a blessing.
        Ms. Hayes. Thank you.
        Senator Tim Scott. Thank you for that.
        Ms. Ross-Karl, I wanted to transition to you based on
    purpose because some of what you were talking about, in my
    opinion, is not just wearing the crown and the sash, it's
    having a purpose. It seemed to be so fitting that what Ms.
    Hayes was talking about, companionship and purpose, and what
    you're working on is not simply how to be your best now; it's
    how to find your best purpose as well. Your activities that you
    talked about, climbing mountains and walls, you just are very
    active, so will you talk to me and talk to us a little bit
    about the importance of, frankly, how the Senior America
    Pageant came about, but also how that helps fulfill the void of
    purpose.
        Ms. Ross-Karl. Thank you. I am so glad I get to go after
    Ms. Hayes because the Ms. Senior America Pageant was born
    because its founder was worked in a nursing home, and it was
    gloomy, and the women were very depressed; and he decided if
    you put a crown and a sash on that woman and had a pageant,
    that he would give them purpose. That is exactly how Senior
    America was born 42 years ago. That purpose is, God gave you
    two hands. One is to take care of yourself because if you don't
    take care of yourself, then you can't be helpful to anyone
    else. The purpose is be the best we can be, and that purpose is
    just to share our enthusiasm, I mean, we have great performers,
    we do good works all over. Put us to work, guys. We'll come and
    see you on your senior day. You know, we'll help launch the new
    month of September as the National Senior Day. You know, we're
    in the fall of our lives. What a perfect partnership that would
    be. Our purpose is just to be helpful wherever we can.
        Senator Tim Scott. What a blessing. Thank you so much.
        Mr. Spence, following these powerful women, you have a
    tough act to follow.
        Mr. Spence. Yes.
        Senator Tim Scott. But you're ready.
        Mr. Spence. I can't follow that properly, obviously, but in
    their wake I shall try.
        Senator Tim Scott. One of the things I'm getting from the
    entire panel is the importance of resiliency and how do you
    build resiliency into your life and into your purpose and your
    passion. You do that multiple ways, obviously. Dr. Bowers
    talked about the role of faith in our lives, no matter whether
    you believe as he does or if you believe as many millions of
    other Americans who have different faiths. The importance of
    purpose cannot be denied, and resiliency and purpose seem to be
    first cousins or synonyms, so to speak.
        Would you talk a little bit about, you certainly focused on
    the physical, but that physical makes you stronger mentally;
    and then you also spoke about sacrifice. You were in a
    position, because of your resiliency and a life well invested
    in physical fitness, to extend the life of your father, which
    anybody that missed that part missed a major part of this
    entire time that we have sat here.
        Mr. Spence. Thank you.
        Senator Tim Scott. Will you just talk about how you build
    resiliency, not just from a fitness perspective. I, like you,
    started off at Health Quest, then went to Life Quest, then went
    to World Fitness, then went to O2, and I'm at Crunch too; so,
    literally, I was chuckling in writing down my journey in
    fitness. Resiliency is a part of that willingness to keep on
    moving when the place that you were is no longer.
        Mr. Spence. Yes, sir. Well, resiliency takes on a whole lot
    of forms.
        Senator Tim Scott. Yes, sir.
        Mr. Spence. I'm in awe of our distinguished panel here and
    the amazing technical aspects of it, but also too just the
    emotion of it all as well because that's really why we do what
    we do. The collection of people here I think together have
    coordinated mind, body, spirit, and it creates something--I
    believe Henry Ford called it the concept of mastermind. He
    couldn't have built the automobile, but he knew how to put
    together a group of people that could build an automobile; and
    kind of, like they say, the rest is history. I'm actually
    driving a Ford right now. I think that's a concept, in putting
    this panel together, and also working together in the Senate
    and working in the House of Representatives in coordination
    with a lot of funding for different agencies and everything as
    well too, the prevention aspect of things. I don't think you
    can deny how much importance that puts on it. I love the ton of
    cure instead of the pound of cure. I think that's so much more
    important because, again, I think money that's spent in
    prevention creates a return on investment that ultimately will
    lead to a decrease in the money invested because we're not
    trying to treat the end result, we're trying to prevent what
    could occur.
