[Senate Hearing 118-322]
[From the U.S. Government Publishing Office]



                                                        S. Hrg. 118-322

                        THE OLDER AMERICANS ACT:
                         SUPPORTING EFFORTS TO
                       MEET THE NEEDS OF SENIORS

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





                                HEARING

                                 OF THE

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS

                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                                   ON

       EXAMINING THE OLDER AMERICANS ACT, FOCUSING ON SUPPORTING  
                 EFFORTS TO MEET THE NEEDS OF SENIORS
                               __________

                             MARCH 7, 2024
                               __________

 Printed for the use of the Committee on Health, Education, Labor, and 
                                Pensions




                           
              
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                  U.S. GOVERNMENT PUBLISHING OFFICE 

55-851 PDF                WASHINGTON : 2024 















                 BERNIE SANDERS (I), Vermont, Chairman
PATTY MURRAY, Washington             BILL CASSIDY, M.D., Louisiana, 
ROBERT P. CASEY, JR., Pennsylvania     Ranking Member
TAMMY BALDWIN, Wisconsin             RAND PAUL, Kentucky
CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
TIM KAINE, Virginia                  LISA MURKOWSKI, Alaska
MAGGIE HASSAN, New Hampshire         MIKE BRAUN, Indiana
TINA SMITH, Minnesota                ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico            MITT ROMNEY, Utah
JOHN HICKENLOOPER, Colorado          TOMMY TUBERVILLE, Alabama
ED MARKEY, Massachusetts             MARKWAYNE MULLIN, Oklahoma
                                     TED BUDD, North Carolina

                Warren Gunnels, Majority Staff Director
              Bill Dauster, Majority Deputy Staff Director
                Amanda Lincoln, Minority Staff Director
           Danielle Janowski, Minority Deputy Staff Director 













           
                             C O N T E N T S

                               ----------                              

                               STATEMENTS

                        THURSDAY, MARCH 7, 2024

                                                                   Page

                           Committee Members

Sanders, Hon. Bernie, Chairman, Committee on Health, Education, 
  Labor, and Pensions, Opening statement.........................     1
Cassidy, Hon. Bill, Ranking Member, U.S. Senator from the State 
  of Louisiana, Opening statement................................     4

                           Witnesses--Panel I

Alwin, Ramsey, President and CEO, National Council on Aging, 
  Arlington, VA..................................................     5
    Prepared statement...........................................     8
    Summary statement............................................    16
Hollander, Ellie, President and CEO, Meals on Wheels America, 
  Arlington, VA..................................................    17
    Prepared statement...........................................    19
    Summary statement............................................    25
Kubik, Martha Y., Ph.D, RN, FAAN, Professor of Nursing, College 
  of Public Health, George Mason University, Fairfax, VA.........    26
    Prepared statement...........................................    28
    Summary statement............................................    29
Branham, Michelle, Secretary, Florida Department of Elder 
  Affairs, Tallahassee, FL.......................................    31
    Prepared statement...........................................    33
    Summary statement............................................    34
Hutchins, Dorothy, Virginia Older Adult, Alexandria, VA..........    35
    Prepared statement...........................................    37

                          Witnesses--Panel II

Barkoff, Alison, Principal Deputy Administrator and performing 
  the duties of the Administrator and Assistant Secretary for 
  Aging, Administration for Community Living, U.S. Department of 
  Health and Human Services, Washington, DC......................    50
    Prepared statement...........................................    51

                          ADDITIONAL MATERIAL

Statements, articles, publications, letters, etc.
Sanders, Hon. Bernie:
    AARP, Statement for the Record...............................    60
    ADvancing States, Statement for the Record...................    63
    Alzheimer's Association and Alzheimer's Impact Movement, 
      Statement for the Record...................................    64
    Diverse Elders Coalition, Statement for the Record...........    65
    Elder Justice Coalition, Statement for the Record............    69
    The National Association of Nutrition and Aging Services 
      (NANASP), Statement for the Record.........................    70
    Philadelphia Corporation for Aging, Statement for the Record.    70
    USAging, Statement for the Record............................    73

 
                        THE OLDER AMERICANS ACT: 
                         SUPPORTING EFFORTS TO
                       MEET THE NEEDS OF SENIORS

                              ----------                              

                        Thursday, March 7, 2024

                                       U.S. Senate,
       Committee on Health, Education, Labor, and Pensions,
                                                    Washington, DC.

    The Committee met, pursuant to notice, at 11:03 a.m., in 
room 430, Dirksen Senate Office Building, Hon. Bernard Sanders, 
Chairman of the Committee, presiding.

    Present: Senators Sanders [presiding], Casey, Baldwin, 
Murphy, Kaine, Hassan, Smith, Hickenlooper, Markey, Cassidy, 
Collins, Braun, and Marshall.

                  OPENING STATEMENT OF SENATOR SANDERS

    The Chair. The Senate Committee on Health, Education, 
Labor, and Pensions will come to order. Before we get to the 
Older Americans Act, which is an issue of enormous consequence, 
I just wanted to say a few words on--briefly on some of the 
subjects.

    First, as all of you know, this Committee has spent a lot 
of time on the high cost of prescription drugs in America and 
the fact that in some cases we pay ten times more for the same 
products that people in other countries pay.

    This Committee did an investigation an exhaustive 
investigation on inhalers. Millions of people have asthma and 
obesity, and it is very difficult for them to pay for the 
products that they need.

    During the last couple of weeks, among other things, I have 
talked to the major manufacturers of those inhalers, or four 
major ones. Two of them were receptive. Two of them not so 
much.

    But I am very happy to mention today that one of those 
manufacturers, Boehringer Ingelheim, announced that it is 
substantially lowering the cost of their inhalers in America by 
making sure that every uninsured or underinsured patient in the 
country will pay no more than $35 for those devices.

    That is a big deal, and I very much appreciate the step 
forward by Boehringer Ingelheim and we look forward to the 
other manufacturers following suit. On another issue, I wanted 
to tell you what all of you know, and that is the minibus that 
was passed by the House yesterday and will soon, I expect, be 
passed by the Senate contains new funding for community health 
centers, the National Health Service Corps, and teaching health 
centers.

    These issues this Committee has worked hard on. The 
community health center program will go up from $4 billion in 
mandatory funding to $4.4 billion. The National Health Service 
Corp will go up from $310 million in funding to $364. And the 
teaching health center will go up from $126 million to $175 
million.

    Now, given the dysfunctionality of the U.S. Congress, these 
are not insignificant steps forward. But given the crisis that 
we face in primary health care, we are not accomplishing 
anything near what we have got to do.

    The system is completely broken. We waste enormous amounts 
of money when people end up in the emergency room in a hospital 
because they don't get the primary care they need. So, my point 
is, I look forward very much to continuing the work that we 
have begun on primary health care and seeing if we can do a bit 
more in the remaining months ahead of us.

    Let's get to the subject matter of the day, and that is the 
Older Americans Act. According to the OECD, 23 percent of 
seniors in America are living in poverty, compared to just 12 
percent in Canada, and 9 percent in Germany, and 4.4 percent in 
France. Further, one out of every four seniors in America is 
trying to survive on an income of less than $15,000 a year, and 
I am not quite sure how anybody can survive on $15,000 a year.

    Today, we will be paying attention to the urgent unmet 
needs of millions of seniors in America and what we should do 
as a society to reduce the senior poverty rate, to reduce 
hunger, and to improve the health and well-being of our parents 
and grandparents, the people who helped build this country.

    In America today, 12 million seniors are dealing with food 
insecurity. Quite unbelievable, but true. Nearly a quarter of 
our Nation's seniors are considered to be socially isolated, a 
huge issue. And more than one out of every four seniors suffer 
from falls, tragic falls, the leading cause of death from 
injury among our elderly population.

    Something we don't pay enough attention to. Nearly 95 
percent of adults over the age of 60 have a chronic health 
condition, and 80 percent have two or more chronic conditions 
like high blood pressure, arthritis, and diabetes.

    Seniors throughout our Country, particularly in rural 
areas, lack the transportation they need to get to a doctor's 
office, the grocery store, or the dentist. And that should not 
be happening in the richest country in the history of the 
world. In my view, both from a moral and from an economic 
perspective, we cannot turn our backs on the millions and 
millions of seniors who are hurting and who desperately need 
our help today.

    Here is the good news. The good news is we have a very 
effective piece of legislation on the books to address the 
urgent needs of vulnerable seniors, and that is the Older 
Americans Act. And I want to thank all of our panelists and so 
many people around the country who have worked so hard on that 
piece of legislation.

    The Older Americans Act provides Federal funding for many 
essential services for our Nation's seniors, including helping 
older adults live at home rather than end up in nursing homes. 
Supporting our Nation's caregivers' activities to combat 
loneliness and isolation, preventing disease, job training, 
protections from abuse, and rides to the doctor's office and 
grocery store.

    Importantly, and this is maybe the main point of today, 
about 45 percent of funding from the Older Americans Act is 
used to provide meals to millions of frail and isolated seniors 
through Meals on Wheels program and through congregate meal 
programs at senior centers.

    When we talk about the Older Americans Act, let's not 
forget 45 percent of the funding goes to nutrition programs for 
seniors who need them. And I suspect all of us have been to 
senior centers and seen the effectiveness of the congregate 
meal program and the Meals on Wheels program.

    Let us be clear, this is a point that needs to be made over 
and over again, these nutrition programs not only provide good 
nutrition, but anyone who understands the Meals on Wheels 
program knows that it is important it is not just the actual 
meals. Literally it is somebody knocking on the door, saying 
hello, asking how you are doing, breaking through the 
isolation.

    That is what Meals on Wheels program does, and we thank all 
the volunteers who are involved in those efforts. But not only 
does the Older Americans Act save lives and ease human 
suffering, it saves money.

    I am almost thinking, Senator Cassidy, that we should 
change the name of this Committee to the prevention committee. 
Because as a Nation, what we do is end up spending a fortune 
after people end up in the emergency room, in the hospital, 
rather than keeping them out of it.

    We treat kids, we don't get the quality education they 
need, and they end up in jail. So, we should be focusing on 
prevention. That is certainly what the Older Americans Act is 
about. If seniors do not get the nutrition they need and 
seniors become malnourished, what happens to those seniors?

    Well, if you are malnourished, by definition, you are going 
to get sick more often than you should. If you are old and you 
are sick, where do you end up? You are going to end up in the 
emergency room. At great expense to Medicare and Medicaid, you 
can end up in the hospital. A great expense to our health care 
system.

    Matter of fact, malnutrition among seniors today costs our 
society over $50 billion each and every year, a rather an 
incredible amount of money. The truth is, it makes a lot more 
sense to provide adequate nutrition to frail seniors than to 
spend money on preventable hospital costs.

    In fact, and I love this number here, it costs less to feed 
a senior, one senior, for an entire year through the Older 
Americans Act than it does for a senior to spend one night in a 
hospital. Feed a senior for a year or spend one night in a 
hospital.

    Well, I think it is a better idea to feed that senior. 
Providing adequate nutrition to seniors, new services for 
seniors also reduces the need for nursing home care. People 
would rather stay at home than end up in nursing home--in 
nursing homes, and that is what Meals on Wheels and other 
programs do.

    Bottom line is here, and what is of concern to this 
Committee is since 2016, despite increased demand that a 
massive increase in the number of seniors in America, funding 
for the Older Americans Act has gone down by nearly 20 percent 
after adjusting for inflation--20 percent in real dollars.

    As a result, seniors who are desperate for nutrition food 
are being put on waiting lists that can last for months. So, we 
have a choice, either we are going to respond to the crises 
facing seniors, adequately fund these programs, or we don't.

    My strong hope is that we go forward and do the right 
thing.

    Senator Cassidy.

                  OPENING STATEMENT OF SENATOR CASSIDY

    Senator Cassidy. Thank you, Chairman Sanders. And two 
things about your opening comments. It is good that Boehringer 
is going to offer those inhalers at $35, but we have learned is 
that when the insulin providers say that they provided an 
insulin at $35, pharmacy benefit managers wouldn't carry it.

    I think it is incumbent upon us to say--to get our PBM 
reform legislation, which we worked on a bipartisan basis in 
this Committee, signed into law. And that is going to take not 
just this Committee, but the entire Senate and the House 
Republicans in the House is to collaborate.

    We are not there yet, but anyone that can pick up a phone, 
call, we need to get that done so that the benefits of that 
actually occurs as merely being something which just wouldn't 
it be nice, but it actually doesn't impact someone's life.

    Second, just a typo and I am sure is an oversight, it is 
good that we have increased the funding for the community 
health centers. It is $4.27 billion, not $4.4, but it shows 
what can happen when we actually work together with reasonable 
numbers and try and make things happen, and that is when this 
Committee is at its best.

    Now returning to the Committee at hand and thank our 
witnesses for being here. Really appreciate it. And one by 
zoom, which I wonder why everybody isn't by zoom because that 
would obviously be more efficient.

    We are discussing the reauthorization of the Older 
Americans Act, or the OAA, legislation empowering American 
seniors to live healthy and independent lives in the settings 
they choose the lifestyle they choose. One of our Members of 
the panel just got her hair dramatically cut. Said it was a 
celebration of her 66 birthday.

    We see that seniors can live on the wild side. So, I just 
want to kind of comment on that right off the bat.

    [Laughter.]

    Senator Cassidy. First enacted in 1965, the OAA provides 
funding to support essential services to aging Americans 
through nutrition--through programs such as nutrition, 
caregiver support, and elder abuse prevention.

    We have, historically in Congress, come together on a 
bipartisan basis to reauthorize this, strengthen its support 
for all seniors. Post-COVID, we need to look at and make sure 
the programs that we are authorizing work. If they are not 
working, improve them. And make sure that those scarce taxpayer 
dollars are being put to maximum benefit.

    How do we build on what works? Replace that which does not. 
During the pandemic, OAA service providers had to adapt, and I 
would tour many of those places seeing how are you doing it 
differently.

    My gosh, they were quick on it. We should take lessons 
learned during the pandemic and use that new knowledge as how 
we can better serve those whom we intend to serve. The OAA is a 
foundation, but it was never meant to meet all needs and we 
have to be clear about that.

    It is also important to understand how to use public 
private, partnerships to leverage this funding to expand 
services beyond the reach of this funding. Today, we will hear 
about some of those partnerships. Again, thank you for being 
here. Maximizing the reach of these dollars requires strong 
organizations on the state and local level.

    We appropriate. It has to be implemented on the state and 
local level. So how do we support those state units and those 
local units to maximize their effect? One of our witnesses 
today, Secretary Michelle Branham, will speak to us about how 
she has successfully done this in Florida, which I think has 
one of our old--one of our--probably the largest population of 
seniors.

    She is looking at me. She is making sure that I don't diss 
Maine. I understand that Maine has got a lot of seniors. 
Believe me, I know Senator Collins. But anyway, Florida has 
just got a bigger population than you. You got to walk a 
tightrope around here, you know what I am saying.

    [Laughter.]

    Senator Cassidy. This year, the HELP Committee will need to 
pass legislation reauthorizing the program, and I am glad to 
join Chair Sanders in leading a bipartisan working group with 
Senators Collins, Braun, Mullin, Casey, Kaine, and Markey.

    With this group, with our stakeholders, we are going to 
come forward with a bipartisan reauthorization, improving the 
lives of all of those who we call senior citizens. I appreciate 
the Chair for engaging. I look forward to hearing from you.

    The Chair. Thank you, Senator Cassidy. We have a wonderful 
panel. Our first witness is Ms. Ramsey Alwin, the President and 
CEO of the National Council on Aging.

    The National Council on Aging has been a national voice and 
advocate for older adults since 1950 and provides resources and 
advocacy to ensure that every person can age with health and 
financial security.

    Ms. Alwin, thank you so much for being with us.

           STATEMENT OF RAMSEY ALWIN, PRESIDENT AND CEO,  
             NATIONAL COUNCIL ON AGING, ARLINGTON, VA

    Ms. Alwin. Thank you for having us. And thank you to the 
Chairman and Ranking Member for your support, your leadership 
on this important topic today, and the bipartisan workgroup 
that you have initiated together.

    We greatly appreciate that leadership. For nearly 75 years, 
the National Council on Aging has operated under the principle 
that aging well in America should be a right, not a privilege 
for the few.

    We applaud the leadership of the Chairman for initiating an 
effort to ensure the Older Americans Act can reach all 
Americans with an appropriations letter, with 41 other Senators 
supporting doubling the support for the program.

    Thank you for that important leadership, because we know 
from our work every day with partners from across the country 
helping older adults secure jobs, enroll in programs that can 
help with food and medicine, and learn how to better manage 
their chronic conditions and prevent falls, there is more need 
and demand than ever before, and this reauthorization is an 
opportunity to strengthen and modernize the act to meet those 
needs.

    Before I get started on our recommendations, I would like 
to share one story of millions that we have collected over the 
years. Ms. West is a family caregiver in her 60's, and she 
shared with our team, navigating all the challenges my mom has 
faced these past few years has been difficult.

    The death of my father, moving in with my husband and I, 
cancer, and surgery, not to mention COVID. Yet after she had a 
fall, the local senior center connected us to the capable team. 
The capable team came into our home with fresh eyes and ears, 
years of experience, and kind hearts.

    They helped by offering home modification ideas we hadn't 
thought of and resources we didn't even know existed. Our home 
is now better equipped to keep my mom safe, and we have a plan 
for the future as her needs increase. She has even gotten 
involved in the senior center and made some new friends.

    Ms. West shares, I wish every senior could have the peace 
of mind all of this has offered us. Stories like this one and 
so many more informed the recommendations I will share with you 
today. We know more than 90 percent of older adults live in 
communities, and the Older Americans Act plays a critical role 
in providing non-medical professional services to ensure all 
can age well at home.

    Our priorities for this reauthorization begin with senior 
centers, which are a time tested model to deliver on the 
promise of the Act. A visitor to a senior center can come into 
exercise, get screened for benefits, take an art class, get a 
hot meal and socialize, learn a new language, or find purpose 
through volunteering.

    Despite all this important work, senior centers face 
chronic budget shortfalls and are not generally funded by the 
Older Americans Act. Through reauthorization, Congress has an 
opportunity to ensure that a modern senior center is available 
to every American.

    We must address lessons learned from the pandemic, 
reinstate a separate title for senior centers, strengthen the 
authorization for modernizing them, and increase funding for 
senior nutrition programs to allow for parity between home 
delivered and congregate meal settings.

    Our second priority is healthy aging. We know that chronic 
conditions are the leading cause of frailty, disability, and 
death in the U.S., but we also know there are evidence based 
programs that make a difference. They save lives and they save 
money.

    For instance, participants in that capable program around 
home modifications to prevent falls on average save $30,000 to 
the health system. Participants in the chronic disease self-
management program are shown to save $700 per participant in 
emergency room and hospital visits.

    Given that 80 percent of older adults have two or more 
chronic conditions, we believe that chronic disease self-
management program should be offered and available in every ZIP 
code, which is not the case today.

    Title 3(d) of the Act supports this work, but funding has 
not kept pace with the growing needs and costs. To expand 
reach, reauthorization should double the authorized funding 
levels for Title 3(d) and expand the continuum of programs 
funded to include those that are evidence formed as well as 
evidence based.

    Our third priority is direct care workforce and the desire 
for home and community based services. Funded by ACL, NCOA 
leads the Direct Care Workforce Strategy Center, which is 
working to address the workforce shortage crisis with state 
systems change.

    We ask that reauthorization strengthen authorities for 
sustained funding for this center to increase technical 
assistance and training for states that are looking for 
creative solutions to build that workforce given the increase 
in demand.

    Finally, the Act is critical to ensuring the economic 
security of older adults, especially those that need and want 
to continue to work. Since 1968, NCOA has served as a National 
Administrator of the Senior Community Service Employment 
Program, or SCSEP.

    A Department of Labor program that is authorized and funded 
under the Act, SCSEP is the only Federal job training program 
focused exclusively on helping older Americans return to the 
workforce.

    The majority of participants are women and people of color, 
and the job training provides more than a job. It is dignity, 
its purpose, its security. We advocate for lowering the 
eligibility for the program from 55 to age 50 and raising the 
income eligibility from 125 percent of Federal poverty to 200 
percent of the Federal poverty level.

    Reaching people earlier, as well as those on the edge, will 
enable more to benefit from this successful program, providing 
them the income, the security, the purpose needed to age well, 
and they will continue to be taxpayers. In conclusion, the 
Older Americans Act provides a critical blueprint for ensuring 
we have the infrastructure needed in our Country to support all 
of us as we age.

    Now is the time to modernize and strengthen the Act to meet 
the needs of today and tomorrow so that every American, 
including each of us here today, can age well. Thank you, and I 
am happy to take any questions you may have.

    [The prepared statement of Ms. Alwin follows.]
                   prepared statement of ramsey alwin
                              Introduction
    Chairman Sanders, Ranking Member Cassidy, and Members of the Senate 
Committee, thank you for the opportunity to speak with you today about 
the vital need to reauthorize, modernize, and fund the Older Americans 
Act OAA to support the needs of older adults.

    I am Ramsey Alwin, President and CEO of the National Council on 
Aging NCOA, the Nation's oldest organization focused on serving older 
adults. For nearly 75 years, we have worked to improve the lives of 
older Americans, especially vulnerable and underserved populations. 
From advocating for passage of the original Older Americans Act, 
Medicare, and Medicaid, to helping end mandatory retirement, NCOA has 
operated under the principle that aging well in America should be a 
right for all, not a privilege for a few.

    NCOA's goal is to improve the health and economic security of 40 
million older adults by 2030, especially women, people of color, LGBTQ, 
low-income, and rural individuals. Working with thousands of national 
and local partners, we provide resources, tools, best practices, and 
advocacy to ensure every person can age with health and financial 
security. Every day, our team works to help individuals secure job 
training and placement, enroll in programs that help with the cost of 
food and medicine, better manage their chronic conditions like diabetes 
and hypertension, and prevent falls. All our insights from our direct 
service delivery inform our reauthorization recommendations.

    The OAA is integral to achieving NCOA's vision of a just and caring 
society in which each of us, as we age, lives with dignity, purpose, 
and security. First enacted in 1965, the OAA establishes priorities and 
operations for key programs and services that help keep our Nation's 
adults ages 60 and older healthy and independent.

    The OAA is the designated vehicle to plan for and provide 
professional assistance to older Americans and their families, 
providing the many nonmedical care services that older adults often 
need and complementing the support provided by Medicare, Medicaid, and 
Social Security. The Act provides the blueprint that encompasses the 
full range of services and supports that address vital social 
determinants of health and allow all of us to age well in community and 
at home as desired. Further, OAA-funded services and supports have been 
shown to reduce health care costs and delay nursing home placement. \1\ 
Given that greater than 90 percent of older adults live in communities, 
\2\ we must recognize the OAA's critical role in supporting family 
caregivers who are the backbone of long-term care for older adults.
---------------------------------------------------------------------------
    \1\  https://www.liebertpub.com/doi/10.1089/pop.2017.0199.
    \2\  https://aspe.hhs.gov/reports/understanding-characteristics-
older-adults-different-residential-settings-data-sources-trends-
0#exhibit2.

    Reauthorization of the OAA provides a critical opportunity to 
strengthen and revitalize its many important provisions. Previous 
bipartisan reauthorization efforts have created innovative new programs 
that have significantly improved the lives of older adults, their 
---------------------------------------------------------------------------
caregivers, and the Aging Network. For example:

          The Supporting Older Americans Act of 2020 created a 
        Research, Demonstration and Evaluation Center for the Aging 
        Network. The purpose of the Center is to coordinate research, 
        evaluation, and demonstration projects and increase the 
        repository of information on evidence-based programs and 
        interventions available to the Aging Network. \3\ This work 
        will help us understand how the Aging Network can improve the 
        lives of older adults and do its part in slowing the growth in 
        expenditures of programs like Medicare and Medicaid.
---------------------------------------------------------------------------
    \3\  https://www.aginganddisabilitybusinessinstitute.org/wp-
content/uploads/2021/05/Policy-Spotlight-OAA-Research-FINAL-508.pdf.

          The OAA Amendments Act of 2006 created the National 
        Center for Benefits Outreach and Enrollment. The Center 
        supports a network of community-based organizations that find 
        and enroll low-income beneiciaries--generally with annual 
        incomes below $22,000--in benefits programs they are eligible 
        for. Thanks to this work, from 2022-2023, 9.3 million low-
        income older adults and individuals with disabilities were 
        connected to benefits \4\ that enable them to afford 
        prescription drugs and other needed health care, as well as 
        food and energy assistance.
---------------------------------------------------------------------------
    \4\  https://www.ncoa.org/article/helping-lower-income-adults-
afford-Medicare.

          The 2000 OAA reauthorization created the National 
        Family Caregiver Support Program, which provides grants to 
        states and territories to fund a range of supports that assist 
        family and informal caregivers to care for their loved ones at 
        home for as long as possible. Grantees provide information to 
        caregivers about available services, individual counseling, 
---------------------------------------------------------------------------
        support groups, caregiver training, and respite care.

    Today's realities demand that we examine the OAA with fresh eyes 
and with innovation at the forefront. The OAA must be modernized to 
better address the needs of the diverse and growing older adult 
population, which includes not only the Silent Generation and Baby 
Boomers, but also Generation X, whose members start to turn 60 in 2025.

