[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                     
          
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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

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                                                                   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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