        Senator Tim Scott. Absolutely.
        Mr. Spence. That's an ideal structure. What I might say is
    this too, and I appreciate you mentioning about kind of
    perseverance and everything as well.
        Senator Tim Scott. Request yes, sir.
        Mr. Spence. Life itself, we have this grand idea that it's
    going to turn out just perfect. I thought, just by what
    happened in my life, that my opportunity in sports, because I
    tried to do the right things all the way through, still do, and
    everything. You know, it was one of the those things where you
    think, well, gosh, if I'm doing all the right things, all the
    best things are going to happen to me; and it did all the way
    through high school. I played four sports, so I was cross-
    training, that sort of thing that we do. What I found was it
    was bringing me success on the field. I was doing well in
    schooling and everything else too because, again, there is a
    connection, I think, connection between physical and the mental
    and the psychological; and I think that's extremely important.
    Spiritual was also. I was a member of Fellowship of Christian
    Athletes when I was in high school and also in college at the
    University of South Carolina.
        As I made it to the North/South All-Star Game--and, again,
    this is my story, but it hits so many people. Everything was
    laid out for me. I had my scholarship. Everything was going
    great. I was playing with Freddie Solomon who was my
    quarterback from Sumter, who was an amazing athlete, God rest
    him. He was my quarterback, and I started on offense and
    defense in the all-star game. I said, God has just blessed me
    with this opportunity. It's amazing. Boy, it just worked great;
    and we won the game, but I didn't get to play the last half
    because a fellow tackled me and I broke my ankle just before
    the first half ended. All of a sudden everything I had laid out
    before me didn't quite turn out the way I thought it should.
        Now, again, I had a spiritual aspect, connecting to Dr.
    Bowers, that allowed me to kind of understand that it's God's
    will. I go back to university. Man, I rehab, I trained, and I
    worked back, stronger than I was before. Gosh, got over there
    and played and everything else, and it was just going great;
    and a knee operation. Okay. That's fine. That's another thing.
    That's fine. Come back from that; another knee operation. Come
    back from that; another broken ankle. All of a sudden I'm
    looking at it saying, okay, I thought I was headed to pro ball
    here or something like that. What do you have in mind for me?
        It didn't come immediately, but as my life played out
    before me, God was using those instances to prepare me for an
    opportunity to effect other peoples' lives by saying, oh,
    you've had that happen to you, well, let me tell you something,
    I can empathize with you. Empathy is gold because when you can
    empathize with someone and share your story with them, you can
    create in them an opportunity to try to create their own story
    that might take them beyond where they were, which they thought
    maybe that's just the end; maybe I just need to settle. No.
    Don't want settle. I want you to grow with me, and we're going
    to grow together through all of this.
        I think that's what's important because, again, it does tie
    in spiritual, mental, physical in the whole concept of it and
    even together something greater than all of us by ourselves.
        Senator Tim Scott. Excellent. Thank you. Going to take
    another five or 6 minutes before we close the hearing out and
    I'm going to ask another round of rapid-fire questions here.
        Dr. Bowers, you mentioned obviously faith a lot; but
    something you also mentioned that caught my intention was the
    importance of companionship. Your brother with his two spouses
    who passed away from cancer; your 46 years of marriage. As we
    think about aging gracefully, the role of companionship.
        Well, a lot of different areas of that, first of all
    marriage and so forth, we do, when we work with these men
    throughout the State, we help them learn how to be the
    husbands--God invented marriage; here's what God's desire and
    design is for marriage. We help them to learn how to care for
    that woman, for the woman to care for the man, and that
    companionship that God's given them. Also friendship. A lot of
    men don't have friends, deep friends that will walk them
    through everything. We've got several--every morning somewhere
    in Columbia we're meeting in men's forums, anywhere between 20
    to 40 guys, and there's a tremendous companionship there as
    well as community. A lot of times, we mentioned it here, but so
    many times the aged, as you get old, they remove themselves
    from community instead of getting into community. We've got to
    be helping each other.