    According to the U.S. Census Bureau, from 2010 to 2020, the 65-plus 
population experienced its largest-ever percentage-point increase--from 
13.0 percent to 16.8 percent of the total population. Before 2010, it 
took 50 years--from 1960 to 2010--for the older population's share of 
the total population to grow by the same number of percentage points. 
\5\
---------------------------------------------------------------------------
    \5\  https://www.census.gov/library/stories/2023/05/2020-census-
united-states-older-population-grew.html.

    The older population is also increasingly diverse. In 2020, 24 
percent of individuals ages 65 and older were members of racial or 
ethnic minority populations. Over the next two decades, the white non-
Hispanic older population is expected to grow by 26 percent, while 
older racial and ethnic minority populations are expected to increase 
by 105 percent, as the younger more racially and ethnically diverse 
generation ages. \6\
---------------------------------------------------------------------------
    \6\  https://acl.gov/sites/default/files/Proile%20of%20OA/
2021%20Proile%20of%20OA/2021ProileOlderAmericans-508.pdf.

    While demand for OAA services is growing and diversifying, OAA 
funding is not keeping pace. This financial reality has made it 
increasingly difficult for the Aging Network to maintain existing 
services, let alone expand. The supplemental funding Congress provided 
to the Aging Network during the COVID-19 pandemic was critical to 
helping older adults most at-risk and in greatest need. But today, the 
demand for these services continues, while the relief funds are running 
out. The pandemic sharply underscored the value of and critical need 
for additional investment in OAA programs. 

                            NCOA Priorities

    As the leading advocate on behalf of older adults and the Aging 
Network, NCOA has several priorities that we believe should be included 
in this year's OAA Reauthorization. Our priorities focus broadly on 
senior centers, healthy aging, and economic security. 

                             Senior Centers

    For more than 80 years, senior centers have provided access to 
support services and opportunities for healthy aging in a highly social 
setting in towns and neighborhoods across the Nation. The OAA has 
recognized their importance for 50 years--by including multi-purpose 
senior centers in 1973 and by establishing the senior nutrition 
program. In the establishment of the Aging Network, senior centers were 
to be given special consideration as community focal points to deliver 
OAA services on a local level. Today, an estimated 11,000 senior 
centers operate locally, sometimes hyper locally, as gathering places 
for generations of older adults to stay active, healthy, and connected.

    Research shows that older adults who participate in senior center 
programs experience better mental health across several measures 
compared to non-participants, including perceived social and health 
benefits, \7\ depression, \8\ friendship, \9\ and stress levels. \10\ 
Compared to their peers, senior center participants have higher levels 
of health, social interaction, and life satisfaction.
---------------------------------------------------------------------------
    \7\  Gitelson, R., McCabe, J., Fitzpatrick, T., & Case, A. 2005. 
Factors that influence perceived social and health benefits of 
attendance at senior centers. Activities, Adaptation & Aging, 30, 23-
45.
    \8\  Choi, N., & McDougall, G. 2007. Comparison of depressive 
symptoms between homebound older adults and ambulatory older adults. 
Aging Mental Health, 11, 310-322.
    \9\  Aday, R., Kehoe, G., & Farney, L. 2006. The impact of senior 
center friendships on aging women who live alone. Journal of Women & 
Aging, 18, 57-73.
    \10\  Farone, D., Fitzpatrick, T., & Tran, T. 2005. Use of senior 
centers as a moderator of stress-related distress among Latino elders. 
Journal of Gerontological Social Work, 46, 65-83.

    Senior centers are a time-tested model to deliver on the promise of 
the Older Americans Act. They provide for the ``maximum co-location of 
services,'' which differentiates them from other community-based 
organizations. A visitor to a senior center can come to exercise and 
also get screened for benefits, take an art class and get a hot meal, 
or learn a new language and find purpose through volunteering. At their 
core, senior centers are places that foster social connection and 
belonging, addressing the epidemic of loneliness \11\ identified by the 
U.S. Surgeon General.
---------------------------------------------------------------------------
    \11\  https://www.hhs.gov/sites/default/files/surgeon-general-
social-connection-advisory.pdf.

    Senior centers also serve as critical lifelines for many older 
adults in the community. This was never more evident as during the 
pandemic that brought a disproportionately harsh impact on older 
adults. Senior centers across the country sprang into action, ensuring 
that older adults, especially the most vulnerable, had credible 
information; access to nutrition through meal delivery, grab-and-go 
meals, and grocery shopping services; and social engagement through 
online programs, parking lot parties, drive-through programs, and 
thousands upon thousands of phone calls. With deep knowledge of their 
communities, senior centers creatively pivoted to meet ever-changing 
needs. Many moved programs from in-person to virtual. Today, their in-
person participation is rebounding, and those with capacity continue to 
offer virtual options for older adults who cannot attend the center due 
to transportation or health issues. When vaccines became available, 
senior centers stepped in to facilitate appointments, provide 
---------------------------------------------------------------------------
transportation, and host clinics.

    Senior centers are also an integral part of the OAA senior 
nutrition program. The OAA created two delivery systems for nutrition--
congregate meals Title III-C1 and, for those unable to access a 
congregate meal, home-delivered meals Title III-C2. The pandemic 
demonstrated the importance of elevating both home-delivered meals and 
congregate meals as equally important vehicles for fighting senior 
hunger and addressing social isolation. These proven and effective 
community-based programs have more than 50 years of experience, 
expertise, and trust to serve those in greatest need. However, with 
rising costs and increasing demand, merely maintaining current funding 
levels is not enough. We need to increase the authorization level and 
provide greater parity to support both approaches at scale.

    Senior centers are the most common site for congregate meals. 
During the pandemic, we saw innovation in meal delivery such as grab-
and-go meals and virtual options for dining with friends. The 
flexibility to implement innovative solutions should be maintained and 
encouraged, as should local flexibility, with limits, to shift funds to 
the most-needed services. However, the OAA should continue to recognize 
and prioritize them as distinct programs and fund them equally and 
adequately. Sharing a meal is one of the most treasured traditions of 
social connection. We must support the modernization of the congregate 
meal, in conjunction with senior centers, to ensure current and future 
generations of older adults have this opportunity.

    While they provide these critical services, senior centers, in 
general, are chronically underfunded. They rely on municipal dollars, 
philanthropy, and fundraising. While some are operated by Area Agencies 
on Aging AAAs, especially when the AAA is part of county government, 
most are not. They are part of municipal government or nonprofit 
community-based organizations. In 1978's Older Americans Act 
Reauthorization, senior centers were placed in the consolidated Title 
III-B, Support Services and Senior Centers. In the allocation of scarce 
resources and without a requirement that any percentage of the 
appropriation for III-B be directed to senior centers, senior centers 
generally are not funded by the OAA. They might get funding on a 
service unit reimbursement rate (e.g., for meal delivery) but not for 
general programs, operations, or facility needs.

    Senior centers that received investments from the American Rescue 
Plan (ARPA) saw innovations that were not possible before. ARPA was an 
infusion of funding that supported innovations like grab-and-go meals, 
allowed communities to make renovations or purchase equipment (for 
exercise, technology, kitchens, etc.), and shored up the senior 
nutrition program. ARPA showed us what was possible with better 
support. However, once ARPA funds are expended, those innovations will 
not likely be funded, and the programs that were supported will, again, 
face budget shortfalls.

    NCOA has been the national voice for senior centers for more than 
50 years. We have over 2,300 senior centers in our affiliate network 
and, through a 3-year cooperative agreement with the U.S. 
Administration for Community Living (ACL), we have established a 
Resource Center for the modernization of senior centers. Through this 
work, we see some senior centers that are modernizing and thriving with 
new or renovated facilities that support today's technological needs, 
fitness programs, evidence-based programs, meal options, and services 
to address complex issues like homelessness and behavioral health. 
These centers also provide support for economic security through 
information and referral and benefits enrollment. They have 
collaborative partnerships with organizations and businesses in their 
communities, with aging network partners like AAAs, and with community 
partners like libraries, parks and recreation, and public health. New 
models of senior centers, including public/private partnerships, 
wellness centers, and intergenerational centers have been developed.

    But not all senior centers are thriving. NCOA conducted an 
environmental scan, which identified the successes and challenges of 
senior centers today. Inadequate support, both in recognition of their 
value and in the allocation of resources, is at the top of the list of 
challenges. \12\ Centers do not have the funding and direction needed 
to upgrade their facilities, to access technology, and to ensure a 
skilled workforce. The centers that struggle the most are those in 
areas of greatest need.
---------------------------------------------------------------------------
    \12\  https://www.ncoa.org/article/the-state-of-todays-senior-
centers-successes-challenges-and-opportunities.

    Through OAA Reauthorization, Congress has an opportunity and 
obligation to provide the focus and funding that will ensure that a 
modern senior center--one that addresses the needs of current and 
future generations of older adults in a way that is culturally 
---------------------------------------------------------------------------
meaningful--is available in every ZIP code.

    OAA Reauthorization should:

          Address lessons learned from the pandemic related to 
        promoting equitable access to senior center services, 
        addressing diverse needs, and pursuing innovation in nutrition 
        programs.

          Ensure strong congregate settings in the community by 
        reinstating a separate title for senior centers and updated 
        language that retains the ``special consideration'' of senior 
        centers as designated focal points and by strengthening support 
        for multipurpose senior center infrastructure and services, 
        while allowing for the flexibility capacity for virtual 
        connections.

          Strengthen the authorization for modernizing senior 
        centers.

          Increase the authorization level of senior nutrition 
        programs to allow for greater parity for both home-delivered 
        meals and congregate meals approaches to be equally funded at 
        scale. 
        
                             Healthy Aging 
                             
                      Title III-D Health Promotion 
                      
    Chronic conditions are the leading cause of frailty, disability, 
and death in the United States. They lead to declining activities of 
daily living ADLs, causing affected individuals to lose their 
independence, require help from family and/or paid caregivers, and need 
long-term services and supports. Yet, there are evidence-based health 
promotion and disease prevention programs that we know can help and 
work.

    NCOA has been a leader in expanding access to health promotion and 
disease prevention programs, many of which have been shown through 
research to reduce or delay expensive hospital or nursing home 
admissions. Through education, outreach, and community programs, NCOA 
provides older Americans with the tools and resources they need to age 
well--physically, cognitively, and mentally. Through our ACL-funded 
National Chronic Disease Self-Management Education and Falls Prevention 
Resource Centers, NCOA provides broad support and technical assistance 
to state agencies and community-based organizations delivering these 
programs.

    These health promotion and disease prevention programs result in 
positive health outcomes related to managing chronic disease, 
preventing falls, increasing physical activity, and reducing symptoms 
of depression and social isolation. These well-researched programs have 
resulted in health care cost savings for participants: \13\
---------------------------------------------------------------------------
    \13\  https://www.ncoa.org/article/falls-prevention-programs-
saving-lives-saving-money-infographic.

          A Matter of Balance, a falls prevention program, 
---------------------------------------------------------------------------
        reduces total annual medical costs by $938 per participant.

          The Otago Exercise Program reduces falls by 35 
        percent, resulting in net savings of $429 per participant.

          The Community Aging in Place Advancing Better Living 
        for Elders Program (CAPABLE) provides home modifications to 
        reduce falls risks resulting in more than $30,000 in medical 
        costs savings.

          The Chronic Disease Self-Management Program (CDSMP) 
        shows participants saved $714 in emergency department visits 
        and hospital utilization. If 10 percent of Americans with one 
        or more chronic conditions were reached by CDSMP, there's 
        potential for $6.6 billion in savings. \14\
---------------------------------------------------------------------------
    \14\  Lorig K, Ritter P, Stewart AL, et al. Chronic Disease Self-
Management Program: 2-Year Health Status and Health Care Utilization 
Outcomes. Medical Care. 2001;39:1217-1223.

    Given that 80 percent of older adults experience two or more 
chronic conditions, NCOA believes CDSMP should be offered in every ZIP 
code across the U.S. in an effort to save lives and decrease health 
care costs. CDSMP is a workshop for adults with at least one chronic 
health condition, which may include diabetes, heart disease, or 
arthritis. Given that chronic conditions are the primary drivers of 
health care costs and disability, as well as declines in quality of 
life, we must ensure that anyone with a chronic illness has access to 
this program. CDSMP focuses on critical disease management skills, 
including decision-making, problem-solving, and action planning. The 
program increases confidence, physical and psychological well-being, 
knowledge of ways to manage chronic conditions, and motivation to 
manage challenges associated with chronic diseases. Interactive 
educational activities include peer discussions, brainstorming, action-
planning and feedback, behavior modeling, problem-solving techniques, 
and decision-making. The program also results in behavior change, such 
as more exercise and relaxation, better communication with health care 
providers, healthy eating, medication management, and better management 
---------------------------------------------------------------------------
of fatigue.

    The delivery of these programs to older adults is funded by OAA 
Title III-D. Funding amounted to $26.3 million in the fiscal year 2023 
Federal budget; this funding is shared across all states, territories, 
and the District of Columbia. Beginning in 2012, ACL required that 
programs funded by Title III-D meet strict evidence-based criteria 
defined as proven effective for improving the health and well-being or 
reducing disease, disability, and/or injury among older adults; and 
proven effective with older adult population, using experimental or 
quasi-experimental design; and results published in a peer-review 
journal; and fully translated in one or more community site(s); and 
includes developed dissemination products that are available to the 
public.

    However, not all these programs are reaching older adults in need, 
especially in rural and diverse communities. This lack of access is due 
in part to inadequate funding under OAA Title III-D, which has not kept 
pace with growing needs and costs to deliver evidence-based programs. 
Congress and the Administration must address lessons learned from the 
pandemic related to promoting equitable access to services, addressing 
diverse needs, and expanding healthy aging programs that are offered 
both in-person and virtually. For example, the costs associated with 
delivery of virtual programs are significantly higher in most cases 
than in-person programs due to greater technology and staffing needs.

    NCOA recognizes that evidence-based programs have some 
implementation challenges and inequities. Most have not been tested 
with a full diversity of populations, communities, or contexts. Some 
communities struggle to implement them as designed. Therefore, we 
advocate for expanding the continuum of programs funded under the OAA 
to include those that are ``evidence-informed,'' defined as an approach 
in which ``practitioners are encouraged to be knowledgeable about 
findings coming from all types of studies and to use them in an 
integrative manner, taking into consideration experience with a program 
or intervention and judgment, clients' preferences and values, and 
context of the interventions.'' \15\
---------------------------------------------------------------------------
    \15\  Adapted from: Nevo, I., & Slonim-Nevo, V. 2011. The myth of 
evidence-based practice: toward evidence-informed practice. British 
Journal of Social Work, 411, 1-22.

    NCOA is proud to be leading the Innovation Lab through funding from 
ACL's Center for Performance and Evaluation. We are partnering with 
researchers to take a ``core-components'' approach to identify what is 
truly necessary to achieve the ultimate goal--better outcomes for 
people and communities. This broader approach gives communities the 
flexibility to deliver programs that match their capacity and meet the 
needs of their culturally diverse populations. This core components 
methodology is being applied to falls prevention interventions, and we 
believe it has significant potential across other areas of aging 
---------------------------------------------------------------------------
services such as nutrition and chronic disease management.

    OAA Reauthorization should:

          Double authorized funding levels for OAA Title III-D 
        to support the licensing, training, technology, and other costs 
        required for implementation of evidence-based programs.

          Expand the continuum of programs funded under the OAA 
        to include those that are ``evidence-informed.'' 
        
                              Jane's Story 
                              
    One of our participants, a 76-year-old woman, initially relied on a 
walker for mobility. However, as she diligently engaged in the 
exercises taught in our sessions, her progress was remarkable. By the 
third session, she entered class confidently using only her cane, 
brimming with pride at her newfound ability. Her excitement was 
palpable as she shared how these exercises had significantly improved 
her mobility and daily activities. Her husband, who accompanied her to 
class, echoed her joy, thrilled to engage in activities together that 
had been out of reach for a while. 

                   Home Safety and Home Modifications 
                   
    NCOA also advocates for using OAA reauthorization to enhance 
resources for home modification screenings and implementation. Older 
adults are living longer in the community, many with chronic conditions 
and disabilities that impact their daily function and risk for falls. 
Across older households, 28 percent have at least one person who has 
difficulty using some element of the home, such as climbing stairs or 
bathing. \16\ The home's condition affects a person's ability to care 
for themselves and caregivers' ability to provide care. Home 
modifications that increase safety and support daily activities play a 
key role in helping people stay in their homes and communities as they 
age. Yet, fewer than 4 percent \17\ of U.S. homes are suitable for 
people with moderate mobility disabilities, and only about 1 percent 
are wheelchair accessible. OAA Title III-B funding can be used to fund 
home modifications, but it is capped at $150 per person based on a 1988 
Federal regulation. In many states, this would not cover the cost to 
install a grab bar. States can request Federal permission to waive that 
cap, but this can be time-consuming, and many are not aware of this 
option or how to go about it.
---------------------------------------------------------------------------
    \16\  https://www.census.gov/library/publications/2013/demo/h150-
11.html..
    \17\  https://www.jchs.harvard.edu/research-areas/working-papers/
how-well-does-housing-stock-meet-accessibility-needs-analysis-2019.

---------------------------------------------------------------------------
    OAA Reauthorization should:

          Remove the outdated $150 per person home modification 
        cap and give states more flexibility and control to support 
        their older population's ability to age in place. 
        
                         Direct Care Workforce 
                         
    Between 2021 and 2031, the direct care workforce is projected to 
add more than 1 million new jobs, resulting in a total of 9.3 million 
direct care jobs need to be filled, \18\ according to PHI. Low wages, 
lack of full-time employment, and the pandemic have caused fewer 
workers to enter direct care at the exact time the need for their 
services is growing.
---------------------------------------------------------------------------
    \18\  https://www.phinational.org/resource/direct-care-workers-in-
the-united-states-key-facts-2023/.

    Funded by ACL, the Direct Care Workforce Strategies Center, housed 
at NCOA, is addressing this challenge by supporting state systems 
change through the provision of resources, technical assistance, and 
training to state systems, providers, and stakeholders to improve 
---------------------------------------------------------------------------
direct care workforce recruitment, training, and retention.

    This Center addresses the charge of OAA and its National Family 
Caregiver Support Program enacted as part of the 2000 OAA 
reauthorization to build and strengthen the care infrastructure needed 
to address the pressing challenges that threaten the independence, 
health, and economic security of older adults who rely on the support 
of family caregivers.

    OAA Reauthorization should:

          Strengthen authorities for sustained funding for the 
        Direct Care Workforce Strategies Center beyond five years to 
        increase dissemination of state technical assistance and 
        training opportunities to ensure an adequate and well-trained 
        direct care workforce. 
        
                           Economic Security

    Older adults are more likely to face economic insecurity as they 
age. In 2023, poverty among older adults rose for the third consecutive 
year to 14 percent. \19\ An analysis conducted by NCOA and the 
LeadingAge LTSS Center at the University of Massachusetts, Boston found 
that of people age 60 and older, 80 percent 47 million do not have the 
financial resources to cover long-term care services or another 
financial shock, nearly 20 percent of older households have no assets 
to draw upon to withstand a financial shock, and 21-80 percent of older 
adults have modest assets but would still be unable to afford more than 
2 years of nursing home care or 4 years in an assisted living 
community. \20\
---------------------------------------------------------------------------
    \19\  https://www.ncoa.org/article/older-adult-poverty-continues-
upward-trend-reaching-an-unacceptable-14-percent.
    \20\  https://www.ncoa.org/article/80-percent-of-older-americans-
cannot-pay-for-long-term-care-or-withstand-a-inancial-shock-new-study-
shows.

    An important factor in determining older adults' economic security 
is the geographic location of their primary residence. Regions such as 
the Northeast and the West Coast have a higher cost of living compared 
to states in the Sunbelt region. NCOA urges Congress and the 
Administration to modernize and increase flexibility in the 
determination of economic need with proven tools such as the Elder 
Index, \21\ which is a more accurate measure of the income older adults 
need to meet their basic needs and age in place with dignity. It 
includes household size, geographic location, housing, and health 
status in determining costs of living. The Elder Index is updated 
annually to include the latest Consumer Price Index data to account for 
inflation costs. Elder Index data show that nearly half of older adults 
live alone, and one in five older couples are economically insecure and 
cannot pay for necessities. \22\ The costs of necessities in every 
state exceeds the Federal poverty thresholds used in eligibility 
requirements for benefits programs.
---------------------------------------------------------------------------
    \21\  https://elderindex.org/.
    \22\  Mutchler, Jan; Su, Yan-Jhu; and Velasco Roldan, Nidya, 
``Living Below the Line: Economic Insecurity and Older Americans, 
Insecurity in the States, 2022'' 2023. Center for Social and 
Demographic Research on Aging Publications. 66.

    The Elder Index also shows that the average Social Security benefit 
does not cover the cost of basic expenses. Researchers from the 
University of Massachusetts, Boston reported that the average Social 
Security benefit only covers 68 percent of the costs for basic 
necessities for a single person living alone and 81 percent for couples 
living together. \23\ This gap identifies the reality that many older 
adults must use other means to cover their basic costs either by 
working, withdrawing from savings and other retirement accounts, or 
relying on social safety net programs such as the Supplemental 
Nutrition Assistance Program SNAP or Medicare Savings Programs.
---------------------------------------------------------------------------
    \23\  https://kfhealthnews.org/news/article/elder-index-aging-
costs-seniors-basic-necessities/.

---------------------------------------------------------------------------
    OAA Reauthorization should:

          Modernize and increase flexibility in the 
        determination of economic need with proven tools such as the 
        Elder Index to ensure the local cost of living are addressed as 
        future generations are expected to age with limited financial 
        resources.

                           Christian's Story 
                           
    Christian, 61, lives with disabilities and relies on a fixed income 
of $1,156 monthly. He relocated to Windsor, VT, to assist his 93-year-
old father with his care. Christian previously paid $148.50 for 
Medicare, along with co-pays for medications, without receiving 
assistance for food, fuel, or prescriptions. Unfamiliar with available 
resources in Vermont due to being a non-native, Christian faced 
financial strain when prescribed a new medication with a $500 co-pay. 
With the help of a local benefits enrollment center, Senior Solutions, 
Christian received a tablet for telehealth, facilitating his connection 
with family in New York and easing access to medical services. 
Additionally, Christian applied for food benefits, fuel assistance, and 
pharmacy aid programs, promptly receiving a tablet for telehealth, a 
SNAP card with $202 for food, $56 for fuel assistance, and relief from 
his Medicare Part B premium, qualifying him for Medicaid after a $60 
spend down. Thrilled by these benefits, Christian anticipates saving 
for a car, resulting in monthly savings exceeding $500. These supports 
allow Christian to continue to care for his father and himself, both 
remaining independent.
                             Older Workers 
                             
    For millions of Americans, aging well means having the opportunity 
to work in the years leading up to and beyond the traditional 
retirement age. The reasons older adults want or need to work are the 
same as at any age. Work provides meaning, social connections, and 
much-needed income to pay for daily needs. As longevity continues to 
climb and many Americans struggle to save enough for retirement, work 
is also essential to affording a longer life. This is especially true 
for older adults of color, who experience higher rates of poverty than 
white older adults, and among rural and LGBTQ+ older adults who face 
access barriers and discrimination in employment.

    Since 1968, NCOA has served as one of several national 
administrators for the Senior Community Services Employment Program 
SCSEP. Today, we provide SCSEP services in 11 states and Puerto Rico, 
including Georgia, New York, North Carolina, and Pennsylvania. This 
work has given us clear insight into the value older workers contribute 
to our economy.

    A Department of Labor program that is authorized and funded under 
OAA, SCSEP is the only Federal job training program focused exclusively 
on helping older Americans return to the workforce. It prioritizes 
services to veterans, individuals with disabilities, those living in 
rural communities, and other most-in-need older adults who have low job 
prospects and significant barriers to employment. Significant 
majorities of participants have incomes below the 125 percent Federal 
poverty line, are women, and are people of color. The program enables 
them to develop new skills and add work experience through subsidized 
community training assignments with local nonprofit organizations.

    SCSEP incorporates benefits coordination and access to wraparound 
services. Older workers--particularly low-income individuals with 
significant barriers to employment--have traditionally been left behind 
by public workforce systems and strategies. Many have been out of the 
workforce due to caregiving responsibilities, health and disability 
challenges, and age discrimination. For many, the traditional 40-hour 
week and year-round employment placement envisioned in Workforce 
Innovation and Opportunity Act WIOA and other public workforce programs 
are not appropriate. These systems lack the targeted, one-on-one 
counseling and assistance many older workers require for successful 
training and re-employment.

    However, the impact on ageism starts much before age 55. We 
advocate for lowering SCSEP eligibility to 50, so we can broaden the 
impact of the program by helping people retool their skill set earlier 
in life. Similarly, we recommend broadening the income eligibility to 
at or below 200 percent of the Federal poverty level to recognize that 
those who are slightly over the current cap still need the help of a 
program like this. If we focus on younger individuals with slightly 
more income initially, we will be able to further decrease the curve of 
individuals falling into a position that requires Federal benefits and 
Medicaid.

    OAA Reauthorization should:

          Update SCSEP eligibility to make it available to 
        adults 50 years and older.

          Adjust income eligibly guidelines to allow for 
        individuals with incomes at or below 200 percent of the Federal 
        poverty level to improve access for older workers struggling 
        with financial security and employment.

                             Susan's Story 
                             
    At age 75, Susan learned of the NCOA SCSEP program while waiting at 
her doctor's office. Unsure of what to expect, but in dire need of 
work, she took a chance and dialed the number listed on the flyer, 
hoping for assistance. At the Crawford County Read Program, Susan found 
fulfillment in helping people of all ages improve their literacy and 
basic math skills. However, when the program faced closure due to 
funding issues, Susan feared returning to financial uncertainty.

    Thankfully, another opportunity arose swiftly, and Susan embarked 
on training as a receptionist at an organization dedicated to mental 
health awareness. As Susan's tenure in the program approached its 
conclusion, her colleagues recognized her value and advocated for her 
to join the team permanently. In a remarkable show of support, Susan's 
coworkers collectively urged management to hire her full-time.

    Now secure in her job and an active taxpayer, Susan expresses a 
newfound sense of relief, stating that she can finally relax knowing 
she has stable employment. She passionately shares her experience with 
others, emphasizing the vital role of SCSEP in assisting older adults 
facing employment obstacles, noting that the program can be a lifeline 
for many.
                               Conclusion 
                               
    The OAA provides our Nation with a blueprint for ensuring we have 
the infrastructure in place to support individuals across the full 
spectrum of domains related to aging in community and at home as we all 
desire. The various titles of the Act intentionally and thoughtfully 
support an ecosystem for deploying services and supports that reflect 
the needs of states and communities, prioritizing the most vulnerable.

    With nearly 12,000 people turning 65 each day this year and for the 
next several years, we applaud ACL's leadership in updating the Act 
with the recently released OAA regulations, largely building upon 
lessons of the pandemic, and we also recognize that demographic trends 
require us to further align Federal, state, and local programs with the 
needs of today and tomorrow. We appreciate this opportunity to offer 
our priorities to reauthorize, modernize, and fund the Older Americans 
Act to ensure every American can age well.
                                 ______
                                 
                  [summary statement of ramsey alwin] 
                  
    NCOA appreciates the opportunity to discuss the vital need to 
reauthorize, modernize, and fund the Older Americans Act (OAA) to 
support the needs of older adults. From advocating for passage of the 
original OAA to helping end mandatory retirement, NCOA has operated 
under the principle that aging well in America should be a right for 
all, not a privilege for a few.

    Today's realities demand that we examine the OAA with fresh eyes 
and with innovation at the forefront. The OAA must be modernized to 
better address the needs of the diverse and growing older adult 
population, which includes not only the Silent Generation and Baby 
Boomers, but also Generation X, whose members start to turn 60 in 2025.

    While demand for OAA services is growing and diversifying, funding 
is not keeping pace. This financial reality has made it increasingly 
difficult for the Aging Network to maintain existing services, let 
alone expand. The supplemental funding Congress provided during the 
COVID-19 pandemic was critical to helping older adults most at-risk and 
in greatest need. But today, the demand for these services continues, 
while the relief funds are running out.

    NCOA has several priorities that we believe should be included in 
OAA Reauthorization:

          Senior Centers: (1) Address lessons learned from the 
        pandemic related to promoting equitable access to senior center 
        services, addressing diverse needs, and pursuing innovation in 
        nutrition programs; (2) Ensure strong congregate settings in 
        the community by reinstating a separate title for senior 
        centers and updated language that retains the ``special 
        consideration'' of senior centers as designated focal points 
        and by strengthening support for multipurpose senior center 
        infrastructure and services, while allowing for the flexibility 
        capacity for virtual connections; (3) Strengthen the 
        authorization for modernizing senior centers; (4) Increase the 
        authorization level of senior nutrition programs to allow for 
        greater parity for both home-delivered meals and congregate 
        meals approaches to be equally funded at scale.

          Title III-D Health Promotion: (1) Double authorized 
        funding levels for OAA Title III-D to support the licensing, 
        training, technology, and other costs required for 
        implementation of evidence-based programs and (2) Expand the 
        continuum of programs funded under the OAA to include those 
        that are ``evidence-informed.''

          Home Safety and Home Modifications: Remove the 
        outdated $150 per person home modification cap and give states 
        more flexibility and control to support their older 
        population's ability to age in place.

          Direct Care Workforce: Strengthen authorities for 
        sustained funding for the Direct Care Workforce Strategies 
        Center beyond five years to increase dissemination of state 
        technical assistance and training opportunities to ensure an 
        adequate and well-trained direct care workforce.

          Economic Security: Modernize and increase flexibility 
        in the determination of economic need with proven tools such as 
        the Elder Index to ensure the local cost of living are 
        addressed as future generations are expected to age with 
        limited financial resources.

          Older Workers: (1) Update SCSEP eligibility to make 
        it available to adults 50 years and older and (2) Adjust income 
        eligibly guidelines to allow for individuals with incomes at or 
        below 200 percent of the Federal poverty level to improve 
        access for older workers struggling with financial security and 
        employment.
                                 ______
                                 

    The Chair. Well, thank you very much. Our next witness is 
Ms. Ellie Hollander, the President and CEO of Meals on Wheels 
America, which is a national membership organization that 
represents 5,000 local community based programs across the 
country dedicated to improving the nutrition and lives of 
seniors. Ms. Hollander, thanks so much for being with us.

            STATEMENT OF ELLIE HOLLANDER, PRESIDENT AND CEO, 
                MEALS ON WHEELS AMERICA, ARLINGTON, VA

    Ms. Hollander. Good morning, Chairman Sanders, Ranking 
Member Cassidy, and esteemed Members of the Committee. It is an 
honor to testify before you on such an important topic, and 
especially during March, the month in 1972 in which the 
nutrition program was added to the Older Americans Act.

    Obviously, I am Ellie Hollander, and I am President and CEO 
of Meals on Wheels America, and I am so proud to present--to 
represent an incredibly dedicated and effective nationwide 
network of senior nutrition programs, an army of committed 
staff and volunteers, and the millions of older adults who rely 
on them as a lifeline.

    Particularly relevant to the hearing today, I am driven to 
amplify the voices of the millions more who would benefit if 
only we had the resources to reach them, whether in their 
homes, in senior centers, or in other community settings.

    There are a few Federal programs which exemplify a 
successful public, private partnership, much less set the gold 
standard. Congress should take a bow on this one, because the 
Older Americans Act is just that.

    It has withstood the test of time, and it continues to 
deliver on its original purpose and intent, improving and even 
saving lives, and all while reducing taxpayer dollars. The 
program is appropriately focused on those in the greatest 
social and economic need, and in return delivers both a social 
and an economic benefit.

    Not many programs can claim that. With that said, we are at 
a precipice that warrants action and there is no time to waste. 
Senior lives hang in the balance. That is because the gap 
between increasing need and our ability to provide resources 
continues to widen at an unprecedented rate.

    Despite critical investments made during the pandemic, we 
cannot keep up with the demand at current funding levels. 
Underscoring that point, 12 million seniors struggle with 
hunger, which is greater than the populations of 44 states and 
the District of Columbia. 2.5 million low income, food insecure 
seniors are not receiving the meals for which they are eligible 
and likely need.

    7 out of 10 Meals on Wheels programs report higher demand 
now than before the pandemic, and 1 in 3 has a waitlist with an 
average waiting time of 3 months for vital meals.

    The good news is that thanks to the foresight of President 
Johnson for enacting the Older Americans Act, President Nixon 
for expanding upon it, and Congress for continuing to invest in 
it, the infrastructure already exists to solve for this growing 
gap.

    That is because local programs have built incredible trust 
within their communities and developed immense expertise and 
resilience through nearly six decades of service, including 
operating through a pandemic. What these programs do on a daily 
basis is truly remarkable and irreplaceable.

    There is more good news, these services offer a significant 
return on that investment. A recent report, The Case for Meals 
on Wheels, showed consistent findings from 38 studies that 
seniors receiving nutritious meals, companionship, and safety 
and wellness checks, the typical Meals on Wheels service model, 
experienced reductions in hospital visits and stays, health 
care services and costs, nursing home usage, loneliness and 
social isolation, falls, food insecurity, and nutritional risk.

    For perspective, the annual cost of senior falls, 
malnutrition, and social isolation exceed $107 billion 
combined. And last, we can provide a senior, as Senator Sanders 
likes to say, Meals on Wheels for an entire year for the 
equivalent of roughly 1 day in the hospital or 10 days in a 
nursing home.

    But the best news of all is that Congress has the power to 
propel a program that has received bipartisan and bicameral 
support throughout the years because, quite frankly, it works. 
Congressional support through this reauthorization is an 
investment in the seniors of today that will improve health, 
save lives, and reduce costs in the future.

    To that end, here are three recommendations for your 
consideration. The first is to increase the authorization 
funding levels for all older Americans support programs to the 
maximum amount possible.

    We estimate that a $774 million increase is needed for the 
nutrition program alone, just to close the current services 
gap. The second is to create a single Title 3 nutrition 
program, unifying the congregate, home delivered, and nutrition 
services incentive programs into one program and funding 
stream.

    Local providers have told us repeatedly that this 
adjustment would improve efficiency and enable them to far more 
easily tailor services to their seniors. And the third is to 
prioritize community based programs in Older Americans Act 
contracts and grant awards.

    Our programs provide a holistic service that starts with 
the meal but opens the door to so much more, leading to better 
health outcomes. Last, as you dig into the reauthorization 
process, as Senator Sanders did, I would like to urge you to 
visit a Meals on Wheels program in your state, if you haven't 
recently, to go on a meal delivery, and to stop by a senior 
center because seeing is believing.

    Thank you, Mr. Chairman, for your leadership on this 
important issue and for the letter that you and 41 other 
Senators sent--signed urging for a doubling of funding for 
programs authorized under the Older Americans Act.

    We all share that belief that no seniors should be left 
hungry or isolated, and I stand ready to help in any way I can.

    [The prepared statement of Ms. Hollander follows.] 
    
                 prepared statement of ellie hollander
    
    Good morning, Chairman Sanders, Ranking Member Cassidy, and 
esteemed Members of the Committee. Thank you for the opportunity to 
testify before you at this critical hearing. I'm Ellie Hollander and am 
proud to present before you as the President and CEO of Meals on Wheels 
America. Meals on Wheels America is the national leadership 
organization representing over 5,000 local nutrition programs committed 
to addressing senior hunger and isolation in virtually every community 
across the country and working toward a vision in which all seniors 
live nourished lives with independence and dignity.

    With the support of hundreds of thousands of committed volunteers 
and staff members, local community programs deliver nutritious meals in 
a variety of ways, including in group and/or grab-and-go settings, as 
well as to individual homes, where they also provide friendly visits 
and social interaction, safety checks, and connections to other health 
and wellness services to support older Americans in greatest need. And 
the underpinning of all this work and impact is a direct result of the 
support, policies and funding provided through the Older Americans Act 
(OAA).

    For more than 50 years, the OAA has supported millions of our 
Nation's seniors and caregivers through a network of state, regional 
and local community-based programs. The local providers that we 
represent at Meals on Wheels America serve as a direct lifeline to 
those struggling with food insecurity, malnutrition, mobility, 
loneliness, and countless other difficulties of aging. We frequently 
say the service starts with the meal and opens the door to so much 
more. It's the purposeful and unique combination of nutritious meals 
and social connection that fosters a relationship with the individual 
senior, enabling Meals on Wheels providers to identify and deliver 
valuable services that promote independence and well-being. The impact 
not only saves lives but also saves taxpayer dollars by ensuring that 
our Nation's seniors live safer, longer and more nourished in their own 
homes and out of other more costly healthcare settings. In fact, we can 
serve a senior Meals on Wheels for an entire year for roughly the same 
cost as 1 day in the hospital or 2 weeks in a nursing home. \1\
---------------------------------------------------------------------------
    \1\  Meals on Wheels America (2024), special analysis of ACL and 
Mathematica's estimated meal cost (OAA Nutrition Programs Evaluation: 
Meal Cost Analysis), Kaiser Family Foundation's daily hospital expense 
data (State Health Facts: Hospital Adjusted Expenses per Inpatient 
Day), and Genworth's cost of semi-private nursing home room (2021 Cost 
of Care Survey) adjusted for inflation. Sources and methods available 
at: https://www.mealsonwheelsamerica.org/docs/default-source/fact-
sheets/2023/what-we-deliver-2023-national-snapshot-sources-methods.pdf.

    The OAA is considered the gold standard of a successful public-
private partnership, having delivered on its original intent and shown 
great resiliency and adaptability through challenging times, including 
a global pandemic. As its reauthorization approaches, Meals on Wheels 
America is focusing on several key legislative recommendations that 
further enhance the support and services provided to older adults. 
Given the significant need, changing demographics, and inflationary 
pressures, we are pushing for increased authorized funding levels 
across all OAA programs, with an emphasis on closing the existing needs 
gap for nutrition services and establishing incentives and funding for 
medically tailored and culturally appropriate meals. An important 
strategic proposal we are recommending involves unifying the Congregate 
and Home-Delivered Nutrition Services with the Nutrition Services 
Incentive Program (NSIP) under a single Title III-C Nutrition Program 
and funding stream. This shift would improve efficiency at all levels 
of the aging network and enable local service providers to tailor their 
offerings to meet the diverse needs of seniors in their community far 
more easily. Additionally, we believe there should be a concerted 
effort to prioritize community-based organizations for nutrition 
services contracts, as local providers are delivering a holistic 
service and not just a meal. Finally, this reauthorization is also an 
opportunity to continue to modernize the OAA to incorporate 
innovations, flexibility, and successful practices that were leveraged 
during the pandemic, ensuring that the Act is adaptable and responsive 
to the evolving needs of America's older population.
               
               The Foundation of the Older Americans Act

    As we look toward this year's reauthorization of the OAA, we first 
and foremost want to protect the core purposes of the Act and 
underscore the significance of it as a solution to ending senior hunger 
and social isolation in our Country and why it must be sufficiently 
resourced.

    The Older Americans Act of 1965 (OAA) was signed into law on July 
14, 1965, as an answer to improving access to social services and 
supports for older adults living in the community. Since then, the Act 
has served as the primary Federal legislation supporting community-
based social services for adults 60 and older and the bedrock of 
Federal support to the nationwide network of senior nutrition programs 
that rely on Federal funding.

    The OAA has evolved and grown over time through prior 
reauthorizations and consists of seven titles today. Of the seven 
titles, all but one is administered by the Administration on Aging 
(AoA), a Federal sub-agency established by the OAA within the U.S. 
Department of Health and Human Services (HHS) Administration for 
Community Living (ACL). At the state and local levels, OAA activities 
are carried out by 56 State Units on Aging (SUA), over 600 Area 
Agencies on Aging (AAA), and thousands of community-based 
organizations. AoA, housed within ACL, is tasked with advocating for 
older adults and persons with disabilities and supporting them in 
securing and maintaining their health, well-being, and independence in 
the community.

    The largest title of the Act, accounting for 72 percent of the 
OAA's total funding in fiscal year 2023, is Title III Grants for State 
and Community Programs, which provides grants to states to help carry 
out a variety of supportive service and health promotion programs for 
older adults and their caregivers. \2\ The Title III Nutrition Program, 
which includes congregate (Title III-C1) and home-delivered (Title III-
C2) nutrition services, and the Nutrition Services Incentives Program 
(Title III-C), is a Federal program that supports the health and well-
being of older adults through nutrition services. We are proud and 
thankful and want to underscore the significance of the OAA Nutrition 
Program, which is the only Federal program designed specifically to 
meet older adults' nutritional and social needs. The OAA Nutrition 
Program is a successful public-private partnership, with the critical 
Federal dollars provided leveraging an impressive funding match of 
approximately 3 to 1, from additional state, local, and private 
sources. \3\
---------------------------------------------------------------------------
    \2\  Congressional Research Service (2023), Older Americans Act: 
Overview and Funding. https://crsreports.Congress.gov/product/pdf/R/
R43414.
    \3\  ACL (2019), Written Statement by Administrator and Assistance 
Secretary for Aging Lance Robertson for the Senate Special Committee on 
Aging. https://acl.gov/news-and-events/announcements/asa-robertson-
testified-senate-hearing-oaa-today.

    Again, we believe that the Act successfully fulfills its purpose, 
and that reauthorization efforts and modifications should be primarily 
focused on improving the ability to reach more seniors. 

                 The Pervasive Problem of Senior Hunger

    Since its inception, the OAA Nutrition Program has provided 
billions of meals to seniors in need, improved countless lives, and 
saved considerable taxpayer dollars through well-established trust 
built at both the community and national levels. While this program has 
worked as it was designed for decades, it is not reaching all those in 
need. Eight out of ten (80.3 percent) low-income, food insecure older 
adults are not receiving the congregate or home-delivered meals that 
they are eligible for and likely need. \4\ From a national survey, we 
found that one in three local Meals on Wheels programs maintain waiting 
lists, with seniors waiting on average 3 months for vital meals--an 
increase of 10 percent for program waitlists from 2021. \5\ The same 
survey found an overwhelming majority of programs, 78 percent, have 
already or would need to add seniors to waitlists due to funding cuts. 
These are only the individuals we are aware of and know that it is an 
underrepresentation of the true need across the country. In fact, 97 
percent in our survey indicated they believe that there is unmet need 
in their communities.
---------------------------------------------------------------------------
    \4\  U.S. Census Bureau (2022), Current Population Survey (CPS) 
Food Security Supplement, Meals on Wheels America calculation of 
dataset available at: https://www.census.gov/data/datasets/time-series/
demo/cps/cps-supp--cps-repwgt/cps-food-security.html.
    \5\  Meals on Wheels America (November 2023), #SaveLunch Member 
Pulse Survey. Internal report.

    Additional research has found that older adults who seek Meals on 
Wheels services are already more vulnerable than the average American 
seniors, with poorer self-reported health, higher levels of depression 
and anxiety, greater fears of falling and more. \6\ Simply put, while 
older adults are on waiting lists and struggling to have their 
nutritional and social needs met, their health is continuing to decline 
and are more likely to end up in a hospital or nursing home prematurely 
and at significantly higher cost to the individual and taxpayers.
---------------------------------------------------------------------------
    \6\  Meals on Wheels America (2015), More Than a Meal Pilot 
Research Study, commissioned report prepared by Thomas & Dosa. https://
www.mealsonwheelsamerica.org/learn-more/research/more-than-a-meal/
pilot-research-study.

    The OAA Nutrition Program is an essential linchpin in supporting 
the healthy aging process for millions of Americans. But its 
effectiveness in making a dent in the national dual crises of senior 
hunger and social isolation depends on being adequately funded. The 
reality of senior hunger and isolation in our Country is sobering. 12 
million older adults aged 60+ worry about having enough food (i.e., are 
marginally food insecure). This was an increase of 2.2 million over 
2021. \7\
---------------------------------------------------------------------------
    \7\  See note 4.

    While daunting, even one individual struggling with hunger is far 
too many. With the issue being pervasive in American communities and 
additional challenges fast approaching with the growth of our senior 
population, there is no time to wait for action. The number of OAA 
meals and seniors we are able to serve nationwide, however, has failed 
to keep pace with demographic shifts, growing demand, and the rising 
costs of food, transportation, and other expenses. While we currently 
serve 251 million nutritious home-delivered and congregate meals 
annually to the 2.2 million older adults facing hunger and isolation, 
we have the infrastructure and know-how to reach millions more, 
especially through increased appropriations and a strong and timely 
reauthorization. \8\
---------------------------------------------------------------------------
    \8\  Administration for Community Living/Administration on Aging 
(2023), State Program Report (SPR) 2021, available on ACL's Aging, 
Independence, and Disability Program Data Portal (AGID) at: https://
agid.acl.gov/.

    The Costs and Consequences of Senior Hunger and Social Isolation 
    
    Today, millions of seniors are experiencing some degree of food 
insecurity and/or social isolation, leaving them at risk for a 
multitude of adverse health issues. Food-insecure older adults 
experience worse health outcomes than food-secure seniors, with greater 
risk for heart disease, depression, and decline in cognitive function 
and mobility. \9\ Some of the most vulnerable seniors that the OAA 
serves--those who are frail, homebound, and socially isolated--rely on 
the home-delivered meal program. Despite the well-founded, inextricable 
link between healthy aging and access to nutritious food and regular 
socialization, millions of seniors struggle to meet these basic human 
needs. The infrastructure and cost-effective interventions to address 
these consequences already exist through the OAA network. As stated 
above, local, community-based organizations serve a critical role in 
addressing the nutritional and social needs of our Nation's older 
adults. The impact of these services on seniors' lives is powerful.
---------------------------------------------------------------------------
    \9\  Ziliak and Gunderson (2021), The Health Consequences of Senior 
Hunger in the United States: Evidence from the 1999-2016 NHANES, report 
prepared for Feeding America. www.feedingamerica.org/research/senior-
hunger-research/senior.

    Most seniors receiving OAA nutrition services from senior nutrition 
programs consistently report that participating in the program helps 
them feel more secure, helps them eat healthier foods, prevents falls 
or fear of falling, and allows them to stay in their own homes. In 
turn, this helps avoid preventable emergency room visits, hospital 
admissions and readmissions, and extended rehab stays, preventing 
premature institutionalization and ultimately reducing our Nation's 
health care costs. The cost of not providing these services and 
---------------------------------------------------------------------------
increasing funding is clear.

    Currently, almost 95 percent of older adults have at least one 
chronic condition, while nearly 80 percent have two or more chronic 
conditions. \10\ Increasingly, older adults need access to nutritious 
meals and comprehensive services that can help them manage their 
chronic conditions.
---------------------------------------------------------------------------
    \10\  National Council on Aging (April 2022), Chronic Inequities: 
Measuring Disease Cost Burden Among Older Adults in the U.S. A Health 
and Retirement Study Analysis. https://ncoa.org/article/the-inequities-
in-the-cost-of-chronic-disease-why-it-matters-for-older-adults.

    Malnutrition, senior falls, and social isolation tell a similar 
story. The economic burden of senior malnutrition alone costs $51.3 
billion annually (in 2010 dollars), while senior falls account for $50 
billion (in 2015 dollars). \11\, \12\ Studies show the highest rates of 
social isolation are found among older adults, putting seniors at risk 
for high blood pressure, heart disease, obesity, a weakened immune 
system, anxiety, depression, cognitive decline, Alzheimer's disease, 
and even death. Research demonstrates that social isolation among older 
adults leads to an extra $6.7 billion in Medicare spending a year (in 
2012 dollars) similar expenditures to that of having high blood 
pressure or arthritis.
---------------------------------------------------------------------------
    \11\  Snider, et al. (2014), Economic Burden of Community-Based 
Disease-Associated Malnutrition in the United States. Journal of 
Parenteral and Enteral Nutrition, 38(2S), 77S-85S. https://doi.org/
10.1177/0148607114550000.

    \12\  Thomas, et al. (2018), Home-Delivered Meals and Risk of Self-
Reported Falls: Results From a Randomized Trial. Journal of Applied 
Gerontology, 37(1), 41-57. https://doi.org/10.1177/0733464816675421.

        The Case for Meals on Wheels and the Older Americans Act 
        
    As noted throughout this testimony, Meals on Wheels is a proven 
solution that addresses the escalating issues of senior hunger and 
isolation. We know this not only through the daily anecdotes we hear of 
how Meals on Wheels has impacted people's lives, but through decades of 
research. Our recently released report, The Case for Meals on Wheels: 
An Evidence-Based Solution to Senior Hunger and Isolation, showcases 
consistent findings that Meals on Wheels improves senior health, 
safety, social connection, and more while saving taxpayer dollars. \13\
---------------------------------------------------------------------------
    \13\  Meals on Wheels America (September 2023), The Case for Meals 
on Wheels: An Evidence-Based Solution to Senior Hunger and Isolation. 
https://www.mealsonwheelsamerica.org/learn-more/research/the-case-for-
meals-on-wheels-sept23.

    The Case for Meals on Wheels analyzed a total of 38 studies, 
spanning 1996 to 2023, and found they consistently reported that Meals 
on Wheels programs reduce healthcare utilization and costs, falls, 
nursing home use, social isolation and loneliness while improving food 
security, diet quality, and nutritional status and seniors' ability to 
age in place. These remarkable outcomes, highlighted below, underscore 
the life-changing impact that Meals on Wheels services have on the 
---------------------------------------------------------------------------
lives of the older adults we serve:

        1. Reduced use of costly health care services: Several studies 
        found Meals on Wheels program participants needed fewer visits 
        to the emergency room or experienced fewer hospital stays or 
        readmissions.

        2. Reduced nursing home use and increased ability to age in 
        place: Access to medically tailored and home-delivered meals 
        allowed individuals to stay in their homes rather than transfer 
        to a nursing facility for nutritional support. Nearly all (92 
        percent) home-delivered meal participants said the meals help 
        them continue to live independently, according to the 2022 
        national survey of Older Americans Act Title III home-delivered 
        meal participants.

        3. Reduced health care costs attributed to reduced hospital and 
        nursing home spending: In line with outcomes one and two, their 
        reduced health care and nursing home use also meant Meals on 
        Wheels participants spent less on health care. One study found 
        that among individuals receiving medically tailored meals, 
        average medical expenditures were 40 percent lower per month 
        for those receiving meals than for a matched group not 
        receiving meals ($843 vs. $1,413).

        4. Increased food security: Several studies concluded that 
        home-delivered meal participants worried less about having 
        enough to eat. Those individuals who received breakfast and 
        lunch deliveries, rather than just lunch, benefited even more.

        5. Improved diet quality: Home-delivered meals led to higher-
        quality diets among participants, as measured by nutrient 
        intake, calories, vitamins, and other indicators. Participant 
        feedback reinforced that meal delivery helped them eat 
        healthier, more nourishing foods.

        6. Reduced or slow decline in nutritional risk: Program 
        participants threatened by malnutrition saw improvement in 
        their nutritional risk scores. Individuals benefited from both 
        improved dietary intake and improved food security.