        Love the two hands illustration you gave, one to help
    yourself but also one to help others. We've got to be serving
    one another. S we emphasize that a lot and the whole idea of
    scripture talks about community. God, trinity, Father, Son, and
    Holy Spirit, is a community. God talks about the church is a
    community, called out ones. It's throughout scripture. God
    says, you cannot live apart from being a part of a team.
        Thank you very much. As we close out this hearing, and
    certainly we've enjoyed the answers to the questions. Certainly
    I, frankly, am enjoying asking questions more than I do
    answering questions, so this has been a great experience for
    me. There is, without question, a surge in our Nation right now
    with the Delta variant and the impact it's having. I think I'd
    be remiss if I didn't at least ask a quick question of Dr.
    Ciccone, and perhaps all of us around the table, to talk about
    the importance of the vaccine and, frankly, of masking up when
    necessary and important. I know that this is not necessarily a
    part of the aging theme specifically. Frankly, if you think
    about the aging community and the most vulnerable community,
    the pandemic is a major part of it. For me not to mention that,
    I think I would regret it.
        Not only to Dr. Ciccone, but I will say that I've heard
    some rumors and some facts. I would love for you to weigh in a
    little bit on this if you don't mind. You may not be prepared
    for this. I'll ask anyway. I just read some stats that say that
    President Trump and President Biden and every living president
    has been vaccinated; that all 50 Governors, Republicans and
    Democrats, have been vaccinated; that the vast majority of
    Congress, heading toward 100 percent of Congress, vaccinated;
    96 percent of physicians, American physicians, vaccinated.
    Those who are dying from this pandemic today, 90-plus percent,
    unvaccinated. Accurate? Thoughts?
        Dr. Ciccone. Yes. I think there's a couple of points about
    the Delta variant. First of all, this is not SARS-2. It's not
    the original coronavirus. It's much more infectious. It's
    affecting the younger population symptomatically, whereas SARS-
    2 did not affect the younger population symptomatically very
    much at all, and the mortality in that population was virtually
    zero.
        What we're seeing is, nationwide and locally here, about 15
    percent of vaccinated persons are contracting the Delta variant
    and becoming infected. That may be because of waning immunity
    because most of us were vaccinated, particularly first
    responders, we were vaccinated in December and January; and
    we're past that 6-month window where we think that immunity
    starts to drop off. The importance of vaccination can't be
    emphasized more. We're learning more about when we should have
    boosters and whether those will be effective and how effective
    they will be.
        When you have a virus that affects a lot of people--a virus
    mutates when it makes a mistake in copying its DNA, and when
    there's more people infected, there's more opportunity for
    variations, and we're beginning to see that now with the Mu
    variant. We don't know enough about that as to whether it's
    going to be as bad as the Delta variant, but the Delta variant
    was certainly worse than the original SARS-2 and has put a
    tremendous strain on our system.
        Fortunately, in the Roper St. Francis system, we have
    tremendous dedication from our nurses, doctors, and from our
    ancillary staff. Even with best intentions, the kids are
    getting sick; the moms who are nurses have to stay home and
    take care of them. The nurses, other ancillary personnel, are
    subject to infection, and they do get it. We're kind of
    stressed to the limit here, but because of the flexibility and
    the leadership that we have in our system, we have been able to
    manage a real significant crisis. It is something that was
    unanticipated. We knew that we would always have to flex into
    certain populations and certain challenges, but we've never
    been stressed to this level.
        I think that, to your point, vaccination is extremely
    important, masking up, especially in closed situations. You
    know, like this is fine, but if you're in a closed environment,
    masking up does help.
        Senator Tim Scott. Yes.