        7. Reduced social isolation and loneliness: Several studies 
        found a link between home-delivered meals and reduced social 
        isolation or loneliness, particularly among participants who 
        lived alone. These benefits resulted from contact with drivers 
        during meal deliveries and opportunities for social connection 
        via other Meals on Wheels programs.

        8. Reduced falls and increased home safety: Several studies 
        found Meals on Wheels participants experienced fewer falls and 
        minimized exposure to hazards in the home, outcomes 
        attributable to safety checks provided at meal delivery, and a 
        reduced need to cook in the kitchen.

    This research alone cannot bring these evidence-based programs to 
the older adults who desperately need them. Seniors' access to these 
critical services is only possible with the support of Congress and 
sufficient Federal funding. This report illuminates the impact that 
Meals on Wheels has and the necessity to protect and increase Federal 
funding to meet the current needs of our growing senior population.

             Older Americans Act Reauthorization Priorities

    While the need for far greater Federal funding is the primary key 
to serving more seniors, especially in the years following the COVID-19 
pandemic, there are opportunities to ease administrative burdens and 
improve our insight into the performance and operations of the network 
at all levels. The Act, including the Nutrition Program, must continue 
to be robust and successful and fulfill its original intent and core 
purpose to reduce hunger, promote socialization, and improve health and 
well-being for older adults in greatest social and economic need.

    Any policy changes must, first and foremost, do no harm to the 
aging services network and the seniors they support. Instead, they must 
address the pervasive and growing challenges of senior hunger and 
social isolation. We believe reauthorization should also build on the 
newly updated OAA regulations by modernizing the law and reflecting the 
on-the-ground needs of service providers, older adults, and their 
families and caregivers. Accordingly, Meals on Wheels America urges 
Congress to enact the following recommendations:

    1. Increase authorization funding levels for all OAA programs and 
provide additional resources for enhanced nutrition services.

          Increase authorized funding, including sufficient 
        funding for Title III Nutrition Services, to address existing 
        waiting lists and reach the ever-growing number of older adults 
        who would benefit from OAA programs.

          Authorize new funding streams and establish 
        incentives for senior nutrition programs to offer medically 
        tailored and/or culturally appropriate meals and expand reach 
        in underserved areas.

          Improve and clarify authorization of funding for 
        senior nutrition programs to maintain and invest in the 
        infrastructure and resources needed to prepare and deliver 
        services, including kitchen equipment, delivery vehicles, 
        labor, etc.

    2. Unify OAA Congregate, Home-Delivered and the Nutrition Services 
Incentive Program into a single Title III-C Nutrition Program.

          Create one authorized funding stream to remove 
        administrative burden, improve efficiency, and enable 
        community-based organizations to tailor nutrition services to 
        seniors' needs more easily.

          Codify alternative nutrition services models, such as 
        grab-and-go and drive-thru meals, proven to reach more older 
        adults struggling with hunger and social isolation.

          Modernize the Nutrition Services Incentive Program 
        through enhanced partnership and coordination with USDA, HHS, 
        states, Area Agencies on Aging (AAA), and local providers to 
        procure commodity foods for preparing OAA meals and coordinate 
        other important Federal benefits and programs for seniors.

    3. Prioritize community-based nutrition programs and experienced 
network providers in OAA grant awards and contracts.

          Encourage states and AAAs to partner more closely 
        with and leverage senior nutrition programs' established 
        infrastructure, dedicated volunteer base, and experience 
        serving their communities to deliver nutritious meals, 
        socialization services, and safety checks to more older adults.

          Ensure timely payment and reimbursement processes for 
        nutrition services provided.

    4. Expand senior nutrition program capacity and infrastructure 
support for further integration into the health care system.

          Reduce administrative and regulatory burdens on local 
        nutrition and aging services providers seeking to establish 
        contracts and partnerships with health care providers and 
        payors.

          Provide additional resources and promote incentives 
        for the aging services network to build the capacity, including 
        infrastructure and technology, to meet the compliance and 
        privacy standards for providing covered health care benefits.

    5. Promote innovations and successful practices learned during the 
COVID-19 pandemic.

          Facilitate continued innovation and implementation of 
        many successful practices leveraged during the COVID-19 public 
        health emergency, including new partnerships, programming, 
        emergency preparedness and outreach.

          Support the expansion of evidence-informed and/or 
        technology-based solutions that can help meet the needs of 
        seniors, including their preferences for meals and social 
        connectedness.

    In addition to improvements through reauthorization, our 
organization and network of senior nutrition providers are pleased with 
the recent effort to update Federal regulations for OAA policies and 
programs for Titles III, VI, and VII for the first time in 36 years. 
\14\ As a result, they are now better aligned with language and 
additions from recent reauthorizations and better reflect the needs of 
today's growing and diversifying older adult population.
---------------------------------------------------------------------------
    \14\  ACL (February 2024), Final Rule [89 FR 11566]: Older 
Americans Act: Grants to State and Community Programs on Aging; Grants 
to Indian Tribes and Native Hawaiian Grantees for Supportive, 
Nutrition, and Caregiver Services; Grants for Supportive and 
Nutritional Services to Older Hawaiian Natives; and Allotments for 
Vulnerable Elder Rights Protection Activities. https://
www.Federalregister.gov/documents/2024/02/14/2024-01913/older-
americans-act-grants-to-state-and-community-programs-on-aging-grants-
to-indian-tribes-and.

    Among the several updated policies we look forward to being 
implemented, we remain supportive of the following nutrition-related 
provisions that are included and/or clarified per ACL's final rule 
---------------------------------------------------------------------------
(effective Friday, March 15, 2024):

          Home-delivered meals--and a certain amount of 
        congregate meals--may be provided via home delivery, pick-up, 
        carry-out, or drive-through.

          Eligibility for home-delivered meals is not limited 
        to people who are ``homebound;'' criteria may depend upon many 
        factors (including ability to leave home unassisted, ability to 
        shop for and prepare nutritious meals, mental health, degree of 
        disability or other relevant factors about their need for the 
        service, including social and economic need).

          Requirements regarding the use and transfer of 
        funding for Title III programs, including clarification under 
        Title III C-1 and C-2 that funds can be used for nutrition 
        education, nutrition counseling, and other nutrition services, 
        as well as cautioning against transitioning money away from 
        Title III-B and Title III-C services for which they were 
        appropriated and intended by Congress.

          States have the option to receive NSIP allocation 
        grants as cash, commodities or a combination of both, and that 
        funds can only be used to purchase domestically produced foods 
        used in meals.

    We are encouraged to see much consideration and modernization of 
OAA regulations through this regulatory process. Nonetheless, 
regulatory updates and guidance can only achieve so much and look 
forward to addressing remaining policy priorities and making further 
legislative improvements during this OAA reauthorization process. 

                               Conclusion

    Thank you for holding this timely hearing and inviting me to 
testify before you. I appreciate the chance to share how the OAA 
improves the lives of senior citizens, communities, and our Nation. I 
would like to extend a special thanks to Chairman Sanders for his 
leadership on the OAA in past reauthorizations and in seeking increased 
funding. And I want to thank all Members of the Committee for sharing 
the belief that no senior in America should be left hungry or isolated. 
I hope the information I provided today is helpful as you consider the 
next reauthorization and look forward to working together to make this 
vision a reality for our older adults. Thank you again for your time, 
and I am pleased to answer any questions you might have.
                                 ______
                                 
                 [summary statement of ellie hollander] 
                 
    The Foundation of the Older Americans Act: Meals on Wheels programs 
serve as a direct lifeline to older adults struggling with food 
insecurity, malnutrition, mobility, loneliness, and countless other 
difficulties of aging. In 2021, local, community-based programs 
supported by Federal funding from the Older Americans Act (OAA) 
delivered 251 million meals to 2.2 million of our Nation's seniors in 
greatest social and economic need.

    OAA Reauthorization Priorities and Recommendations: Our 
recommendations are designed to protect the core purposes of the Act, 
underscore its importance as a solution to end senior hunger and social 
isolation, ensure it is sufficiently funded, and does no harm to 
seniors or the aging network. Our priorities include:

          Increasing authorization funding levels for all OAA 
        programs and providing additional resources for enhanced 
        nutrition services

          Unifying OAA Congregate, Home-Delivered and the 
        Nutrition Services Incentive Program into a single Title III-C 
        Nutrition Program

          Prioritizing community-based nutrition programs and 
        experienced network providers in OAA grant awards and contracts

          Expanding senior nutrition program capacity and 
        infrastructure support for further integration into the health 
        care system

          Promoting innovations and successful practices 
        learned during the COVID-19 pandemic

    Understanding the Unmet Needs of Our Growing Senior Population: 
Waitlists for OAA nutrition services aren't an accurate picture of 
total need; waitlists measure pent-up demand, not unmet need.

          One in three local Meals on Wheels programs currently 
        maintain waiting lists, with seniors waiting on average 3 
        months for vital meals and 97 percent of Meals on Wheels 
        programs indicate they believe that there is unmet need in 
        their communities

          Eight out of ten (80.3 percent) low-income, food 
        insecure older adults are not receiving the congregate or home-
        delivered meals that they are eligible for and likely need

    The Critical Role of OAA Nutrition Programs: Local, community-based 
organizations serve a critical role in addressing the nutritional and 
social needs of our Nation's older adults. Most seniors receiving OAA 
nutrition services report that participating in the program helps them 
feel more secure, prevents falls or fear of falling, and allows them to 
stay in their own homes. The impact not only saves lives but also saves 
taxpayer dollars by ensuring that our Nation's seniors can live healthy 
at home and out of other more costly healthcare settings, helping to 
avoid preventable emergency room visits, hospital admissions and 
readmissions, and extended rehab stays, ultimately reducing our 
Nation's health care costs.

          Nearly all (92 percent) home-delivered meal 
        participants said the meals help them continue to live 
        independently

          One study found that among individuals receiving 
        medically tailored meals, average medical expenditures were 40 
        percent lower per month for those receiving meals than for a 
        matched group not receiving meals ($843 vs. $1,413)

          The economic burden of senior malnutrition alone 
        costs $51.3 billion annually (in 2010 dollars), while senior 
        falls account for $50 billion (in 2015 dollars)

          Almost 95 percent of older adults have at least one 
        chronic condition, while nearly 80 percent have two or more 
        chronic conditions. It is estimated that $73 billion in January 
        2024 dollars is spent annually on disease-associated conditions

    The Case for Meals on Wheels: The Case for Meals on Wheels: An 
Evidence-Based Solution to Senior Hunger and Isolation found that Meals 
on Wheels programs reduce healthcare utilization and costs, falls, 
nursing home use, social isolation and loneliness while improving food 
security, diet quality, and nutritional status and seniors' ability to 
age in place. Meals on Wheels services: reduce use of costly health 
care service; reduce nursing home use and increased ability to age in 
place; reduce health care costs attributed to reduced hospital and 
nursing home spending; increase food security; improve diet quality; 
reduce or slow decline in nutritional risk; and reduce social isolation 
and loneliness.
                                 ______
                                 

    The Chair. Thank you very much, Ms. Hollander. Our next 
witness is Dr. Martha Kubik, Professor of Nursing at George 
Mason University. She will be introduced by Senator Kaine.

    Senator Kaine. Thank you, Chairman and Ranking Member for 
stacking this panel. Four of the five are from Virginia. We 
don't demand 100 percent, but this ratio seems very acceptable 
to me. I will be glad to introduce Dr. Marti Kubik, who is a 
Professor of Nursing in the College of Public Health at George 
Mason University close by in Fairfax.

    Dr. Kubik is a behavioral epidemiologist and advanced 
practice nurse with over 20 years of community based primary 
care experience as a nurse practitioner. She has extensively 
researched health promotion and disease preventions across the 
lifespan, with a particular focus on low income and minority 
populations.

    Her testimony will focus on a pilot program connecting pre-
licensed nursing students with older adults at congregate meal 
sites in Washington, DC. and Kentucky. Dr. Kubik, welcome.

     STATEMENT OF MARTHA Y. KUBIK, PH.D., RN, FAAN, PRO-
        FESSOR  OF  NURSING, COLLEGE OF  PUBLIC  HEALTH, 
        GEORGE MASON UNIVERSITY, FAIRFAX, VA

    Dr. Kubik. Thank you, Dr. Kaine. I appreciate the 
introduction. Thank you, Committee, for allowing me to visit 
this morning to the Committee and share the work and testify 
about the reauthorization of the Older Americans Act.

    The Congregate Nutrition Services Section of the OAA, as 
you all know, provide seniors a nutritious meal in a familiar 
and easy to reach community setting. As a result, we have a 
unique national network of trust in gathering places for 
seniors.

    Expanding services at these sites to address the 
increasingly complex health and social needs of a burgeoning 
and aging population, most with multiple chronic conditions as 
has already been noted by many, is one approach to help seniors 
age well and age in place.

    As the older adult population continues to boom, access to 
primary care health services remains problematic, contributing 
to poor health outcomes and increase hospitalizations, as has 
been noted by Senator Sanders.

    Establishing academic practice partnerships between senior 
centers and dining sites, and health professions schools, and 
particularly schools of nursing, to bring students to the 
community sites to provide health services holds great 
potential to improve health outcomes, while at the same time 
preparing a health workforce better equipped to meet the needs 
of community residing adults for years to come.

    My funding partner, the National Foundation to End Senior 
Hunger, recently supported two proof of concept studies that I 
have led. One here in the District of Columbia that we 
completed last year, and the other in eastern Kentucky, which 
is currently ongoing and will wrap up May 2024.

    Both were conducted in partnership with district or state 
level departments of aging, community nonprofits here in the 
district, Area Agencies on Aging in Kentucky, senior centers 
and dining sites, 6 per each of the locations for a total of 
12, and local nursing programs, 2 at each location for a total 
of 4.

    The faculty supervised pre-licensure nursing students, so 
students studying to be registered nurses typically in their 
last year of studies, delivered the program that we call 
ageWELL once weekly for 6 to 12 weeks at 5 of the 12 sites that 
we randomly selected.

    Health services included one on one visits between a senior 
and a nursing student with a focus on medication management, 
blood pressure assessment, and health coaching guided by the 
senior's priorities and goals.

    Other services delivered in an interactive group setting 
were focused primarily on healthy eating strategies and 
physical activity. Across sites both in the district and in 
Kentucky, nursing student engagement and program participation 
and satisfaction among seniors has been high. Outcomes are 
pending in Kentucky.

    In the district, most of the seniors who participated in 
the ageWELL program self-reported improved diets and increased 
physical activity. Blood pressure that we measured before and 
after we delivered the ageWELL program, across all six sites, 
not just the sites where we delivered the program, demonstrated 
a 5.9mm of mercury decrease and systolic blood pressure.

    We were able to lower the top number of the blood pressure 
by six points that favored the ageWELL group. While this was 
not a statistically significant difference in our study, likely 
due to the small sample size and the pilot nature, it is 
nonetheless very promising and merits further study. In 
closing, our study results support feasibility, acceptability, 
and potential of the ageWELL program to improve chronic disease 
self-management for seniors.

    The time is right to expand services for the older adults 
that access community dining sites and senior centers and the 
congregate meal program.

    In reauthorizing the OAA, we encourage the Committee to 
include support for further study of the ageWELL approach, so 
as to assess program effectiveness on health comes, such as 
blood pressure, and also scalability.

    Thank you for your opportunity to speak today, and I am 
happy to answer questions.

    [The prepared statement of Dr. Kubik follows.] 
    
                   prepared statement of martha kubik

    The Congregate Nutrition Services section of the Older Americans 
Act provides nutritious meals, health promotion programming and social 
engagement for seniors (age 60 and older) in congregate dining sites in 
a variety of neighborhood locations throughout the U.S., creating a 
unique national network of trusted gathering places for older adults. 
Expanding services at dining sites to address the increasingly complex 
health and social needs of a burgeoning aging population, most with 
multiple chronic conditions, is one approach to help seniors age well, 
while aging in place. The time is right to explore new partnerships and 
more curated programming for the older adults that access community 
dining sites and the congregate nutrition program. 

                            Study Locations

    The ageWELL proof of concept studies were funded by the National 
Foundation to End Senior Hunger. An academic practice partnership model 
was used to engage local nursing schools to bring faculty-supervised, 
prelicensure nursing students to senior centers/dining sites to provide 
health services to seniors to improve self-management of health, 
wellness and chronic conditions. The study was initially piloted in the 
District of Columbia (2022-2023) in partnership with the Department of 
Aging and Community Living, four local community-based nonprofit 
agencies, two university-based nursing programs and six community 
dining sites/senior centers, representing five of the district's eight 
wards. The study is presently being replicated in eastern Kentucky 
(2023-2024) in partnership with the University of Kentucky (research 
partner), KY Department of Aging and Independent Living, three Area 
Agencies on Aging, six senior centers and two university-based nursing 
programs.

    Given the pilot nature of the study and funding and staffing 
constraints, the number of study sites at each location was limited to 
six. With the small sample size, the study was not powered (lacked a 
large enough sample) to detect a difference in health outcomes between 
groups, even if a difference was present. However, the pilot allowed 
evaluation of proof of concept, and an assessment of feasibility, 
acceptability and potential of the ageWELL program and an academic 
practice partnership model to improve program participants' self-
management of health, wellness and chronic disease conditions.

    The study's principal investigator (PI) is Martha (Marti) Kubik, 
Ph.D., RN, FAAN, a professor of nursing at George Mason University 
(GMU). For the District of Columbia study site, the GMU Institutional 
Review Board (IRB) approved the research study. The study period was 8/
1/2022 to 9/30/2023.

    For the Kentucky study, Martha Biddle, Ph.D., APRN, CCNS, FAHA, 
Professor, College of Nursing, University of Kentucky (UK), is the site 
PI. The UK IRB approved the research study. The study period is 9/1/
2023 to 8/31/2024.

                     Study Sample and Study Design 
                     
    The pilot studies used a two-group randomized controlled trial 
design. Dining sites were randomly selected to continue usual 
programming or supplement usual programming with ageWELL. This allowed 
a comparison of health outcomes (i.e. blood pressure) between the two 
groups. Randomization of dining sites occurred within pairs matched by 
shared group characteristics such as type of site and geographic 
location. Meal program participants across dining sites were also 
invited to take part in evaluation activities that included measuring 
blood pressure, height, weight and completing a survey, before 
(baseline) and after (follow-up) implementation of the 6-12 week 
ageWELL program. Program participants also completed a satisfaction 
survey. Nursing students documented their engagement with seniors 
(service counts) and following the program, completed an evaluation of 
the dining site experience.

    Across locations, faculty-supervised, prelicensure nursing students 
delivered the ageWELL program once weekly for 6-12 weeks at 5 of the 12 
sites. Health services included one-on-one visits between a senior and 
nursing student with a focus on management of medication, blood 
pressure assessment, and health coaching guided by the senior's 
priorities and goals. Other services, delivered in an interactive group 
setting, were focused mostly on healthy eating strategies and physical 
activity.

    Among seniors (N=392) completing baseline measurement (DC=215; 
KY=177), most were female, lived alone, with average age 74 years. In 
DC, 94 percent were non-Hispanic Black; in KY, 98 percent were non-
Hispanic White, with 54 percent and 72 percent, respectively, reporting 
≤ high school education. In DC, 189 seniors were measured following 
the nursing student program for an 88 percent retention rate. A brief 
summary of DC outcomes follows. KY outcomes are pending program 
completion and final measurement in May 2024. 

                           Outcomes: DC study 
                           
    Across the DC sites, there were 627 service counts, including 
tailored (57 percent) and targeted (22 percent) services and a health 
fair (21 percent). Most seniors participated weekly or twice monthly, 
with satisfaction with programming and nursing student engagement high. 
Nursing students were productive and engaged, with most reporting a 
better understanding of the health needs of community-residing older 
adults following the experience. Dining site leadership, nursing 
administrators and clinical faculty were interested in continuing the 
partnership and ageWELL programming. The small sample size limited 
evaluation of health outcomes. However, a decrease in systolic blood 
pressure of 5.9 mm Hg following the program that favored ageWELL 
compared to usual program participants was promising and merits further 
evaluation. 

                               Conclusion

    Study results from the DC pilot support proof of concept and 
feasibility, acceptability and potential of the ageWELL program to 
improve senior's self-management of health, wellness and chronic 
conditions. The DC pilot also confirmed the feasibility of conducting a 
fully powered randomized control trial to determine effectiveness of 
the ageWELL program to improve health outcomes. Finally, the KY pilot 
demonstrates potential for scalability and generalization across 
diverse populations of older adults.
                                 ______
                                 
                  [summary statement of martha kubik]
                  
    Thank you for the opportunity to speak with the Committee about my 
work and testify about the reauthorization of the Older Americans Act 
(OAA). The Congregate Nutrition Services section of the OAA provides 
seniors a nutritious meal in a familiar and easy-to-reach community 
setting, resulting in a unique national network of trusted gathering 
places for seniors. Expanding services at these sites to address the 
increasingly complex health and social needs of a burgeoning aging 
population, most with multiple chronic conditions, is one approach to 
help seniors age well, while aging in place.

    As the older adult population continues to `boom,' access to 
primary care health services remains problematic, contributing to poor 
health outcomes and increased hospitalizations. Establishing academic 
practice partnerships between senior centers and dining sites and 
health profession schools, and particularly schools of nursing, to 
bring students to the community sites to provide health services holds 
great potential to improve health outcomes, while also preparing a 
health workforce better equipped to meet the needs of community-
residing older adults, for years to come.

    My funding partner, the National Foundation to End Senior Hunger 
recently supported two proof of concept studies that I led, one in the 
District of Columbia (2022-2023), the other in eastern Kentucky (2023-
2024). Both were conducted in partnership with district/state-level 
Departments of Aging, community nonprofits (DC), Area Agencies on Aging 
(KY), senior centers/dining sites (six per location) and local nursing 
schools (two per location). Faculty-supervised, prelicensure nursing 
students delivered the program (called ageWELL) once weekly for 6-12 
weeks at 5 of the 12 sites (random selection). Health services included 
one-on-one visits between a senior and nursing student with a focus on 
medication management, blood pressure assessment, and health coaching 
guided by the senior's priorities and goals; other services, delivered 
in an interactive group setting, were focused mostly on healthy eating 
strategies and physical activity.

    Across sites, nursing student engagement and program participation 
and satisfaction among seniors has been high. Outcomes are pending in 
Kentucky. In the District, most seniors reported improved diets and 
increased physical activity. Blood pressure measured before/after the 
program demonstrated a 5.9 mm Hg decrease in systolic blood pressure 
that favored the ageWELL group. While not a statistically significant 
difference, likely due to the small sample size, it is promising and 
merits further study.

    In closing, our study results support feasibility, acceptability 
and potential of the ageWELL program to improve chronic disease self-
management for seniors. The time is right to expand services for the 
older adults that access community dining sites and the congregate meal 
program. In reauthorizing the OAA, we encourage the Committee to 
include support for further study of the ageWELL approach so as to 
assess program effectiveness on health outcomes, such as blood 
pressure, as well as scalability.

    Thank you again for the opportunity to speak today. I am happy to 
answer questions.
                                 ______
                                 

    The Chair. Well, thank you very much, Dr. Kubik. Our next 
witness is Ms. Dorothy Hutchins from Alexandria, Virginia. And 
Senator Kaine is going to introduce his fellow Virginian.

    Senator Kaine. Thank you, Chairman. And Ms. Hutchins, it is 
so great to see you. Dorothy Hutchins is 93 years old, and she 
joins us virtually from her home in nearby Alexandria. Dorothy 
has had a full life.

    In her testimony, we are going to hear about her career as 
a geologist and her journey raising 5 children, 17 
grandchildren, and now 27 great grandchildren. She receives 
Older Americans Act services through one of our state's 
regional Area Agencies on Aging, the Fairfax Agency on Aging.

    This network of the agencies does superb work. And the 
services that she receives, like socialization provided at 
senior centers and nutritious meals through Meals on Wheels 
help her remain independent in her own home. Ms. Hutchins, it 
is great to have you here with us today. Unmute.

    [Technical problems.]

    Senator Kaine. Ms. Hutchins, we are still having a hard 
time hearing you. I don't know whether it is your end or our 
end. Nope. And Ms. Hutchins has some kind of staff assistant 
there with her. Perhaps, Mr. Chair, we should move to the fifth 
witness and then circle back to Ms. Hutchins? Should we try 
that?

    The Chair. We can do that.

    Senator Cassidy. I think staff assistance is a euphemism 
for grandchild.

    [Laughter.]

    Senator Kaine. If only I could get assistance----

    Senator Kaine. Before we get back to Ms. Hutchins, let's go 
to our final witness, Ms. Michelle Branham. She will be 
recognized by Senator Cassidy.

    Senator Cassidy. Yes. A pleasure to introduce Secretary 
Michelle Branham, appointed by Governor Ron DeSantis to serve 
as the agency head for the Department of Elder Services in 
December 2021.

    Under her leadership, the department serves Florida's 6.3 
million seniors over the age of 60, providing services and 
supporting initiatives through Florida's Aging Network to help 
those seniors live well and age well in their state.

    Prior to that, I could just go through a whole list of ways 
that she has been involved serving those with Alzheimer's, 
addressing the needs, understanding, otherwise helping our 
society as a whole address Alzheimer's. So, Secretary Branham, 
thank you for being with us.

        STATEMENT OF MICHELLE BRANHAM, SECRETARY, FLORIDA   
           DEPARTMENT OF ELDER AFFAIRS, TALLAHASSEE, FL 

    Ms. Branham. Thank you, sir. Chairman Sanders, Ranking 
Member Cassidy, esteemed Committee Members and fellow 
panelists, I truly appreciate the opportunity to discuss how 
Florida champions seniors and the important role of the Older 
Americans Act in supporting our cherished elders.

    I spent my first year and a half as Secretary on the road 
in the senior centers and adult day centers, working with our 
providers, as we have all mentioned. It is really exciting for 
us to share our story because, as we may already know, we are 
either seniors or we are seniors in the making.

    If we are blessed to continue aging, it is imperative that 
we provide not only the seniors now, but the seniors of 
tomorrow the brightest and best possible future. Florida 
remains a top destination for seniors, as you mentioned, with 
over 6.3 million residents aged 60 and above.

    We rank among the Nation's fastest growing and the third 
most populous state. And as the Secretary of the Florida 
Department of Elder Affairs, I am truly grateful for Governor 
Ron DeSantis' ongoing and steadfast commitment to prioritizing 
our seniors.

    At our agency, we take great pride in leading the charge 
and ensuring the dignity, independence, and fulfillment of 
seniors in Florida. Serving as a designated standalone state 
unit on aging, and that is a distinction not many states have, 
our goal is to provide an environment where seniors can 
maintain their independence within their homes for as long as 
possible, thereby creating a happier, healthier lifestyle, 
while also promoting fiscal responsibility as aging in place is 
considerably more cost effective.

    Under the leadership of Governor DeSantis, Florida excels 
nationally in addressing Alzheimer's and other related 
dementias, with pioneering initiatives, a first of the Nation 
mobile outreach program, and significant state funding each 
year, thus reflecting our commitment to those impacted by 
Alzheimer's and related dementia. And you just said Senator 
Cassidy, that is near and dear to my heart.

    Our agency oversees $511 million in state and Federal 
funding, and that is including $154 million from the Older 
Americans Act, aiming to enable older adults to age well and 
live well in the place of their choosing, thus contributing to 
Florida's vibrant communities through our collective efforts 
with our Aging Network. As you know, the OAA tailors a range of 
services designed for seniors and caregivers.

    These include, for us, in-home and community based support 
services to address cognitive decline, individual needs, 
fostering social connections, and ultimately reducing the 
impact of loneliness, isolation, and depression.

    This approach has resulted in significant increased 
participation in our various programs and senior centers all 
across Florida. And while the department continues to review 
the new OAA rule and its potential impact, I urge Congress and 
HHS to consider continuing to collaborate closely with states 
to ensure these new regulations do not unnecessarily hinder the 
process, especially in Florida over the past three decades.

    Now I am just going to hit a few of the high points for the 
Older Americans Act in Florida. Over our entire state, we are 
witnessing increased participation in senior centers, 
congregate meal sites, and adult day centers.

    Last year alone, we provided more than 10 million meals in 
Florida served through OAA. Supplemental services are also 
available in Florida to caregivers of vulnerable individuals 60 
and older, and grandparents that are providing care for 
grandchildren.

    Other types of services include home repairs, shore 
assistant, respite care, and specialized support for elders 
with Alzheimer's disease and related dementia. And one of my 
favorite programs, I know we mentioned it, was the Senior 
Community Center Service Employment Program, and that helps 
older Floridians who face challenges in the job market or 
reentering the job market.

    The wonderful part of this program is that due to workforce 
shortages, it also helps fill essential gaps in Florida's job 
market with our vibrant seniors. So, I absolutely love this 
program.

    Our centralized long term care ombudsman program, among 
other programs, plays a pivotal role in safeguarding our 
seniors from abuse, neglect, fraud, and exploitation. And this 
wonderful volunteer based program works tirelessly to protect, 
defend, and advocate for Florida's seniors living in the 
state's 4,000 long term care communities.

    In summary, Florida is proud to be the most senior friendly 
State in the country, with the Older Americans Act serving as 
one of the most critical keystones of Florida's efforts to 
support and protect Floridians as they continue to age.

    As Secretary of the Department of Elder Affairs, I have 
seen firsthand how our Governor has shown unwavering dedication 
to seniors from his time in Congress, all the way through the 
groundbreaking initiatives as Governor, like our Dementia 
Action Plan and the Florida Alzheimer's Center of Excellence.

    He has reinforced training standards for senior care, 
increased funding for our memory disorder clinics throughout 
the state, and enacted comprehensive reforms to Florida's 
prescription drug market.

    Florida, under his leadership, remains at the forefront of 
next generation initiatives, program explorations, critical 
funding, executive and legislative support, and collective 
research that promotes not only aging but aging well for all 
residents of the Sunshine State. I am happy to answer any 
questions at this time. Thank you.

    [The prepared statement of Ms. Branham follows.] 
    
                 prepared statement of michelle branham

                              Introduction

    Chairman Sanders, Ranking Member Cassidy, esteemed Committee 
Members, and fellow panelists, I appreciate the opportunity to discuss 
how Florida champions seniors and the important role of the Older 
Americans Act in supporting our elderly population.

    Florida, with over 6.3 million residents aged 60 and above, stands 
as a premier haven for seniors, ranking among the Nation's fastest 
growing and third most populous states. As the Secretary of the Florida 
Department of Elder Affairs, I am truly grateful for Governor Ron 
DeSantis' unwavering commitment to prioritizing our seniors.

    Our agency is at the forefront, steering initiatives to ensure the 
dignity, independence, and fulfillment of Florida's senior population. 
Operating as the designated state unit on aging, our goal is to provide 
an environment where seniors can maintain their independence within 
their homes for as long as possible, fostering a contented, healthier 
lifestyle while promoting fiscal responsibility.

    Under the leadership of Governor Ron DeSantis, Florida leads 
nationally in addressing Alzheimer's and other related dementias, with 
pioneering initiatives, a first in the Nation mobile outreach program, 
and significant funding increases, reflecting our commitment to those 
impacted by Alzheimer's and related dementias. Our agency oversees $511 
million in state and Federal funding, including $154 million from the 
Older Americans Act, aiming to enable older adults to age in their 
homes and contribute vibrantly to Florida's communities through our 
collective efforts in the Aging Network. 

                     Older Americans Act in Florida

    As you know, the OAA tailors a range of services for seniors and 
caregivers, providing in-home and community-based support to address 
cognitive decline, individual needs, and foster social connections and 
reduces isolation, which has led to increased participation in various 
centers across Florida. While the Department continues to review the 
new OAA rule and its potential fiscal impact, I urge Congress and HHS 
to work closely with states to ensure these new regulations do not 
unnecessarily hinder the progress Florida has made over the past three 
decades. 

                          Supportive Services 

    OAA funds provide crucial support for seniors, promoting 
independence at home and in the community. Services encompass 
transportation, outreach, and information, as well as in-home 
assistance like homemaking, home health aide support, companionship, 
and telephone reassurance. Additionally, services include home repairs, 
chore assistance, respite care, and specialized support for families 
facing Alzheimer's and related dementias. 

                  Home-Delivered and Congregate Meals 
                  
    In fiscal year 2022-2023, over 10 million OAA-funded meals were 
provided, addressing the need for senior nutrition. Recognizing that a 
meal is more than sustenance, these programs make a significant impact 
on the lives of older residents. Home-delivered and congregate meals 
not only enhance physical health but also combat loneliness and social 
isolation, offering vital opportunities for socialization and 
engagement. With over 300 congregate meal sites in Florida, thousands 
of meals are served daily, fostering a sense of community and 
connection for our elders. 

           Florida's Dementia Care and Cure Initiative (DCCI) 
           
    The Department of Elder Affairs and the Aging Network, mandated by 
the Older Americans Act, play a crucial role in coordinating aging 
services at the community level. Governor DeSantis showcases his 
commitment through initiatives like the Dementia Care and Cure 
Initiative (DCCI), addressing the significant impact of Alzheimer's in 
Florida. The DCCI establishes Dementia-Caring Communities, providing 
training and support. Governor DeSantis solidified this commitment with 
a five-point Dementia Action Plan in 2019, leading to the recent 
establishment of the Florida Alzheimer's Center for Excellence in June 
2022. Operated through the Department of Elder Affairs, this center 
marks a milestone in Florida's ongoing efforts against dementia, 
serving as a template for other states. 

                          Health and Wellness 
                          
    Florida's health and wellness programs empower seniors and 
caregivers with impactful interventions, fostering informed decision-
making and proactive health practices. These initiatives, emphasizing 
medication management and lifestyle interventions, play a crucial role 
in averting nursing home placements. By preventing and managing chronic 
health conditions, these programs contribute to the sustained health 
and vitality of Florida's aging population, aligning with the objective 
of enabling older Americans to age in their preferred homes and 
communities. 

                           Caregiver Support 
                           
    Through OAA, Florida caregivers receive tailored support, including 
respite, adult day care, and assistance in health, nutrition, and 
financial literacy for individuals aged 60 and older. Caregiver 
Supplemental Services extend aid to caregivers of vulnerable 
individuals aged 60 and older or grandparents caring for grandchildren. 
Grandparent or Non-Parent Relative Support Services aid these 
caregivers, providing training, child day care, counseling, legal aid, 
and transportation. 

          Senior Community Service Employment Program (SCSEP) 
          
    The Senior Community Service Employment Program aids unemployed or 
low-income Floridians aged 55 and older, addressing job market 
challenges. With dual goals of community service job training and 
transitioning participants to unsubsidized employment, the program 
fosters economic self-sufficiency, contributing to Florida's workforce 
vitality. A key aspect is filling workforce shortages, making it 
mutually beneficial. Participants engage in community service 
activities at non-profit and public agencies, gaining valuable 
experience. In fiscal year 2022-2023, the Department received over $4.7 
million in OAA funding to sustain this vital program. 

     Elder Abuse Prevention Program and Long-Term Care Ombudsman 
                            Program (LTCOP) 
  
    The Elder Abuse Prevention and Long-Term Care Ombudsman Programs, 
mandated by OAA Title VII in Florida, are pivotal in safeguarding 
seniors from abuse, neglect, and exploitation. While not directly 
involved in abuse investigations, the Department prioritizes prevention 
and education initiatives, with coordinators disseminating information 
statewide. The volunteer-driven Long-Term Care Ombudsman Program 
advocates for individuals in long-term care, emphasizing abuse 
prevention. 

    Prioritizing the Well-Being of Florida's Most Vulnerable Seniors 
    
    The OAA is a vital funding source for serving older Floridians, 
emphasizing responsible fund utilization. Prioritizing vulnerable 
seniors is facilitated by Population Maps, custom GIS maps for each 
Area Agency on Aging. These maps, integrating census and client data, 
identify concentrations of seniors needing assistance. 

                                Summary 
                                
    Florida proudly stands as the most senior-friendly state in the 
country, with the Older Americans Act being a key element in our 
efforts to address the needs of our seniors through their golden years. 
As Secretary of the Department of Elder Affairs, I have seen firsthand 
how Governor Ron DeSantis has shown unwavering dedication to seniors 
from his time in Congress through his groundbreaking initiatives like 
the Dementia Action Plan and the Florida Alzheimer's Center of 
Excellence. He reinforced training standards for senior care, increased 
funding for memory disorder clinics, and enacted comprehensive reforms 
to Florida's prescription drug market. Florida, under his leadership, 
sets a resolute example for other states to follow in prioritizing and 
supporting seniors.

    I am happy to answer any questions you may have. Thank you.
                                 ______
                                 
                [summary statement of michelle branham] 
                
    It is exciting for us to share our story, because, as you may know, 
Florida remains the top destination for seniors, boasting a population 
of over 6.3 million residents aged 60 and older out of our 22.2 million 
residents. The Sunshine State is the second fastest-growing state in 
the Nation, also ranking as the third most populous state in the 
country and surpassing the populations of 15 other states combined. 
It's amazing to think that every day, an estimated 1,000+ individuals 
choose Florida as their new home; and nearly a quarter of these new 
Floridians are aged 60 and older.

    With this ever-growing senior population continuing to age in our 
great state, I am proud to serve as the Secretary of the Florida 
Department of Elder Affairs (DOEA) during this time of continued 
advancement. Appointed by Governor Ron DeSantis in 2021, I have spent 
these past years in the field working closely with our Area Agency on 
Aging (AAAs) partners and their providers in our state's vast aging 
network.

    Governor DeSantis' ongoing and steadfast commitment to prioritizing 
and supporting the needs of Florida's seniors has provided a well-
forged path for our Agency. His unwavering dedication to enhancing the 
quality of life--for older adults across our state--underscores the 
tremendous value he sets on aging in place. With his leadership, 
Florida's mission continues to be that all of us--as we continue to get 
older--live in the place of our choosing, for as long as we choose, 
understanding that this essential concept undoubtedly frames our 
overall happiness, wellness, and comfort in later years. With support 
also from Florida's legislature, our Agency is empowered and funded to 
advance initiatives and services that ensure dignity, independence, and 
fulfillment of Florida's expansive senior population.

    Our Agency plays a pivotal role as Florida's designated, stand-a-
lone state unit on aging, a distinction not shared by all states--but 
further showcasing the immense value and importance placed on Florida's 
older adults. We serve as the primary state agency for administering 
human services and programs specifically tailored to meet the needs of 
our cherished seniors. A primary objective at the Department is to 
ensure our aging adults can maintain their independence, remaining in 
the comfort of their own homes for as long as possible. This not only 
fosters happier and healthier lives for us and our families as we age, 
but also promotes fiscal responsibility in the state and its 
communities--as aging in place is the most affordable and cost-
effective option in choosing how we live in later years.

    The DOEA oversees more than $511 million in state and Federal 
funding--including more than $154 million in funding from the Older 
Americans Act (OAA). We partner with our 11 (AAAs), 48 Lead Agencies, 
and thousands of direct service providers across Florida to assist 
seniors with the OAA, other Federal funding, and state-funded programs 
and services. This culmination of critical and collective offerings 
aims to wrap support around our older adults and their families so that 
our seniors can remain in their own homes as long as possible and 
continue to be vibrant contributors to our state's communities, no 
matter their age. Together, we lead Florida's Aging Network, leveling 
up as a collective team to meet the needs of an ever-changing and often 
difficult aging infrastructure that produced a host of challenges. 
Across the Nation, all aging networks feel the systemic presence of 
workforce shortages, senior homelessness, provider/lead agency 
challenges and funding shortfalls. With this, we are convinced Florida 
must work, not only to ensure we are monitoring our partners, but also 
providing them with key tools and acumen to stand them up for success. 
Our Agency, and our state, believe that leveling up together as an 
aging network will continue to guide our pathway to excellence in our 
service to seniors.
                                 ______
                                 

    The Chair. Thank you very much. It appears that the 
technical problems with Ms. Hutchins were at our end, not at 
her end. And so, with that, we welcome back, Ms. Hutchins.

           STATEMENT OF DOROTHY HUTCHINS, VIRGINIA OLDER   
                       ADULT, ALEXANDRIA, VA 

    Ms. Hutchins. My name is Dorothy Hutchins. In July, I will 
be 94 years old. I live alone, but I am blessed to have a large 
supportive family. I have 5 children, 17 grandchildren, and 27 
great grandchildren.

    I started my career in 1952 as a young geologist, part of 
the women's salary geologist at the time with the Geological 
Survey. I wrote Gemstones of the United States under my maiden 
name, Dorothy Schlegel in 1956.

    One highlight of my career was mapping the Verde Quadrangle 
in the deserts of Arizona. When my husband passed away in 1973, 
I retired from geology and stayed home with my family. I have 
gone on to live on services under the Older Americans Act since 
the early 1990's.

    I attended two different local senior centers, Lincolnia in 
Alexandria and Bailey's in Falls Church. I was able to drive 
myself. At the senior centers, I would play bridge, take 
exercise classes, eat lunch with my peers, and participate in 
events on holidays and special occasions. The work they do is 
so important and should be available to all seniors.

    I started attending the senior centers during COVID. During 
that time, I found out that I was eligible to receive meals 
delivered to my home. On Thursdays, six frozen dinners and six 
lunches are delivered to my home.

    The same young woman from Peru comes every week and we chat 
a little. The food meets my needs and sometimes more than I can 
eat in one sitting. I fell and hurt my hip in January 2021. I 
then got surgery 1 week later.

    After rehab, I came out and walked with a walker. Almost 
exactly 1 year later, I fell again and had another show started 
and rehab. I have had to be very cautious since my falls. I 
don't wear shoes in my home.

    I wear a life alert around my neck and only shower when 
someone is in the house with me. I am fortunate to receive 
occupational and physical therapy in my home. I since stopped 
driving and can no longer attend the senior centers. I do get a 
little lonely. I lost my husband early in our marriage and I am 
an only child.

    Most of our friends are dead. I have one friend in Syracuse 
in a senior living community. But she pays $8,000 each month 
and I can't afford that. I used to go to church every week, but 
I don't go to church anymore in person. I am able to watch it 
on my tablet.

    I stay busy and I like to learn. I have a friend across the 
street brings me The New York Times and Wall Street Journal 
every day, and I get the Washington Post. I have plenty to 
read. I also do the crosswords and watch a lot of TV.

    I have been in my home for 61 years. Thanks to my family 
support and services provided to me by the Fairfax area Agency 
on Aging, I am able to be independent and continue to live in 
my own home. I am also blessed not to have serious health 
problems.

    Everyone deserves a chance to live more of a great choose, 
and for most of us, we want to remain in our home and 
communities. The services provided under the Older Americans 
Act make that possible for me and many other seniors.

    I hope that Congress will continue to support this 
important work. Thank you, and I am happy to answer your 
questions.
    [The prepared statement of Ms. Hutchins follows.] 
    
                 prepared statement of dorothy hutchins 
                 
    Chairman Sanders, Ranking Member Cassidy, and Members of the 
Committee, thank you for inviting me to testify today. It is an honor 
to be testifying from my home in Alexandria, Virginia, today.

    My name is Dorothy Hutchins. In July, I will be 94 years old. I 
live alone, but am blessed to have a large supportive family. I have 5 
children, 17 grandchildren, and 27 great grandchildren.

    I started my career in the 1952 as a young geologist, part of the 
Women's Auxiliary Geologists at the time with the U.S. Geological 
Survey. I wrote ``Gem stones of the United States'' under my maiden 
name, Dorothy Schlegel, in 1956. One highlight of my career was mapping 
the Verde quadrangle in the deserts of Arizona. When my husband passed 
away in 1973, I retired from geology and stayed home with my family.

    I have benefited from services under the Older Americans Act since 
the early 1990's. I attended two different local senior centers, 
Lincolnia in Alexandria and Bailey's in Falls Church, and was able to 
drive myself. At the senior centers, I would play bridge, take exercise 
classes, eat lunch with my peers, and participate in events on holidays 
and special occasions. The work they do is so important and should be 
available to all seniors.

    I stopped attending the senior centers during COVID. During that 
time I found out that I was eligible to receive meals delivered to my 
home. On Thursdays, six frozen dinners and six lunches are delivered to 
my home. The same young woman from Peru comes every week and we chat a 
little. The food meets my needs and is sometimes more than I can eat in 
one sitting.

    I fell and hurt my hip in January 2021 and had surgery 1 week 
later. After rehab I came home and walked with a walker. Almost exactly 
1 year later I fell again and had another surgery and rehab. I have had 
to be very cautious since my falls. I don't wear shoes in my home, I 
wear a life alert around my neck, and only shower when someone is in 
the house with me. I am fortunate to receive occupational and physical 
therapy in my home.

    I've since stopped driving and can no longer attend the senior 
centers. I do get a little lonely. I lost my husband early in our 
marriage and am an only child. Most of my friends are dead. I have one 
friend in Syracuse in a senior living community, but she pays $8,000 
each month and I can't afford that. I used to go to church every week, 
but I don't go to church anymore in person. I am able to watch it on my 
tablet though.

    I stay busy and I like to learn. I have a friend across the street 
who brings me his New York Times and Wall Street Journal every day and 
I get the Washington Post. I have plenty to read. I also do the 
crosswords and watch a lot of TV every day, too.

    I have been in my home for 61 years. Thanks to my family's support 
and the services provided to me by the Fairfax Area Agency on Aging, I 
am able to be independent and continue to live in my own home. I am 
also blessed not to have serious health problems.

    Everyone deserves the chance to live where they choose, and for 
most of us we want to remain in our homes and communities. The services 
provided under the Older Americans Act make that possible for me and 
many other seniors. I hope that Congress will continue to support this 
important work.

    Thank you and I'm happy to answer your questions.
                                 ______
                                 

    The Chair. Well, thank you very much, Ms. Hutchins, and we 
apologize for the technical problems. And you are a great 
witness. We appreciate it. Now, we begin our round of 
questions.

    Let me start off with a very simple one to all of the 
expert panelists who are here, and Ms. Hutchins can jump in as 
well. What all of you have discussed is that we have a growing 
senior population, we have millions of seniors who have hunger 
issues, literally some dealing with malnutrition.

    We have people who are staying home, who are lonely, who 
are isolated. We have people who are falling, causing serious 
injuries. Do any of you doubts that investing in prevention--I 
mean, this is America.

    I mean, we shouldn't be talking about the need to keep 
seniors from going hungry. That should be a given, I would 
hope, in the wealthiest country on earth. When we talk about 
doubling funding for the Older Americans Act, yes, we are 
talking about $2 billion, a lot of money.

    Do any of you doubt that investment will not end up saving 
taxpayers money by preventing hospitalizations or nursing home 
visitation--nursing home care when people want to stay at home? 
Let me start with Ms. Alwin and we will go right down the line.

    Ms. Alwin. Well, thank you. Thank you for the question and 
thank you for elevating the issue. For over 55 years, the Older 
Americans Act has demonstrated a unique ability to provide 
these robust services, and, frankly, protect and enhance some 
of the other Federal resources.

    The preventative service means savings for Medicare and 
Medicaid. And on average, the Older Americans Act funding 
represents less than one-third of 1 percent of all Federal 
discretionary spending, and yet the return on investment is 
amazing.

    The local and state providers leverage other state 
resources, local resources, philanthropic as well as 
volunteers, providing services annually to over 11 million 
older adults and their caregivers.

    The Chair. My question is----

    Ms. Alwin. Let's double----

    The Chair [continuing]. Is the investment going to save 
money?

    Ms. Alwin. It is absolutely going to save money.

    The Chair. Okay.

    Ms. Hollander.

    Ms. Hollander. 100 percent. Absolutely. The best investment 
that we can make. It is a program that has worked, and it is 
continuing to keep people out of emergency departments, 
readmissions, admissions, and premature nursing home 
placements. It is a no brainer as far as I am concerned. You 
invest more, you will get a huge return on that investment.

    The Chair. All right. While you have the mic, let me ask 
you this, in Vermont, and I think around the country, there are 
waiting lines to get into the Meals on Wheels program. Can you 
say a word about that?

    Ms. Hollander. Well, the waiting list is because, the 
resources aren't there. Programs are doing their very best to, 
if they need to, cut back, scale back so they can serve more 
seniors in need.

    But the fact is that the resources have never kept pace. 
You mentioned that earlier, about the reduction 20 percent over 
time. And the population is growing, and we have never really 
adjusted for inflation.

    With the pandemic, of course, everything is more expensive. 
All the things that are required to prepare, to deliver, to 
procure meals and food to do it. But I think the other thing I 
just want to mention real quick is it isn't just about the 
meal, right?

    It is about those people that are needing to have 
socialization, social connectedness. Both of those have----

    The Chair. Okay. I wanted to go down the line. Thanks very 
much, Ms. Hollander.

    Dr. Kubik.

    Dr. Kubik. Yes. Senator Sanders, there is no question that, 
preventing an issue is preferred over waiting until an issue 
occurs. Unfortunately, our health care delivery system has 
mostly been set up to respond to conditions rather than 
prevent.

    But as a public health professional, there is no question 
in my mind that continued support of the OAA for food, 
nutrition, and extended services is exactly what our seniors 
and our growing population of seniors need in order to stay 
home, and age well, and age in place.

    The Chair. Thank you. Ms. Branham, does investing in 
prevention save money long term?

    Ms. Branham. Thank you, Senator Sanders. I think for us, we 
just went through a workshop with our Area Agencies on Aging, 
so I think maximizing the dollars that we have is something 
that is critical to me.

    Making sure that our Aging Network knows how to spend, has 
the ability to spend, and the confidence to spend. So, right 
now we are focusing on maximizing the dollars that we do have, 
and I do think interventions are very helpful.

    The Chair. Okay. Let me say a word. I have visited, as I 
think probably every Senator here has, senior centers and 
congregate meal programs. I love them. Are they getting the 
resources they need to pay for the meals that they serve?

    Ms. Alwin.

    Ms. Alwin. Sure. With 12,000 people turning 65 every day, 
there is increasing demand. And as was shared, it is tough to 
keep up with the cost of inflation. There is growing demand, 
there are growing costs.

    We need to elevate the support and funding both for 
congregate meals and home delivered. There is not enough 
support.

    The Chair. All right. My time is expiring. Last question, 
in Vermont we have some senior centers that are doing really 
great. Some are really struggling in the rural areas. They just 
don't have the funding. Do we have the network of senior 
centers all over this country, the robust network that we need 
to satisfy the needs of seniors in general? Who wants to answer 
that one? Yes.

    Ms. Branham. Thank you, Senator. We have the network, 
11,000 senior centers, but there is no designated funding 
stream for senior centers.