        Dr. Ciccone. I think to get correct information out there
    is so important. There's been a lot of misinformation, and with
    social media you can basically put anything out there and it
    doesn't have to be the truth. I think a consistent message from
    the government that is factually based will allay a lot of
    people's fears. A lot of people are afraid because they're not
    trusting.
        Senator Tim Scott. Certainly. I know I've been vaccinated
    and looking forward to the booster, whenever it comes out
    there.
        One other question for the panel for anyone who wants to
    weigh in specifically to answer this question briefly, as we're
    committed to getting out of here 3 minutes ago. The importance
    of virtual opportunities to engage with seniors I think is
    still top of the mind because, frankly, as we head out the
    doors today and back into normal life in many ways, one of the
    goals we'll have is to keep seniors integrated and
    communicating; and sometimes that's going to require virtual
    communication, whether it's fitness training, I know that today
    you can turn your TV on and see 1,000 commercials for how to
    get a trainer and to do life from a fitness perspective from a
    distance. Certainly, Ms. Hayes, I think about expos and ways to
    have people come together maybe virtually. I know that this
    hearing for the most part is being done virtually to take into
    consideration the health and well-being of the seniors who
    hopefully are still tuned in right now.
        I think it's really important for us to not leave without
    giving seniors some encouragement about the ability, the
    opportunities that may unfold over the next few months of
    having, frankly, your doctors seen virtually. Virtual
    healthcare is something that I'm, telemedicine, I've been
    focused on and will continue to push legislation that makes it
    more available. From health and fitness to beauty pageants to
    expos to our Director on Aging, I'd just love to hear just
    quick comments on how we can encourage our seniors to engage in
    life virtually and not just sit home, four walls, and asking
    yourself, is it worth it. The answer, of course, is it's worth
    it; but let's give them a little reason to understand why we
    know that it is.
        Ms. Munn. I'll start.
        Senator Tim Scott. Yes, ma'am.
        Ms. Munn. Basically, we have, very quickly, a broadband
    initiative that we have done with Palmetto Care Connections,
    which is actually connecting our seniors with telehealth, with
    being able to talk with their families, and they also provide
    digital literacy training. What we've found, you know, as we
    talk about resilience, our seniors are resilient. We have seen
    that during COVID. They've stepped up. They've been utilizing
    iPads that we provide for them, and that's a pilot project that
    we hope to provide across the State. For the Enhance program
    that we discussed earlier there can be Zoom meetings. Most
    important, it keeps you connected with family and friends and
    loved ones and your churches as well. We know all of our
    churches went remote and Zoom. It gives them that opportunity.
        Senator Tim Scott. I even figured out how to use Zoom. It's
    really easy. If I can figure it out, anybody can figure it out,
    so just know that.
        Anything you want to add, Dr. Ciccone?
        Dr. Ciccone. Yes. Let me just speak to the telemedicine
    part of this. COVID gave us bad things, but it also gave us an
    opportunity to get patients used to telemedicine visits. We're
    going to go beyond telemedicine. We're going to go to virtual
    care. Whether that is the social part of it, to give social
    support to seniors in need and the companionship that was
    mentioned; or whether it's actually virtual care where you're
    having meaningful visits with remote patient monitoring.
    Particularly in this COVID age, where we send patients home
    from the emergency department with specific criteria to go
    home, and if you're feeling worse, you let us know, we're
    relying on the patients, but we don't have remote monitoring.
    That's something that Roper St. Francis is very much active in
    in the hospital at home; whereas we'll be able to monitor those
    patients more carefully with remote patient monitoring and
    perhaps avoid a lot of admissions, particularly to the ICU, and
    ultimately avoid mortality in those patients. That's going to
    be a very burgeoning part of the healthcare market right now.
        Senator Tim Scott. Excellent. Any other thoughts from
    anybody else who wants to add in?
        Ms. Hayes. I just want to point out that even though we
    were social distancing physically, I think that we should be
    mindful that we don't do it emotionally too, that we keep the
    connectivity there. When there are virtual activities that are
    happening, all of us need to make sure that we get the word out
    to those entities that are servicing our aging beauties so that
    they know about it.