    A third, if they are fortunate, receive dollars from the 
Area Agency on Aging, a third from Parks and Recreation, and 
the final third are left to their own devices to fundraise and 
scrape resources together. So, the quality of services, the 
options available varies greatly by your zip code. It doesn't 
have to be that way.

    The Chair. Okay. Thank you very much.

    Senator Cassidy.

    Senator Cassidy. I defer to Senator Collins.

    Senator Collins. Thank you very much, Dr. Cassidy. Dr. 
Kubik, an issue that we, the panel has not discussed, but which 
Mrs. Hutchins brought up is the problem of falls among our 
seniors.

    This often starts a spiral of downward health and is very 
serious. The Older Americans Act Title 5 or 4, I guess it is, 
does provide some funding to try to support health independence 
and longevity activities.

    I know in the State of Maine, the Aroostook County Area 
Agency on Aging offers classes called a matter of balance, 
which is evidence based. And the Bangor Y also offers similar 
courses.

    Can you tell me how important it is for us to try to ensure 
that there is funding to support programs to prevent falls, 
which can have such devastating consequences?

    Dr. Kubik. Yes. Thank you, Senator Collins, for the 
question. I think as our guest from Alexandria indicated, two 
falls 2 years in a row and with, good health care, good medical 
care, good support at home from an occupational therapist, 
likely a physical therapist, she has been able to stay at home.

    But again, as we bump up the number of us who are over the 
age of 65, who are having varying levels of decline physically, 
if we can prevent and maintain mobility, if we can maintain 
safe mobility, if we can--what the nursing students have done 
with the seniors is they take them for a walk, they accompany 
them on a walk. And during those accompanying walks, you can 
talk about safety.

    You can talk about preventing falls. We also implemented 
foot care at all the clinics. So, if you can take care of your 
feet, you have a firmer base to walk on, which is often 
overlooked when we go to primary care offices. So, I think it 
is critical that we work and prioritize fall prevention among 
our seniors.

    Senator Collins. Thank you. Secretary Branham, welcome. We 
have worked together on Alzheimer's disease in the past and it 
is good to see you today. I want to talk about another issue 
that has been alluded to but not focused on, and that is the 
problem of widespread loneliness among American seniors.

    We know that poses health risks that are as deadly as 
smoking 15 cigarettes a day. Social isolation and loneliness 
have been estimated to shorten a person's life span by as many 
as 15 years, and loneliness and isolation have also been linked 
to cognitive decline and an increased risk of dementia.

    That problem was exacerbated during the pandemic, but even 
before the pandemic, approximately one in four older Americans 
suffered from loneliness. We tried to respond to this in the 
2020 reauthorization of the older Americans Act, which I was a 
coauthor, but I am interested in hearing from you what more we 
could do.

    Congregate feeding areas, meals, obviously help. Visits 
from home health nurses help enormously to have wellness 
checks, but also checking in. Delivering meals on wheels helps. 
But what else would you suggest?

    Ms. Branham. Thank you for the question, Senator Collins. I 
loved working with you. I think that is a major issue, and 
spending so much time in the field, seeing these vibrant senior 
centers open with music and congregating and being together and 
taking tai chi classes and mobility classes for falls 
prevention, learning new things, learning IT, all of that has 
done a tremendous job in improving because isolation, 
loneliness, and depression is something that we saw even with 
our most vulnerable population to a degree that was just so 
sad. And I think there is so much more that we can do.

    We talked about the companionship care, not just delivering 
a meal, but sitting there, talking with the person, making that 
meal more of an opportunity, an event, than just putting 
something down there. So that has been tremendous.

    Even with a more flexibility with OAA, being able to grab 
and go and taking that home and maybe sitting down with a 
person in a park, having those capabilities and flexibilities 
with the new OAA rule has been significant and our Area 
Agencies on Aging love that.

    But I think making sure that we have senior centers that 
are vibrant, adult day centers that are vibrant, help to 
mitigate the impact of isolation, loneliness, and depression. 
And there is absolutely more that we can continue to do.

    Senator Collins. Thank you.

    The Chair. Thank you, Senator Collins.

    Senator Casey.

    Senator Casey. Mr. Chairman, thanks very much for calling 
this hearing. I want to thank you and Ranking Member Cassidy 
for the work that goes into and your teams' work to the 
planning of this hearing.

    Of course, we want to thank our witnesses and thank both 
the Committee leadership as well as our witnesses for uplifting 
the Older Americans Act. A landmark piece of legislation that a 
lot of Americans only hear about every few years, so it is 
important for us to uplift it and celebrate how important it 
is, but also to make sure that we get this reauthorization 
right.

    As Chairman of the Senate Aging Committee, I have worked on 
a bipartisan basis with colleagues over many years now to 
reauthorize the Older Americans Act before, and I am working 
again, and I am grateful to be at the negotiating table once 
more to begin this reauthorization process.

    I think we can all agree, despite all of our divisions in 
the Senate and the House, I think we can all agree that older 
Americans deserve to age with dignity, and it is our 
obligation--it is not optional. It is an obligation, to make 
sure that we are doing everything possible to make that a 
reality.

    I wanted to start with Ms. Alwin and Ms. Hollander about 
the question of the strategic plan for aging. As you both know, 
our population is aging so rapidly, and your testimony 
highlights that reality. Local communities and states still 
need to be able to provide more services and more supports to 
older adults in the years ahead.

    We have heard testimony already, Ms. Hollander, about your 
good work at Meals on Wheels, and Ms. Alwin, on the National 
Council on Aging. Both provide invaluable services for older 
adults and are critical to supporting our older adults as they 
continue to age.

    Across the country, states, including my home State of 
Pennsylvania, have been working on multi-sector--so-called 
multi-sector or master plans for aging. These plans bring 
stakeholders, both public and private stakeholders, together to 
coordinate service delivery and transform infrastructure to 
better meet the needs of our aging population.

    I recently introduced with Senator Gillibrand the Strategic 
Plan for Aging Act. Our bill would provide funding for states 
that are developing or implementing these long term care, or 
long term plans I should say, for aging.

    We want to thank both Meals on Wheels and NCOA for your 
endorsement of the bill. I will be pushing to include this 
legislation in the reauthorization of the Older Americans Act.

    Start with Ms. Alwin. How could long term planning and 
improved coordination across all levels of Government better 
support states, local providers, and of course, the older 
adults that they serve?

    Ms. Alwin. Well, thank you, Senator. Thank you for the 
question and for your leadership with the Special Committee on 
Aging and with the important legislation that really elevates 
lessons from these multi-sector plans.

    We applaud that good innovation going on across the country 
and recognize there is an opportunity to pull that through into 
the reauthorization of the Older Americans Act. Because aging 
well means addressing all the domains of aging well, and long 
term planning around all the domains, as the multi-sector plans 
have initiated, is really an important step to make the most of 
the limited resources available and coordinate across Federal, 
state, and local administering agencies.

    We also applaud the great work of the Administration on 
Community Living for leveraging the Inter Agency Coordinating 
Council opportunity already made available through the Act, 
really modeling that Federal coordination across the various 
departments that states have initiated with the multi-sector 
plans.

    When those conversations and those stakeholders are around 
the same table, we can have thoughtful conversations about the 
demographic trends and provide more preventative services and 
supports, bringing in a greater savings ultimately and 
improving the quality of life.

    Senator Casey. Thank you.

    Ms. Hollander.

    Ms. Hollander. I think Ramsey did a nice job of summarizing 
the benefit of that. I would say, from someone who is actually 
going through a strategic planning process for my own 
organization, I know how important it is to make sure that 
there is alignment, that all the stakeholders are at the table, 
and that you are creating, a plan that is flexible and 
adaptable because we have a very rapidly changing demographic 
in our Country. It is an explosion.

    As you know, we have just been talking about the senior 
population, but there is also far greater diversity, and we 
need to have plans at the state level that are able to flex to 
that change.

    I would just say that one of the things I think is really 
important is rather than having individual plans, there has to 
be some opportunity to look for cross organization--cross state 
synergies to be able to leverage those synergies, those 
learnings, but also to bubble up where there are gaps so that 
at the national level there is symbiotic planning between what 
is happening at the national level, what is happening at state 
levels.

    I only want to caution that to say that we need to have 
people at the table that are sharing that information across, 
and I would also say one more thing, which is a plan is a 
living document, and what we can't do is put all our time into 
developing a plan.

    We have to make sure part of that is making sure that we 
are accountable for delivering on that plan, tracking that 
plan, and making sure that we make adjustments along the way.

    Senator Casey. Thank you, Mr. Chairman.

    The Chair. Thank you.

    Senator Hassan.

    Senator Hassan. Well, thank you, Mr. Chairman. And thanks 
to you and the Ranking Member for holding this hearing. To all 
of our witnesses, thank you very much for your excellent 
testimony. Mrs. Hutchins, I wanted to start with a question for 
you. I want to highlight the epidemic of loneliness in our 
Country, which as we have been talking about, especially 
impacts older Americans.

    A recent study shows that more than one in three older 
adults report feeling lonely or socially isolated. Loneliness 
not only has negative impacts on mental health, but can also 
lead to increased risk for dementia, heart disease, and stroke.

    Mrs. Hutchins, you talked about your challenges with 
loneliness, about your personal experience with it. What tools 
and supports do you find most helpful in combating social 
isolation?

    Ms. Hutchins. I am thinking.

    [Laughter.]

    Ms. Hutchins. I have periods of loneliness, but I have 
lived a long, very interesting life and I have many wonderful 
memories that I fall back on when I get lonely. And I, of 
course, talk on the phone to my family and my one friend who is 
up in Syracuse. And I watch certain programs on TV, and I make 
it through the day.

    I am just grateful to have my son and my grandson stopping 
in from time to time and it is--and my church. I just try the 
best I can to make it through the day. But I have not been 
depressed. So, I just, if I feel a little low, I will just 
think of some wonderful thing that has happened to me in the 
past and that gets me over it. But most of the time, I am in 
good spirits.

    Senator Hassan. Well, that is excellent. And I think one of 
the things you are really describing is the importance of that 
social interaction, even if it is just by phone or seeing 
people and really having that connection is very important.

    Ms. Hutchins. Oh, yes. I enjoyed the senior centers so 
much. I went for 20 years to Lincolnia.

    Senator Hassan. Yes.

    Ms. Hutchins. Played bridge, art classes. I even 
volunteered on the desk, and it was very rewarding. I was there 
at least 3 days a week.

    Senator Hassan. Well, thank you.

    Ms. Hutchins. Their meals were very good, too.

    Senator Hassan. Yes. Thank you very much for that. I want 
to turn to Secretary Branham now. One way to address loneliness 
is to create more opportunities for social connection across 
different generations.

    One senior community in Hanover, New Hampshire, called 
Kendal at Hanover hosts a day care and early education program 
for children up to 6 years old. This model, also called 
intergenerational care, gives seniors the opportunity to 
volunteer in the classroom and participate in social activities 
with very young students.

    For residents who enter the facility alone or who are 
experiencing health issues and may be more prone to social 
isolation, volunteering in the classroom and interacting with 
the kids has become their favorite part of the day.

    Intergenerational programs can obviously benefit both of 
our seniors and our young people by giving them opportunities 
to build new relationships and learn from each other. So, 
Secretary, can you speak to how intergenerational care programs 
like this can be useful in combating loneliness?

    Ms. Branham. Yes. Thank you, Senator. I love our senior 
volunteer program. First, here at the department, we have 
seniors providing care for seniors. So, a lot of companionship 
care and I absolutely love that volunteer program.

    We have so many testimonies from across the state of that 
because it is more than just, like I said, dropping off a meal. 
It is taking time to read or bake cookies and spend time. But 
on the intergenerational side, I think it is really exciting 
because through the First Lady of Florida's initiative, we have 
a mentoring program.

    Seniors mentoring children at risk, children in the 
elementary school system, and children graduating out of foster 
care who need assistance. And I think that intergenerational 
connection has been a win, win, both for the people, the young 
people, the families surrounding them, and the seniors. So, it 
has been really exciting to watch that.

    Senator Hassan. Well, excellent. Thank you. And finally, to 
Ms. Alwin, I want to focus a little bit on family caregivers 
who obviously play such a central role in caring for loved 
ones. Congress recognized the key role of family caregivers 
when it added the Family Caregiver Support Program to the Older 
Americans Act in 2000.

    It is critical that we reauthorize and build on the 
caregiver resources provided through the Older Americans Act to 
ensure that families have the support that they need. That is 
why I joined my colleagues in pushing for policies that support 
caregivers, such as the Credit for Caring Act, which would give 
much needed tax relief to family caregivers. What are the other 
ways, Ms. Alwin, that Congress can support family caregivers?

    Ms. Alwin. Fabulous. Well, thank you for your leadership in 
introducing that important legislation, Senator. There are many 
different actions Congress can place, and we are supporters of 
the Raise Coalition and the incredible release of the National 
Family Caregiver Strategy, where there are over 350 actions 
that can be taken by Federal agencies already today to better 
support family caregivers.

    Many of the services and supports provided by the Older 
Americans Act help those family caregivers. So, reauthorizing 
the Older Americans Act, doubling the funding so those services 
and supports, including respite care, are available to family 
caregivers is critical.

    Senator Hassan. Well, thank you very much, and I would add 
my support for respite services. They are really, really 
important. Thank you.

    The Chair. Thank you, Senator Hassan.

    Senator Cassidy.

    Senator Cassidy. Thank you, Chairman Sanders. And thank you 
all for being here. Really a great mission. Ms. Hutchins, you 
kind of inspire us all to live that better life. Secretary 
Branham, believe me, I just met with some fast food folks. They 
are talking about the cost of labor.

    We know that inflation has really bit--I am sure it has bit 
your budget too. And yet, with all this growing population, you 
are expanding services. Clearly, you are collaborating with 
others. Can you speak about that collaboration? What are best 
practices?

    Ms. Branham. Something that we just--thank you, Senator, 
for the question. It is something that we just did is our SCSEP 
program out of OAA has been connected to career source.

    Senator Cassidy. SCSEP program. Please, for everybody 
watching who doesn't know acronyms?

    Ms. Branham. Yes. It is the Senior Community Employment 
Program. We love our acronyms. So that program has been really 
paramount for us because it takes seniors back into the 
workforce, educates and trains them, pays them while we are 
doing it, and then really helps with the gaps in service that 
we are seeing in Florida.

    Now, we have added that SCSEP program, those seniors that 
are in the program, into Career Source Florida, so that we can 
really look at all the gaps across all of the industries in 
Florida.

    Senator Cassidy. If you will, you are not competing for the 
person who might be doing lawn work out there, but rather you 
are taking a group of folks who would have maybe more empathy 
with the clientele, and you are giving them another chance at 
employment.

    Ms. Branham. Yes, sir. And usually, I see through our SCSEP 
program, seniors helping seniors, and they traditionally go 
into the social work environment, which I really enjoy 
watching.

    Senator Cassidy. Yes. I know this is a different Committee, 
but do you run into problems with the retirement earnings test 
in which they get a decrease in their Social Security payment 
if they go back to work? Are you familiar with that?

    Ms. Branham. No, sir. I am not.

    Senator Cassidy. Dr. Kubik, I am a doc. I love the idea 
that you are using--you are finding the win, win, win, if you 
will. Elaborate a little bit on that, please.

    Dr. Kubik. I definitely agree, it is a mutually beneficial 
partnership. I think that we can do so much more to connect our 
health profession students to our seniors and our aging 
population. At this point, their exposure is mostly when that 
person is in the emergency room or in the hospital, very 
vulnerable, very frail.

    Most of our seniors are not frail. Most of them are wanting 
to stay at home, wanting to be successful, wanting to be 
healthy, wanting to be productive, wanting to be able to go and 
visit with their friends and socialize.

    Senator Cassidy. Now, did I hear you correctly that you 
have lowered systolic blood pressure to 20 points?

    Dr. Kubik. Yes. Six point, almost. Yes. As you know, most 
of the high blood pressure we get when we get older is the top 
number. Our systolic blood pressure goes up.

    Senator Cassidy. That is the top number.

    Yes. That is a bottom number for people who----

    Dr. Kubik. Right. So, we lowered that top number by almost 
six points in the group that received the ageWELL program.

    Senator Cassidy. Now, did you do that just by making sure 
they were compliant, by looking at their diet, and making sure 
they weren't eating Fritos for breakfast?

    Dr. Kubik. No. The intervention, the work that we did with 
the nursing students, it wasn't just one thing. It was a lot of 
medication management. Every week they were there, they were 
checking blood pressures.

    We were writing blood pressures down. We were encouraging 
them to take their lists to their health care provider. We were 
getting up and walking with them. So, it wasn't just showing 
them exercise, it was taking them and exercising with them. So, 
in my opinion, it was all that coming together.

    In our work, most of our seniors were taking three to five 
medications or more every day. Whether they needed all those 
medications or not is something that we need to look further 
into, but it is a challenge to manage all these chronic 
conditions that they have.

    I think the feedback and the engagement that they were 
having with the nursing students was an incentive to, perhaps 
eat better, to be more active.

    Senator Cassidy. By the way, and I forget again, it was you 
or Ms. Hutchins, because I forget, but I think one of you said 
something about making sure that you minimize the risk for 
falls. I think about these throw rugs that are easy to slip 
upon and somebody breaks their hip.

    Dr. Kubik. Right. Exactly.

    Senator Cassidy. Or fall and----

    Dr. Kubik. That is right.

    Senator Cassidy. Let the record show I slapped my head. And 
so, if nothing else, you are creating that awareness among 
those who are----

    Dr. Kubik. Yes.

    Senator Cassidy. A comment on that, please.

    Dr. Kubik. Well, I think it is, again, that one on one 
engagement between the senior and the nursing student allowed 
the senior to prioritize concerns, but it also provided the 
nursing student an opportunity to provide prompts.

    Tell me about safety in your home. Tell me about how you 
manage moving around your furniture and cooking and storing and 
putting things away. Next week, when you come back, let's talk 
about that some more. That is the other opportunity that the 
nurses take----

    Senator Cassidy. I am almost out of time, but I started off 
speaking about a partnership with an outside agency that would 
actually extend and leverage the dollars. And then you just 
gave us another great example of how that is actually training 
our next generation of nursing students. So, thank you both, 
and thank you all.

    The Chair. Senator Markey.

    Senator Markey. Thank you, Mr. Chairman. My mother had 
Alzheimer's. My father was a milkman. My mother was president 
of the senior class. So, my father said, Eddie, it was an honor 
that your mother married me. She is a brilliant woman.

    She has Alzheimer's. There is something wrong. Shows you 
that the strongest brains can be attacked. So, we are going to 
keep her in the living room. That is going to be our job. She 
is never going to go to a nursing home at age 80, 82, 84, 86, 
88, 90. And here is a milkman. So, the right arm of a milkman 
is like my upper thigh. He could do it. But it is hard. And so, 
all he had was a visiting nurse 1 hour a day.

    23 hours, we had her in the living room. Very difficult. 
So, with Senator Wyden, I created a program called Independence 
at Home to help people with chronic illnesses to have the 
dignity of staying in their homes.

    Ms. Branham, can you share how the Older Americans Act in-
home services and outreach programs for individuals with 
Alzheimer's and others can provide for their families at home?

    Ms. Branham. Thank you, Senator Markey, for the question 
and touching my heart. I spent 10 years at the Alzheimer's 
Association alongside people living with the disease and their 
caregivers.

    Some of the most courageous people I have ever witnessed. 
Yes, I think living at home and being able to stay at home is 
the best possible concept for someone living with dementia, but 
it is really hard to do that by yourself. And I applaud your 
father for doing that. So, having those wraparound services is 
not something that just the OAA provides.

    But here in Florida, the Alzheimer's Disease Initiative is 
something that we fund. It has increased funding each year 
for--to supplement OAA for services like that, because staying 
at home and wrapping around care and services is not just for 
the person living with the disease, but the caregiver too, is 
really, really significant.

    Senator Markey. Yes. And again two-thirds of Alzheimer's 
patients are women. It is a one-third, two-thirds split.

    Ms. Branham. Yes.

    Senator Markey. There is a lot of work to be done to figure 
out what is going on here because women are the caregivers. In 
general, it is a reverse, and there aren't enough men to--that 
can do that for all those women.

    I led my colleagues in writing to the U.S. Department of 
Agriculture and the Social Security Administration asking them 
to make it easier for seniors and people with disabilities 
applying for Social Security benefits to also get SNAP 
benefits.

    My goal is to make sure that because they didn't know they 
could get help or got mixed up trying to fill out their 
paperwork. Ms. Hollander, in your testimony, you mentioned that 
over four in five low income food insecure are not receiving 
the meals that they are eligible because of long waitlists.

    Meanwhile, you noted that various funding streams with 
different requirements and standards can make it very hard for 
nutrition service providers to partner with others in the 
community and tailor older Americans' meals to their specific 
health needs.

    Can you elaborate on that and what has to be done in order 
to make sure that we make it easy for people to get access?

    Ms. Hollander. Thank you for the question, Senator Markey. 
Yes, I think we are talking about an older population that 
generally 76 on average. Most of whom are women, as a matter of 
fact.

    I think some of the, for example, SNAP applications and so 
forth is a little more complicated for them than it is for 
others. But I, actually Senator Casey left, but I think he put 
forward recently an act to help facilitate that process, the 
Senior Hunger Prevention Act.

    But I think just generally speaking, making sure that we 
have people that are working with seniors, that are familiar 
with all of the various benefits that might--they may be 
eligible for is very important, and making sure they are 
educated to do so.

    Senator Markey. Thank you. Ms. Alwin, finally, how would 
mechanisms within existing Older Americans Act programs to 
support underserved populations like LGBTQ older adults help us 
meet their unique health and social needs?

    Ms. Alwin. Absolutely. So, to keep pace with the growing 
number of older adults and the greater diversity among older 
adults, we need to modernize and strengthen and fully fund the 
Older Americans Act.

    But those senior centers really are a front door to all 
resources and services available for all older adults, 
including LGBTQ+ older adults. And making sure we have the 
right mechanisms in place to help support building the capacity 
of those senior centers, sharing promising practices, providing 
technical assistance, and designated funding so they can build 
their relevance and capacity and culturally competent 
programing is critical.

    Senator Markey. Yes. And the Congress is the right place to 
be, because the secret plan for every single Senator is to live 
to be a very old person, Okay. So, we are completely into your 
agenda to make sure that we help that population. Thank you so 
much. Thank you, Mr. Chairman.

    The Chair. My understanding is that Senator Baldwin is on 
her way. So, I am going to give her two more minutes and I will 
take a minute and give a minute to Senator Cassidy just to ask 
another question.

    I think the average American would be stunned to learn that 
millions of seniors are dealing with hunger issues or going 
hungry, that we have actually malnutrition in America today. I 
mean, that is rather an astounding reality. Ms. Hollander or 
Ms. Alwin, do you want to say a word on hunger among seniors in 
America?

    Ms. Hollander. Well, it is a silent epidemic. That is part 
of the challenge, that it is behind closed doors. And one of 
the things we have to do is we have to amplify the fact that 
this is a grave and growing issue, and we have the 
infrastructure to do it.

    One of the things I neglected to mention earlier when you 
asked the question about funding, is that this is a successful 
public, private partnership. For every Federal dollar that 
comes in through the Older Americans Act, it is matched by 
about $3 by private and state local sources.

    Even though we are making investments, it is not carrying 
the full freight of what we are asking. It is actually 
attracting additional funding to do that.

    The Chair. Thank you.

    Senator Cassidy, want to take a minute?

    Senator Cassidy. Yes. Ms. Hutchins, tell me, you are a 
recipient. You have received meals both I gather going to some 
place so called congregate and you have had meals delivered to 
you. Would you have any suggestions to how to make either of 
those programs a better program? You are on mute. Oh, go 
ahead----

    [Technical problems.]

    Senator Cassidy. Thank you ma'am. Thank you.

    The Chair. Thank you very much. Okay, let me thank all of 
our panelists. You did a great job. We look forward to working 
with you on this enormously important issue. Thank you very 
much.

    We will now hear from our second panel. Okay. Our final 
witness, and our witness for this panel, is Ms. Alison Barkoff, 
the Acting Administrator and Assistant Secretary for Aging. Ms. 
Barkoff leads the Administration for Community Living.

    The Administration's mission is to maximize the 
independence, well-being, and health of older adults, people 
with disabilities across the lifespan, and their families and 
caregivers. Thank you very much for being with us today, Acting 
Administrator. You may proceed with your testimony.

     STATEMENT OF ALISON  BARKOFF, PRINCIPAL  DEPUTY  AD-
       MINISTRATOR  AND PERFORMING  THE DUTIES OF THE AD-
       MINISTRATOR AND ASSISTANT SECRETARY FOR AGING, AD- 
       MINISTRATION FOR COMMUNITY LIVING, U.S. DEPARTMENT 
       OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC

    Ms. Barkoff. Good afternoon, Chairman Sanders, Ranking 
Member Cassidy, and Members of the Committee. Thank you for the 
opportunity to provide testimony on the Older Americans Act and 
for the Committee's long standing support of the Older 
Americans Act programs and healthy aging.

    I am Alison Barkoff, the Principal Deputy Administrator and 
Senior Official, performing the duties of Administrator and 
Assistant Secretary for Aging. I am pleased to share 
information today about our work to strengthen OAA programs and 
the aging services network that implements them, which 
ultimately will help ensure our Nation's ability to meet the 
needs of older adults.

    OAA programs help older adults age in place, as the vast 
majority want to do. They provide meals, family caregiver 
support, preventative health services, personal care services, 
transportation, senior centers, legal assistance, elder abuse 
prevention, long term care ombudsman services, and so much 
more.

    These programs reach nearly one in four--five older adults 
who tell us in survey after survey that OAA programs help them 
stay in their own homes. These effective programs are an 
incredible value.

    With OAA dollars, the Aging Network leverages another $3 to 
$4 from other sources to support OAA programs. For the next 20 
years, 10,000 people, the population of a small town, will turn 
65 every single day.

    Helping people age in place and avoid more costly 
institutional care will only become more important. For nearly 
60 years, the structure of the OAA has driven its success. It 
sets broad policy but gives the Aging Network the flexibility 
to meet local needs. We saw the power of that during the 
pandemic.

    The network pivoted quickly and creatively, working with us 
to use that OAA's flexibilities to continue services. They 
created contactless service options, grab and go meals, and 
more.

    They increased coordination and forged new partnerships 
with public health, emergency management, and others, while ACL 
partnered with agencies across HHS to leverage our collective 
resources to meet the unique needs of older adults. Working 
through the pandemic highlighted the need to update the OAA 
regulations to clarify its flexibilities and disaster 
requirements.

    Updating the rule also allowed us to provide guidance for 
programs authorized since the last update, like the family 
caregiver programs. We also aligned the regulations with 
changes made to the law during reauthorization and addressed 
questions that had arisen in the field about the statutory 
updates.

    We received input from states, tribes, Area Agencies on 
Aging, and others. They sought greater clarity on requirements 
but underscored the importance of preserving flexibility. The 
final rule strikes that balance.

    It reflects best practices from the field and provides the 
updated modern framework needed to strengthen the network and 
sustain the OAA's success. ACL is able to have an outsized 
impact on issues critical to older adults through partnerships, 
leveraging our programs and the Aging Network, and coordinating 
across Federal Government to prevent duplication between 
programs.

    For example, we promote healthy aging with evidence based 
programs, many developed by NIH and CDC, that have been proven 
to improve overall health, prevent falls, and reduce health 
care expenditures.

    We have partnered across HHS and with the Aging Network and 
nonprofits on our work to help older adults avoid social 
isolation. We are collaborating to improve support to the 
Nation's 53 million family caregivers, and we are working with 
partners across Government to address the dire shortage of 
direct care workers, which is jeopardizing community living for 
older adults and putting more on family caregivers.

    We are also partnering with HUD to improve coordination of 
our programs to support community living and reduce older adult 
homelessness. With the updated regulations and the partnerships 
ACL and the aging services network are building across every 
level of Government, OAA programs and the network are well 
positioned to help older adults maintain their health and 
independence, both today and into the future.

    Thank you for the opportunity to participate in today's 
hearing. ACL has appreciated the Committee's support of the 
Older Americans Act and the Aging Services Network, and we look 
forward to working with you in the future. I am happy to answer 
your questions.
    [The prepared statement of Ms. Barkoff follows.] 
    
                  prepared statement of alison barkoff 
                  
    Good afternoon, Chairman Sanders, Ranking Member Cassidy, and 
Members of the Committee. Thank you for the opportunity to provide 
testimony on the Older Americans Act (OAA) and for the Committee's 
longstanding support of the OAA programs and interest in healthy aging. 
I am pleased to share information today about the Administration for 
Community Living's recent efforts to ensure our Nation's ability to 
meet the needs of the growing population of older adults by 
strengthening the OAA programs and the national aging services network 
that implements them. These include the first comprehensive update to 
the OAA regulations in more than 30 years and a number of partnerships 
to address the issues most important to older Americans.

    I am Alison Barkoff, the Principal Deputy Administrator and senior 
official performing the delegable duties of the Assistant Secretary for 
Aging and Administrator of the Administration for Community Living 
(ACL) at the U.S. Department of Health and Human Services (HHS). ACL 
was created around the fundamental principle that older adults and 
people with disabilities of all ages should be able to live where they 
choose, with the people they choose, and with the ability to 
participate fully in their communities. ACL makes this principle a 
reality for millions of older adults through implementation of the OAA, 
working with and through the national aging services network of states, 
tribes, area agencies on aging (AAAs), local service providers, and 
volunteers who provide services that enhance the health, independence, 
and dignity of our Country's older adults. 

  OAA Programs Are Critical to Meeting the Needs of America's Growing 
                            Aging Population 
                            
    The OAA programs provide a range of community-based services to 
help older adults age in place, which is the preference of the vast 
majority of older adults, and to maintain their health and engagement 
in their communities. These services include home-delivered and 
congregate meals, support for family caregivers, preventive health 
services, personal and home care services, transportation, senior 
centers, legal assistance, elder abuse prevention, and so much more. In 
addition, the OAA provides ombudsman services for people who live in 
long-term care facilities. The OAA programs reach nearly one in five 
adults in the United States.

    OAA services are effective in helping millions of older adults stay 
in their own homes and communities instead of having to enter long-term 
care facilities. For example, over 65 percent of caregivers who receive 
OAA services like respite care and peer support report that without OAA 
services, their high-risk care recipients likely would have had to 
enter a nursing home or assisted living facility. Similarly, 82 percent 
of people who participate in the congregate meals program and 92 
percent of home-delivered meal recipients report that meals received 
through the programs allowed them to continue to live independently. 
Likewise, 66 percent of older adults using transportation services rely 
on them for the majority of their trips to doctors' offices, 
pharmacies, meal sites, and other critical daily activities that help 
them to remain in the community. OAA services help prevent older adults 
from having to spend down to become eligible for Medicaid to enter a 
long-term care facility.

    For nearly 60 years, the structure of the OAA programs has been a 
hallmark of its success. The OAA and its implementing regulations 
provide broad policy and guidance while allowing states, tribes, and 
AAAs the flexibility to work together to design programs that are 
responsive to local needs. In addition, the OAA programs are an 
incredible value with a strong return on investment; with every OAA 
dollar provided, the aging services network leverages another four 
dollars from state, local, and private sources.

    Despite the excellent return on investment and the broad reach of 
the OAA programs, the demand for OAA services far exceeds capacity. 
While anyone over the age of 60 is eligible to participate in the OAA 
programs, not every older person needs the services and supports 
equally. That is why the OAA requires services to be targeted to older 
adults in the greatest economic and social need. This includes those 
who are low income, as well as those whose needs are caused by 
noneconomic factors, such as physical and mental disabilities, language 
barriers, and cultural, social, or geographic isolation, such as 
minority older individuals, older persons with limited English 
proficiency, older persons residing in rural areas, older persons with 
disabilities, and older individuals who are LGBTQ or living with HIV/
AIDS. For example, over 92 percent of OAA program participants have 
multiple chronic conditions and are at risk for hospitalization; over 
69 percent of case management clients take five or more medications; 
and more than 40 percent of home-delivered meal clients need support 
with three or more activities for daily living. In addition, five 
million older individuals live below the Federal poverty level, many of 
whom are served by the OAA programs.

    The demand for--and importance of--the OAA programs continues to 
grow as the population in the United States rapidly ages. Every 7 
seconds today, and for the next 20 years, someone in America will join 
the ranks of becoming an older adult; that is a rate of 10,000 a day, 
or the equivalent of a small town in America. One in six people are 
currently aged 65 or older, a 35 percent increase since 2010. By 2040, 
that number will increase to one in five people. Helping people age in 
place and avoid costly institutional care will only become more 
important. 

  Lessons Learned from the Pandemic and Updated Regulations Have Well-
          Positioned the Aging Services Network for the Future 
          
    Older adults were among the most impacted by the COVID-19 pandemic, 
at highest risk for severe complications, illness, and even death. The 
aging services network quickly pivoted with innovation and creativity, 
working with ACL to find new ways to use the OAA's flexibilities to 
serve older adults. For example, they modified programs to provide 
contactless service, grab-and-go meals, and virtual wellness checks to 
assess needs and combat social isolation.

    Supplemental funding from Congress was also critical to their 
success. Throughout the pandemic, the aging services network increased 
coordination and forged new partnerships, including with public health 
and emergency management entities, faith-based organizations, and other 
community groups. At the Federal level, ACL partnered with sister HHS 
agencies, including the Administration for Strategic Preparedness and 
Response (ASPR), the Centers for Disease Control and Prevention (CDC), 
and the Health Resources and Services Administration (HRSA), to bridge 
gaps, pool resources, and leverage each of our networks to meet the 
unique needs of older adults and address barriers to accessing 
vaccines, treatment, and supports and services.

    The pandemic underscored the need for ACL to update the OAA 
regulations, which had last been updated in 1988. Rulemaking was an 
opportunity not only to imbed lessons learned from the pandemic, such 
as the importance of the flexibilities allowable under the OAA and of 
inclusive disaster preparedness and response, but also to provide 
guidance for programs that had been authorized after the last 
regulations, such as the family caregiver programs. ACL also used the 
rulemaking process to align the regulations with changes made during 
reauthorizations of the OAA, including clarifying and answering 
questions that had arisen in the field about statutory updates.

    In updating the regulations, ACL sought the input of states, 
tribes, AAAs, service providers, and older Americans themselves. ACL 
held listening sessions and sought public comment through a formal 
request for information in May 2022 and a notice of proposed rulemaking 
in June 2023. During this process, ACL heard from commenters--including 
state agencies and AAAs--seeking greater clarity from ACL on various 
statutory requirements, including fiscal requirements. At the same 
time, commenters also underscored the importance of flexibility to 
address local community-level needs within the framework of the 
statute.

    The final rule strikes this balance, and sets forth an updated, 
modern framework that reflects best practices from the field and 
strengthens the aging services network. The regulations make clear that 
state plans must describe how state agencies and AAAs will use OAA 
funding, and how requirements for public participation are met. They 
also require state agencies and AAAs to ensure coordination between 
programs that serve all older adults, including tribal elders. Other 
requirements clarify the state agency's responsibility to establish and 
maintain policies and procedures to monitor the programmatic and fiscal 
performance of programs and activities.

    The regulations also detail how greatest economic need and greatest 
social need are determined. Prioritizing people who have the greatest 
economic and social needs has always been a basic tenet of the OAA; the 
updated rule clarifies this requirement and sets expectations for 
serving these older adults and ensuring that their perspectives are 
incorporated into planning efforts by state agencies and AAAs. 
Consistent with ACL's approach to rulemaking, this portion of the rule 
also gives states flexibility to include additional populations based 
upon local considerations.

    The final rule addresses questions from the field about how the 
aging services network can engage in business relationships to expand 
their reach, such as partnering with health plans to deliver services 
to older adults that address their health-related social needs. The 
final rule sets forth the appropriate roles, responsibilities, and 
oversight of such activities, and requires state agencies to establish 
flexible and streamlined processes for AAAs to receive approval for 
contracts and commercial relationships. The provision is intended to 
promote and expand the ability of the aging network to engage in 
business activities while ensuring that the unique roles of OAA 
grantees are preserved. Relatedly, the regulations define ``conflicts 
of interest'' and establish several requirements to prevent them. These 
provisions are intended to ensure the integrity of--and trust in--the 
activities carried out under the OAA, while preserving the ability of 
the aging network to innovate and partner with other entities that 
serve older adults.

    The final rule also modernizes the OAA's senior nutrition programs. 
These essential programs not only reduce hunger and food insecurity, 
but they also improve health and address social isolation by providing 
opportunities for older adults to engage with other people and to be 
screened for other needs before they become crises. The COVID-19 
pandemic both necessitated popular innovations across the programs and 
brought to light limitations in the previous regulations. For example, 
the new regulations clarify that home-delivered meals may be provided 
via home delivery, pick-up, carry-out, or drive-through; eligibility 
for home-delivered meals is not limited to people who are 
``homebound''; and home-delivered meal participants may also 
participate in congregate meals programs. The rule also clarifies that 
the OAA allows for grab-and-go meals to be provided through the 
congregate meals program in some circumstances. The regulation also 
clarifies requirements for transfers of funds between the congregate 
and home-delivered meals programs, as well as between the senior 
nutrition programs and supportive services and senior centers. These 
flexibilities allow states to tailor their programs to local needs and 
older adults' preferences.

    Just as the pandemic led to innovations in the senior nutrition 
program, it also required the aging services network to think 
creatively about other services, including senior centers. The pandemic 
showed that for many older adults, especially those living in rural 
areas, virtual senior center activities were welcomed and helped foster 
important social connections. In the process of seeking input from the 
field and stakeholders to inform the regulations, ACL heard from many 
participants that they prefer senior centers be a part of larger 
community centers, in part to encourage intergenerational 
opportunities. Based on this, ACL has been testing approaches to 
modernize senior centers, including transforming them into community 
hubs, expanding programming to support overall wellness, and improving 
their relevance to the current generation of older adults. The updated 
regulations provide flexibilities that will allow senior centers to 
evolve to continue to meet the needs and preferences of older adults.

    The pandemic also highlighted that emergencies and disasters have 
disproportionate impacts on older adults and family caregivers, and 
often create unique challenges for the aging services network. However, 
the previous OAA regulations included limited guidance addressing these 
situations. The updated regulations create a new subpart regarding 
supports for older adults and family caregivers, including those in 
tribal communities, during emergencies and disasters. The new 
regulations require state agencies and AAAs to establish emergency 
plans and have policies and procedures in place for communicating and 
coordinating with state, tribal, and local emergency management 
entities within their jurisdictions. State agencies may set aside 
funding to exercise flexibilities during a major disaster declaration 
and procure items on a statewide level, subject to certain conditions. 
To further be responsive to the need for flexibility, the rule makes 
clear that the Assistant Secretary for Aging may modify emergency and 
disaster-related provisions in the regulation when a major disaster or 
public health emergency is declared.

    The regulations also include important updates to OAA programs that 
protect the rights of older adults and prevent and address abuse and 
neglect. An estimated one in 10 adults over the age of 60 have 
experienced some form of elder abuse, which can reduce their quality of 
life and limit their independence. OAA programs play a critical role in 
promoting elder justice, ensuring that older adults can live safely in 
the community or in long-term care settings, and upholding older 
adults' rights to participate in decisions about their lives. The 
regulations outline how states must ensure the independence of long-
term care ombudsman programs that work to resolve problems related to 
the health, safety, welfare, and rights of individuals who live in 
nursing homes, assisted living facilities, and other residential care 
communities. The updates also specify that efforts related to 
guardianship must include assisting older adults with less restrictive, 
more person-directed decisional supports whenever possible. Our elder 
abuse work under the OAA is coordinated with ACL's programs under the 
Elder Justice Act, including adult protective services (APS). We are in 
the process of the first-ever rulemaking for APS, following the first-
ever annual appropriations for that program.

    Finally, the updated OAA regulations provide guidance for the first 
time on the OAA's family caregiver programs, which were added as part 
of the OAA's 2000 reauthorization. The programs provide a range of 
supports, including counseling, case management, and respite care, to 
nearly 800,000 informal caregivers. Studies show that these services 
enable caregivers to provide care longer, making it possible for older 
adults to remain in their own homes and avoid or delay the need for 
costly institutional care. The regulations provide key definitions, 
implement statutory mandates, and clarify requirements for family 
caregiver support services, allowable uses of funds, and the method of 
funds distribution.

    The final rule goes into effect on March 15, 2024, and the network 
has until October 1, 2025, to implement its changes. Over the coming 
months, ACL will continue to share resources and provide robust 
technical assistance to support states, tribes and tribal 
organizations, AAAs, and others in the aging services network in 
meeting the requirements of the new regulations. ACL also will work 
with states and other network partners in a supportive corrective 
action process if more time is needed to fully comply with specific 
provisions. 

 Through Partnerships, ACL and the Aging Services Network Are Helping 
          Address the Most Pressing Issues Facing Older Adults 
          
    ACL and the aging services network are able to have an outsized 
impact on issues critical to older adults through partnerships, 
leveraging our programs and network and coordinating across Federal 
Government programs to ensure there is no duplication. For example, 
healthy aging is an important issue, particularly as people are living 
longer. ACL and the aging services network promote healthy aging by 
implementing an array of evidence-based and evidence-informed health 
promotion and disease prevention interventions--many developed by NIH 
and CDC--that have been proven to improve overall health, better manage 
chronic disease and illness, reduce falls and risks of injury, and 
reduce healthcare expenditures. Falls prevention interventions are a 
particular focus for ACL, given the significant financial, physical, 
and social impacts falls can cause. Under the authority granted in the 
most recent reauthorization of the OAA and with funding first provided 
in fiscal year 2023, ACL is designing a research, demonstration, and 
evaluation center to study an expanded set of effective falls 
prevention approaches that can be implemented by the aging services 
network. In addition, ACL is collaborating with more than a dozen 
Federal agencies, including NIH and CDC, to create a strategic 
framework for a national plan on aging through the Interagency 
Coordinating Committee on Healthy Aging and Age-Friendly Communities 
(ICC), an interagency working group created by Congress in the 2020 
reauthorization of the OAA and that ACL recently launched after 
receiving funding for the ICC for the first time in fiscal year 2023.

    Social isolation is an epidemic that poses serious health risks to 
millions of older adults. To increase the impact and reach of the OAA 
programs that address social isolation, ACL has partnered with the HHS 
Office of the Assistant Secretary for Health, the aging services 
network, and non-profit organizations to establish Commit to Connect, a 
cross-sector initiative to reach people who are socially isolated. 
Commit to Connect has catalyzed a nationwide network of champions to 
increase awareness and availability of programs and strategies that 
address social isolation and loneliness and to strengthen partnerships 
to leverage efforts, resources, innovations, and activities related to 
social isolation.

    ACL is also partnering across the Federal Government to address one 
of the most pressing issues facing older adults--the direct care 
workforce crisis and its impact on family caregivers. Because of 
workforce shortages, many older adults who need services to remain in 
the community cannot get them, and those who do receive services often 
experience disruptions and inconsistent quality, both of which 
jeopardize the health and safety of the people receiving services and 
increase demands on family caregivers. ACL launched the Direct Care 
Workforce Strategies Center (Strategies Center) in collaboration with 
the Department of Labor, the Centers for Medicare & Medicaid Services 
(CMS), and the HHS Office of the Assistant Secretary for Planning and 
Evaluation. The Strategies Center provides technical assistance and 
resources to strengthen collaboration across state agencies (including 
aging, disability, Medicaid, and workforce development), direct care 
professionals, people receiving services, and other stakeholders in 
order to improve recruitment, retention, and development of this 
critical workforce. ACL just announced several intensive technical 
assistance opportunities available to states through the Strategies 
Center, funded in part by the fiscal year 2023 OAA funding Congress 
directed toward workforce issues.

    Interagency partnership and collaboration with stakeholders also 
are critical to ACL's efforts to support the more than 53 million 
family caregivers in the United States, including grandparents raising 
grandchildren. ACL facilitated the development of the first-ever 
National Strategy to Support Family Caregivers, submitted to Congress 
in September 2022, which included more than 300 commitments from almost 
15 Federal agencies and recommendations for state and local government, 
business, and other stakeholders. ACL is leading the implementation and 
update of the strategy. With OAA funding provided to ACL in fiscal year 
2023, ACL recently awarded the first-ever Caregiver Projects of 
National Significance to focus on implementation of recommendations in 
the strategy by the aging services network.

    Older adults are the fastest growing age group among those 
experiencing homelessness, currently comprising nearly half of the 
homeless population, and their numbers are estimated to triple by 2030. 
To address this serious issue, ACL leads the Housing and Services 
Resource Center (HSRC), a partnership between the Department of Housing 
and Urban Development (HUD) and HHS, to coordinate across the 
healthcare, aging, disability, housing, and homeless sectors the 
affordable housing and community services that many older adults and 
people with disabilities need to remain stably housed in the community. 
The HSRC is funded in part through the OAA Aging Network Support 
Activities, and the aging network is a key partner and beneficiary of 
the HSRC activities. Jointly funded by ACL, HUD, and the Substance 
Abuse and Mental Health Services Administration, the HSRC recently 
launched a year-long intensive technical assistance initiative with 
nine states focused on coordinating housing and services to address 
homelessness, including among older adults.

    Inclusive disaster preparedness and response is another priority 
area where ACL and the aging services network are leveraging 
partnerships to meet the unique needs of older adults during disasters. 
Inability to evacuate, loss of services, inaccessible shelters, and 
other issues can result in unnecessary institutionalization, poor 
health outcomes, and even death for older adults during disasters. 
Through ACL initiatives and supplemental funding during the pandemic, 
the aging services network built partnerships with their state and 
local public health and emergency management agencies to provide 
expertise and fill gaps in addressing the needs of older adults. ACL 
has partnered with other Federal agencies, including ASPR, CDC, HRSA, 
and the Federal Emergency Management Agency, to build upon and 
strengthen those partnerships. Recognizing the important role that 
ACL's programs and the aging and disability networks can play in 
disasters, HHS has established a Disaster Human Services Coordinating 
Council, co-chaired by ACL, the Administration for Children and 
Families, and ASPR, with participation of over a dozen HHS agencies, 
and HHS's legislative proposals related to disaster preparedness and 
response in the Fiscal Year 2024 President's Budget include a disaster 
human services emergency fund that would allow the HHS Secretary to 
provide real-time funding during disasters to vulnerable populations, 
including people with disabilities, older adults, and children and 
families.

    Finally, ACL and the aging services network closely collaborate 
with CMS and state Medicaid agencies and service providers on the 
delivery of Medicaid-funded home and community-based services (HCBS). 
Many in the aging network partner to expand the reach of the OAA 
programs by also providing HCBS to low-income older adults, and as 
discussed above, through commercial relationships with health plans, 
many are able to help address health-related social needs like food 
insecurity. 

                               Conclusion 
                               
    The OAA and its aging services network proves its worth every day 
in the lives of older adults throughout the country. The importance of 
the OAA programs and the demand for its services have never been 
stronger and both continue to grow as the American population rapidly 
ages. The OAA has a long history and strong record of providing cost-
effective services that successfully help older adults remain in their 
own homes and communities and avoid unnecessary and costly care in 
long-term care facilities. Key to the OAA's success has been the 
flexibility it provides to states to design programs responsive to 
local needs and the input received from older adults and the 
organizations that serve them. ACL is pleased to have had the 
opportunity to develop a comprehensive set of regulations that both 
maintains these critical features and the longstanding processes for 
effective stewardship of Federal resources and provides new 
opportunities to modernize and strengthen the OAA programs. ACL is 
excited to implement these regulations in partnership with the aging 
services network to build on the decades of successful programming and 
to position the aging services systems in the United States for 
tomorrow's challenges.

    Thank you for the opportunity to participate in today's hearing. 
ACL has appreciated the Committee's support of the Older Americans Act 
and the national aging services network in the past, and we look 
forward to working with you in the future. I am happy to answer any 
questions you may have.
                                 ______
                                 

    The Chair. You ended right on the button. Congratulations. 
Well, thank you very much for being with us, Ms. Barkoff, and 
the work that you do.

    We have heard testimony today that millions of seniors are 
dealing with hunger issues in the United States of America, 
that a lot of seniors are suffering from loneliness, that too 
many seniors are falling, and that life expectancy is going 
down for those and other reasons.

    What would increase funding for the Older Americans Act 
mean in terms of keeping seniors well nourished, keeping them 
in better mental health?

    What do you think it would mean in terms of actually saving 
money in terms of cost of Medicare, Medicaid, nursing home 
costs, etcetera?

    Ms. Barkoff. Thank you, Senator Sanders.

    The Chair. Try that mic. Is your mic on? Yes.

    Ms. Barkoff. Thank you, Senator Sanders. And as you heard 
from every single witness today, the OAA programs are 
incredibly effective.

    The statistics are regarding senior nutrition, for the 
people we can serve, for the vast majority, we are their one 
healthy meal in every single day. Our preventative health 
programs help prevent people from entering emergency rooms.

    Our programs focused on falls, whether it is the home 
modifications or evidence based programs like Tai Chi help 
prevent the incredibly challenging problems caused by falls, 
both health problems and incredible expenses.

    The programs work. What we don't have is the resources to 
reach everyone. That is why in every single budget since this 
Administration has been in place, we have asked for more 
resources. We have to target our funding right now to reach 
those in the greatest need, but we know there are so many more 
people who could benefit from those services.

    Additional funding would help our incredible networks reach 
more people, and it would help us prevent--increased health 
care costs from falls, from chronic illnesses, and help people 
age in place instead of going into expensive nursing homes.

    The Chair. Help me out here. But my understanding is that 
the OAA does not directly provide funding to senior centers.

    Senior centers utilize the funding, obviously, for 
congregate meal programs, for the Meals on Wheels program, and 
for other activities. In my state, I think we have, and I 
suspect I speak for many other rural states, a real checkered 
situation.

    You have some senior centers that are really doing a great 
job in terms of exercising, in terms of disease prevention, 
really wonderful educational programs to engage seniors. Others 
really are not.

    Rural areas are having a hard time staffing. Maybe they 
have a half time staffer inadequately paid. Do we need to take 
a new approach to senior centers across the country?

    Ms. Barkoff. Senator Sanders, senior centers are a critical 
part of OAA services, and they have absolutely served our 
Country's older adults well. They are part of Title 3(b) of the 
Older Americans Act and included under the Supportive Services 
and Senior Centers.

    The statute does currently authorize acquisition, 
alteration, construction, modernization, as well as funding to 
the services provided there. We have seen and I have gone to a 
number of senior centers, kind of the evolving senior centers. 
They have gone from being a place to just going to get a meal 
to, like you said, really community hubs.

    They are often places that provide--we heard a question 
from Senator Hassan about intergenerational programing. That is 
incredibly important. When people are there, we always say it 
is more than a meal.