        Senator Tim Scott. Mr. Spence.
        Mr. Spence. Just quick, one of my other sidelines is I'm
    actually a supervisor with South Carolina DHEC. I work with the
    COVID data entry program. I was vaccinated with Pfizer vaccine
    back in March of this year. I see every day, you know those
    numbers that you see on TV, the teams that I work with,
    actually we put those out for the upState region and all around
    the other regions of the State. I've seen the younger
    population being affected by this Delta variant.
        Also, when I hit about the six month point, guess what, I
    was a break through case. The Delta variant hit me, but because
    I had been fit, thank goodness, I have a pulse oximeter at
    home. Checked it regularly. Never did my lung function go below
    about 95 percent. The key on this, the vaccine may not of have
    kept me from getting the Delta variant, which is more
    transmissible. Obviously it's like superglue around your cells.
    What it did was give me a milder case, but it gave me a long
    haul. I'm a long hauler. Took me about fiv weeks to get through
    it. It felt like three-a-day practices or something. The key on
    that is I got through it. I did not require hospitalization. At
    no point did I feel like I needed to go there.
        I also used for people, to help prevent things, a virtual
    cycling class that I did. My oldest person was 82 years old. I
    believe you talked about your golfer. Eighty-two years old; the
    youngest was about 38 years old. They stayed with me for a year
    and a half during COVID riding with me, and that was good.
        I want to share something from DHEC. A young lady of 102
    years old in the upState region went in, and she was
    interviewed as she was getting vaccinated. They said, why in
    the world, you're 102 years old, why would you want to get
    vaccinated. She said I'm 102 years old. I've lived a long time.
    I ain't through living yet.
        Senator Tim Scott. I like that.
        Mr. Spence. I kind of like that.
        Senator Tim Scott. I'm going to stop on that point right
    there. There's no better place to stop than at 102, in this
    discussion. It's good for her to continue living, by the way.
    Didn't want to be misunderstood there. Let me just say this
    too, thank you all, this has been fun to me, enjoyable,
    informative, educational, very helpful. I would say without any
    question I think the people of South Carolina and around the
    country that have watched this have left encouraged, inspired,
    and motivated to do something that they may not have been doing
    before. Certainly it's been a joy to have this first hearing in
    South Carolina and would also remember that in the next few
    decades, hopefully we'll all be here by 2060, couple years
    away, one out of four Americans will be over the age of 65, one
    out of four. We are a population aging. Dr. Ciccone talked
    about the fact that our mortality rate is one for one I think
    it was, right? That's going to happen, right? Our birth rates
    are falling, though.
        Dr. Ciccone. Yes.
        Senator Tim Scott. We're doing one thing that is 100
    percent guaranteed. The other one we're not doing enough of.
    We've got some challenges heading our way if we don't figure
    some things out.
        I do want to say thank you to the Waring Senior Center, and
    specifically to Ms. Elizabeth Bernat, the center's director.
    She's standing in the back. Thank you for allowing us to use
    this beautiful location to talk about the importance of living
    gracefully, especially in our golden years. I'm very proud of
    this facility. Keith, you and your family, I thank you for a
    family of service and servants, actually, more importantly
    servants.
        I will say that at this point, please note that the
    committee members will have until Wednesday, September 22 to
    submit questions for the record, something that we do at every
    hearing. Thank you all for attending. To our virtual audience,
    I hope you too walk away with a lot of good information. I'm
    hopeful that you will visit Ms. Connie Munn's website so that
    you can learn about the 350 ways you may be able to help
    yourself. If you need more assistance, please look to her site.
    For all of those who have invested the last 90 minutes with us,
    we are very thankful for that and look forward to talking to
    you sometime in the near future. God bless you, and this
    concludes the hearing.
        (Hearing concluded at 11 a.m.)

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                                    APPENDIX

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                          Prepared Witness Statements

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