    We are able to evaluate people, connect them with 
preventative health services, the exercise programs. We are 
looking and we are working with our partners at NCOA, on 
strategies for modernizing senior centers. It is a great 
initiative. Thank you for the funding to be able to do that.

    I think we are trying to figure out how to best meet the 
needs of older adults in the future. People really want 
different kinds of things. And so, what I would say is, I think 
the infrastructure that we have in the Older Americans Act is 
an incredible foundation, and we would look forward to working 
with you on any changes that you think would help strengthen 
senior center services.

    The Chair. Thank you very much.

    Senator Cassidy.

    Senator Cassidy. Hey, thanks for being here. And thanks for 
being here because I will note that the Department of Labor has 
close to 20 percent of all OAA funding. I was going to ask them 
about the Senior Community Service Employment Program, and they 
declined to attend.

    I am a little bit kind of befuddled how an agency over 
which we have jurisdiction declines to come to have oversight 
conducted. But that is not your issue. That is the DOL's issue. 
And by the way, that--is inexcusable in my mind. So, let me 
kind of get back comported, and find my question for you.

    Your rule, give us some particulars as to what your rule is 
doing, is advocating that is going to make the senior, Ms. 
Hutchins' life better, or someone in Baton Rouge or Shreveport, 
Louisiana. Give me a, like, boom, boom, boom, three things.

    Ms. Barkoff. I think some of the things that were really 
important that we put into this rule, one, I would say that we 
never had any regulations related to the family caregiver 
program.

    We heard a lot today about the incredible support from Ms. 
Hutchins too, about families, the need for respite, the need 
for those programs. And it was a real privilege to be able to 
do the first set of regulations there.

    Senator Cassidy. What were those regulations? An example of 
a new regulation.

    Ms. Barkoff. The regulations provide the rules around how 
to use the funding, how to leverage that. What is the 
definition of a family caregiver. Who is eligible----

    Senator Cassidy. How are you leveraging that?

    Ms. Barkoff. How are we leveraging that? Well, we were----

    Senator Cassidy. Or how would you suggest to leverage it, 
if you will?

    Ms. Barkoff. Sure. So, we have done a couple things with 
the family caregiver program. First of all, we have been very 
pleased to have additional funding from Congress over the last 
couple of years to really expand the reach of those programs.

    For example, I know one thing the Committee has cared a lot 
about is grandparents who are raising grandchildren, and we 
have been able to expand that reach, something that we have 
seen really a growing population as part of that epidemic. We 
have worked--sure----

    Senator Cassidy. That is actually the abled grandparent 
helping the child. So, how does this--but it is not the 
incapacitated elderly or the semi--the less able. So, it seems 
a little bit of a stretch of the original mission, if you 
follow what I am saying. So, elaborate on that. What are you 
doing for that grandparent caring for that grandchild?

    Ms. Barkoff. Sure. So, the family caregiver program and the 
statute itself defines who is a caregiver. We absolutely 
provide supports to family members who are caring for, as you 
said, an older adult who has disabilities and has needs.

    The family caregiver program absolutely covers that. It 
also covers an older adult who is taking care of another family 
member. And again, we provide services----

    Senator Cassidy. Now, let me ask because--I don't mean to 
interrupt. I just got a few minutes. He is about to gavel me 
down. So, you have limited dollars. It does seem like you run 
the risk of the so-called woodworking effect, that the more you 
cover, far more, the more you cover--if you follow what I am 
saying.

    If you extend the mission of--I am 66. I am kind of like 
eligible for your services. But at the same time, if you extend 
it, are you kind of detracting from the ability to care for 
that person who is caring for somebody with Alzheimer's, in 
which they truly need a respite program?

    Ms. Barkoff. We prioritize, consistent with Congressional 
intent, for all of our programs. Again, we don't have enough 
resources----

    Senator Cassidy. Now, you can't prioritize for all of your 
programs. That is kind of oxymoronic.

    Ms. Barkoff. Well, we do prioritize to those populations in 
the greatest social and economic need. We work with states, and 
they create a state plan where they look at how are they going 
to distribute funding across states and different communities 
using data, the census----

    Senator Cassidy. Okay, but particular because you are 
speaking--and I know you know your stuff, and so I am not 
trying to challenge. But so much and the people watching on C-
Span, we got to drill down to something that they take away. 
They know it.

    Can you give me a particular of something post-pandemic 
that we are now doing differently that would be recognized by 
Ms. Hutchins or by her family--by her family caring for her?

    Ms. Barkoff. Sure. Again, we, one of the new things that we 
have in the Older Americans Act, and I think something that 
maybe Miss Hutchins might experience is some of the work that 
we are doing around inclusive disaster preparedness. It is 
something that really people across----

    Senator Cassidy. Increasing disaster preparedness in 
Louisiana, I understand the need for that. So, drill a little 
bit on that, please.

    Ms. Barkoff. Sure, sure. We have, for the first time, put 
in place requirements about how state units on aging and AAAs 
can respond and help provide additional services when there are 
disasters that happen, which we are seeing happening more and 
more across----

    Senator Cassidy. If somebody is evacuated to an area of 
congregate living, a basketball stadium, for example, and they 
are on a cot, how would their experience be different because 
of what you are doing--knowing that there is many other people, 
how would their experience be different?

    Ms. Barkoff. Through the new regulations, the AAAs, we will 
be able to, again, hopefully in advance be having more of a 
plan to reach out.

    They will be able to surge services through what is in the 
older Americans Act with some reimbursement services there and 
be able to really help identify who are people who need support 
from the AAA, who might be able to get in-home meals, who might 
need help with finding accessible housing.

    That is another place where, again, we created an entirely 
new title to address some of these flexibilities.

    Senator Cassidy. Okay.

    The Chair. Ms. Barkoff, thank you very much. And again, I 
thank all of the panelists for helping us deal with an 
enormously important issue, and I promise you, this Committee 
is going to do its best to address the many problems that all 
of you have raised.

    That is the end of our hearing today, and I want to thank 
all of our witnesses for their participation. For any Senators 
who wish to ask additional questions, questions for the record 
will be due in 10 business days, March 21st at 5.00 p.m.

    Finally, I ask unanimous consent to enter into the record 
eight statements from stakeholder groups outlining the 
priorities for the re-authorization of the Older Americans Act. 
Without objection.

    [The following information can be found on page 60 in 
Additional Material.]

    The Chair. The Committee stands adjourned. Thank you.

                          ADDITIONAL MATERIAL

                                              AARP,

                                                     March 7, 2024.
Hon. Bernie Sanders, Chair,
Hon. Bill Cassidy, M.D., Ranking Member,
Senate Committee on Health, Education, Labor, and Pensions,
Washington, DC.

    Dear Chairman Sanders and Ranking Member Cassidy:

    AARP, which advocates for the more than 100 million Americans age 
50 and older, thanks the Committee for holding this hearing, ``The 
Older Americans Act: Supporting Efforts to Meet the Needs of Seniors.'' 
We appreciate the opportunity to work with you to advance support for 
older adults and their family caregivers through the Older Americans 
Act (OAA).

    The OAA has a powerful legacy. Since 1965, it has supported older 
Americans so they can live at home with independence and dignity, 
deferring or eliminating more costly institutional services and 
hospitalizations. According to AARP's 2021 Home and Community 
Preferences Survey, the vast majority of adults age 50-plus--nearly 80 
percent--want to remain in their communities and homes as they age. The 
OAA plays a critical role in making sure people in this country can age 
at home, where they want to be.

    In a typical year, OAA programs provide services for approximately 
11 million older adults. These include home care, congregate and home-
delivered meals, case management, family caregiver support, 
transportation, adult day care, legal services, elder abuse prevention, 
and job training and employment opportunities for low-income older 
adults. Additionally, OAA Native American programs provide nutrition, 
support and caregiver services to older American Indian, Alaska Natives 
and Native Hawaiians. OAA programs are cost-effective investments that 
serve the needs of older Americans while deferring or eliminating the 
need for costly institutionalization.

    Unfortunately, the need for these programs outweighs OAA's current 
funding, which has not kept pace with inflation or increased demand. 
While the number of people age 60 and older has grown by 74 percent 
since 2001, OAA funding has lagged behind in that same time period, 
rising only 41 percent. When adjusted for inflation, total OAA funding 
over this time period has declined by 18 percent. Additionally, people 
age 80 and older are among the most likely to need help to live 
independently in their homes and communities, and this population is 
projected to nearly double from 2023 to 2040.

    Put another way, America is on the brink of a serious aging crisis. 
Family caregivers are filling in the gaps, providing care to their 
loved ones at significant expense to themselves in terms of both time 
and money. As the population ages, the number of family caregivers is 
not likely to keep up with the demand. Now more than ever, OAA is 
essential for our Country.

    As we approach OAA reauthorization, we look forward to continuing 
to build on OAA's many successful programs, including the National 
Family Caregiver Support Program (NFCSP) and Title VI Native American 
Caregiver Support Services, the Senior Community Service Employment 
Program (SCSEP), the Long-term Care Ombudsman Program (LTCOP), and the 
Nutrition Services Program, which are outlined below.

 National Family Caregiver Support Program (NFCSP) and Title VI Native 
                  American Caregiver Support Services

    NFCSP was created in 2000 to support a range of services that 
assist family and other unpaid caregivers. Similarly, OAA's Title VI 
Native American Caregiver Support Services provide support for American 
Indian, Alaskan Native, and Native Hawaiian families, including through 
information and outreach, access assistance, individual counseling, 
support groups and training, respite care, and other supplemental 
services. Protecting and increasing funding for NFCSP and Title VI 
Caregiver Support Services will allow grantees the ability to fully 
respond to local needs without having to shift resources from one 
caregiver population to another.

    More than 48 million family caregivers are the backbone of the U.S. 
long-term care system, providing about $600 billion annually in unpaid 
labor to their loved ones. The care they provide ranges from bathing 
and dressing to paying bills and transportation, and their assistance 
helps save taxpayers billions of dollars by helping to delay or prevent 
expensive nursing home care and unnecessary hospital stays. However, 
despite the many benefits family caregivers contribute to the economy 
and the important role they play in preserving the health and well-
being of their loved ones, family caregivers often face significant 
financial, physical, and emotional challenges. According to Caregiving 
in the U.S. 2020, nearly 60 percent of family caregivers perform 
medical and nursing tasks for their loved ones; too often, they have 
little preparation or training. By supporting family caregivers, we can 
help people stay at home, helping to delay or prevent more costly 
nursing home care and unnecessary hospitalizations. As part of the 
Act's reauthorization, we urge the Committee to help support our 
Nation's family caregivers and meet their needs.

          Senior Community Service Employment Program (SCSEP)

    SCSEP is the only Federal program specifically created to assist 
low-income workers 55 and older to regain entry into the workforce. The 
program provides part-time community service assignments for low-income 
persons age 55 or older who would otherwise have poor employment 
prospects because older jobseekers continue to face barriers to 
employment, often due to age discrimination. SCSEP-funded services are 
available in nearly all 3,000 U.S. counties and territories.

    Grantees include public workforce agencies and national nonprofit 
organizations. Participants are unemployed, disadvantaged older workers 
who work an average of 20 hours a week at minimum wage. Work experience 
is gained typically in community service activities at nonprofit and 
public facilities, serving as a bridge to unsubsidized employment 
opportunities. SCSEP has helped thousands of older jobseekers into jobs 
providing them work-based training and the opportunity to use their 
skills. According to the recent Department of Labor Workforce GPS 
survey, participants strongly believe that the program helped prepare 
them for success in the workforce (8.4 on a 10-point scale). SCSEP adds 
needed value as the only Federal program targeted at lower income older 
jobseekers. 

                Long-Term Care Ombudsman Program (LTCOP) 
                
    LTCOP is the most effective program to advocate and act as a 
resource for older adults and people with disabilities who live in 
nursing homes, assisted living, and other licensed adult care homes. 
Every state--plus Puerto Rico, Guam and the District of Columbia--has a 
long-term care ombudsman office. These offices work to resolve problems 
related to the health, safety, welfare, and rights of individuals who 
live in long-term care facilities, and help residents understand and 
exercise their rights to good care in an environment that promotes and 
protects their dignity and quality of life.

    Data from the 2022 National Ombudsman Reporting System (NORS), 
shows that LTCOP's nearly 2000 full time staff and approximately 4000 
certified volunteers investigated more than 182,000 complains 
nationwide and provided assistance to more than 400,000 individuals 
looking for information about long-term care. The COVID-19 pandemic 
highlighted the critical role these ombudsmen play in the long-term 
care system. 

                       Nutrition Services Program 
                       
    Congregate nutrition services and home-delivered nutrition services 
provided by the OAA Nutrition Services Program reduce hunger and 
support older adults' health and independence, including their ability 
to remain in their homes. A 2017 evaluation found that 42 percent of 
congregate meal participants and 61 percent of home-delivered meal 
participants reported they would skip meals or eat less without the 
program. OAA-funded senior nutrition programs also provide more than a 
meal; they provide opportunities for social engagement, offer nutrition 
screening and counseling, and link participants to other home-and 
community-based supports. The majority of participants report that the 
program helped them to eat healthier and continue to live 
independently.

    Congregate meals are offered in congregate or group settings, 
giving older adults and sometimes their caregivers the opportunity to 
socialize over food. Compared to nonparticipants, research shows lower-
income congregate meal participants have fewer nursing home admissions, 
and those living alone have fewer hospital admissions. Other research 
has found that low-income congregate meal participants are less likely 
to be food insecure than nonparticipants.

    Home-delivered meals serve many frail, homebound, or isolated older 
adults. Research finds that home-delivered meals may improve 
participants' nutritional status, with one study finding the program is 
also associated with increased well-being, reduced loneliness, and 
greater food security levels.

    These OAA nutrition programs may also reduce social isolation, 
which is a significant risk factor for poor health status and increased 
mortality. A 2017 AARP Public Policy Institute study found social 
isolation costs Medicare $6.7 billion per year. Congregate meals 
participants report seeing friends more often due to the meals. 
Relatedly, the home-delivered meal program is associated with reduced 
loneliness among new participants, with delivery individuals often 
being the only human contact of the day for homebound clients. The 
reduced isolation can lead to improved health and reduced associated 
health care costs among program participants. 

                               Conclusion 
                               
    AARP welcomes the opportunity to collaborate and buildupon the 
success of these and other OAA programs through the 2024 
reauthorization process. We look forward to working with the Committee 
on a bipartisan basis as the process moves forward. If you have 
additional questions, feel free to contact me or have your staff 
contact Lauren Ryan on our Government Affairs team.

            Sincerely,
                                      Bill Sweeney,
                                     Senior Vice President,
                                        Government Affairs.
                                 ______
                                 
                                  ADvancing States,

                                                     March 7, 2024.
Hon. Bernie Sanders, Chair,
Hon. Bill Cassidy, M.D., Ranking Member,
Senate Committee on Health, Education, Labor, and Pensions,
Washington, DC.

    Dear Chairman Sanders, Ranking Member Cassidy, and Senate HELP 
Committee Members:

    ADvancing States is a nonpartisan association of state government 
agencies that represents the Nation's 56 state and territorial agencies 
on aging and disabilities. We work to support visionary state 
leadership, the advancement of state systems innovation, and the 
development of national policies that support home and community-based 
services for older adults and people with disabilities. Our members 
administer services and supports for older adults and people with 
disabilities, including overseeing Older Americans Act (OAA) programs 
and services in every state.

    We deeply appreciate the Committee's focus on the reauthorization 
of the OAA and thank you for hosting this hearing as a forum for 
discussion on the past, present, and promising future of the OAA. The 
OAA is a pivotal piece of legislation that underscores the Nation's 
commitment to the well-being of its aging population. We believe this 
reauthorization presents an opportunity to incorporate lessons learned 
and successful innovative strategies implemented during the COVID-19 
public health emergency (PHE).

    We are grateful to the Committee for inviting Michelle Branham, 
Secretary of the Florida Department of Elder Affairs, to serve as a 
witness at this hearing. State units on aging (SUAs) serve as the 
linchpin for ensuring that the intent of the legislation translates 
into tangible benefits for older adults and their caregivers within 
their respective regions. SUAs play a crucial role in the development, 
administration, and oversight of OAA programs and services, and their 
perspective is crucial to informing the upcoming reauthorization.

    As the Committee considers the upcoming reauthorization and 
improvements to strengthen the OAA, we urge you to consider the 
following:

          Expand opportunities for state innovation: During the 
        COVID-19 PHE, the Administration for Community Living (ACL), 
        SUAs, area agencies on aging (AAAs) and service providers had 
        to shift quickly to implement necessary flexibilities and 
        innovative solutions to continue service delivery. States 
        continue to be interested in testing innovative strategies to 
        meet the needs of older Americans. To support ongoing 
        innovation, we recommend allowing SUAs to reserve 1 percent of 
        Title III funds to support piloting new programs and innovative 
        strategies.

          Increase flexibility for the delivery of nutrition 
        services: Flexibility and innovation for nutrition services 
        were especially important during the COVID-19 PHE. During that 
        time, ACL authorized the transfer of nutrition funds to allow 
        the provision of ``grab & go'' meals (under Title III, part C-
        1, congregate meals). The new OAA regulation makes this 
        flexibility permanent. In addition, as aging networks move 
        toward increased person-centered practices and individualized 
        community-based models of supports, the need for flexibility 
        with Title III C has increased. We recommend allowing states 
        full flexibility to determine the level of funding for home 
        delivered meals and congregate nutrition.

          Establish a resource center within the Administration 
        for Community Living to support states: ACL currently houses 
        several resource and technical assistance centers, but none are 
        geared specifically toward SUAs. We recommend creating a 
        resource center for states, to offer technical assistance, 
        provide strategic planning support for new programs and 
        initiatives, and serve as a hub for peer-to-peer collaboration 
        and sharing of best practices.

    Thank you for your focus on the reauthorization of the Older 
Americans Act, as well as your consideration of ADvancing States' 
recommendations for this vital piece of legislation. If you have any 
questions about ADvancing States or our priorities for the OAA 
reauthorization, please reach out to Rachel Neely.

            Sincerely,
                                    Martha Roherty,
                                        Executive Director,
                                          ADvancing States.
                                 ______
                                 
        alzheimer's association and alzheimer's impact movement 
        
    The Alzheimer's Association and Alzheimer's Impact Movement (AIM) 
appreciate the opportunity to submit this statement for the record for 
the Senate Committee on Health, Education, Labor, and Pensions (HELP) 
hearing entitled ``The Older Americans Act: Supporting Efforts to Meet 
the Needs of Seniors.'' The Association and AIM thank the Committee for 
its continued leadership on issues important to the millions of 
individuals living with Alzheimer's and other dementias and their 
caregivers. This statement highlights the importance of policies and 
programs within the Older Americans Act (OAA) that can help meet the 
unique needs of our Nation's growing number of Americans living with 
Alzheimer's and other dementias.

    Founded in 1980, the Alzheimer's Association is the world's leading 
voluntary health organization in Alzheimer's care, support, and 
research. Our mission is to eliminate Alzheimer's and other dementias 
through the advancement of research, to provide and enhance care and 
support for all affected, and to reduce the risk of dementia through 
the promotion of brain health. AIM is the Association's advocacy 
affiliate, working in a strategic partnership to make Alzheimer's a 
national priority. Together, the Alzheimer's Association and AIM 
advocate for policies to fight Alzheimer's disease, including increased 
investment in research, improved care and support, and the development 
of approaches to reduce the risk of developing dementia.

    An estimated 6.7 million Americans age 65 and older lived with 
Alzheimer's dementia in 2023. Total payments for all individuals with 
Alzheimer's or other dementias are estimated at $345 billion (not 
including unpaid caregiving) in 2023. Medicare and Medicaid were 
expected to cover $222 billion or 64 percent of the total health care 
and long-term care payments for people with Alzheimer's or other 
dementias, which are projected to increase to more than $1.1 trillion 
by 2050. These mounting costs threaten to bankrupt families, 
businesses, and our health care system. Unfortunately, our work is only 
growing more urgent.

    As the prevalence of Alzheimer's disease and other dementias 
increases, so does the need for care and support services for those 
living with these diseases. The OAA provides Federal funding and the 
necessary infrastructure to deliver vital support programs and social 
services to our Nation's seniors, including those with Alzheimer's 
disease. These critical programs are utilized by millions of low-income 
Americans and provide for such services as home-delivered and 
congregate nutrition services; in-home supportive services; 
transportation; caregiver support; community service employment; health 
and wellness programs; the long-term care ombudsman program; services 
to prevent the abuse, neglect, and exploitation of older adults; and 
other supportive services. Twenty-four percent of older individuals 
with Alzheimer's disease and other dementias who have Medicare are also 
eligible for Medicaid, punctuating the need within the Alzheimer's 
community for such programs as Meals on Wheels and the National Family 
Caregiver Support Program.

    We are grateful that the Supporting Older Americans Act of 2020 
(P.L. 116-131) included the Younger Onset Alzheimer's Disease Act, 
championed by Senator Susan Collins (R-ME), to codify existing 
authority to provide services to individuals living with younger-onset 
Alzheimer's disease under the National Family Caregiver Support Program 
and the Long-Term Care Ombudsman Program. The services provided under 
the OAA are particularly helpful for individuals with younger-onset 
Alzheimer's disease and related dementias who need assistance with 
activities of daily living and accessing care. 

                     Supporting Dementia Caregivers 
                     
    Eighty-three percent of the help provided to older adults in the 
United States comes from family members, friends, or other unpaid 
caregivers. Nearly half of all caregivers who provide help to older 
adults do so for someone living with Alzheimer's or another dementia. 
And, for the over 11 million Americans caring for individuals with 
Alzheimer's and other dementias, the emotional, physical, and financial 
costs can be overwhelming. In 2022, caregivers of people living with 
Alzheimer's or other dementias provided an estimated 18 billion hours 
of unpaid care, a contribution valued at $339.5 billion. Of the total 
lifetime cost of caring for someone with dementia, 70 percent is borne 
by families--either through out-of-pocket health and long-term care 
expenses or from the value of unpaid care.

    Community services provided under the OAA offer invaluable support 
for individuals living with dementia, and, due to the unique challenges 
they face, it is paramount to continue prioritizing care coordination 
efforts within communities during the reauthorization process. Dementia 
often requires a multi-disciplinary approach involving medical 
professionals, caregivers, social workers, and community support 
services. Effective coordination helps caregivers navigate the complex 
healthcare and social service systems and ensures that caregivers and 
health care professionals collaborate seamlessly, providing 
comprehensive care tailored to their individual needs. Challenges such 
as cognitive decline, communication difficulties, and fluctuating 
symptoms necessitate specialized strategies for coordination. 
Initiatives promoting dementia-friendly communities and caregiver 
education programs play crucial roles in enhancing coordination and 
support networks. By prioritizing and refining care coordination, 
communities can offer a better quality of life and support for 
individuals living with dementia and their caregivers.

    When developing legislation to reauthorize OAA, we ask that the 
Committee consider provisions to emphasize the unique and growing 
support services needed by Alzheimer's and dementia caregivers. We are 
grateful for the Committee's longstanding work to enhance access to the 
National Family Caregiver Support Program, and the swift implementation 
of the country's first National Family Caregiver Strategy as created by 
the Family Caregiving Advisory Council established by the Recognize, 
Assist, Include, Support, and Engage (RAISE) Family Caregivers Act. 
These dedicated caregivers greatly benefit from increased resources, 
training, and support to help them navigate the strain of caregiving 
and improve their health and quality of life. 

               Strengthening the Dementia Care Workforce 
               
    We ask that the Committee consider policies to reduce barriers and 
ensure individuals living with dementia have adequate access to long-
term care and home-and community-based services (HCBS). People living 
with Alzheimer's and other dementias make up a significant portion of 
all long-term care residents, comprising 49 percent of all residents in 
nursing homes and 34 percent of all residents in assisted living 
communities and other residential care facilities. Given our 
constituents' intensive use of these services, the quality of this care 
is of the utmost importance. As a result, we encourage the Committee to 
consider policies to enhance long-term care and support services for 
the growing number of Americans with Alzheimer's and other dementias 
who are eligible to receive OAA services.

    A strong dementia care workforce is needed to ensure quality care 
for aging populations. For example, individuals living with dementia 
make up a large proportion of all elderly people who receive home-and 
community-based services, and 31 percent of individuals using adult day 
services have dementia. Access to these services can help people with 
dementia live in their homes longer and improve the quality of life for 
both themselves and their caregivers. In-home care services, such as 
personal care services, companion services, or skilled care, can allow 
individuals living with dementia to stay in familiar environments and 
be of considerable assistance to caregivers. Adult day services can 
provide social engagement and assistance with daily activities. When 
drafting language to reauthorize the OAA, we urge the Committee to 
consider the unique needs of individuals with Alzheimer's and other 
dementias directly benefit from a well-trained workforce specialized in 
dementia care. 

                               Conclusion 
                               
    The Alzheimer's Association and AIM appreciate the Committee's 
steadfast support and commitment to advancing issues important to the 
millions of individuals living with Alzheimer's and other dementias, as 
well as their caregivers. We look forward to working with you as the 
Older Americans Act reauthorization effort moves through the 
legislative process and again ask that you keep individuals living with 
dementia in mind as you develop this bill.
                                 ______
                                 
                        diverse elders coalition 
                        
    Chairman Sanders, Ranking Member Cassidy, and Members of the 
Committee:

    On behalf of Diverse Elders Coalition (DEC), I appreciate the 
opportunity to submit a statement for the record regarding ``The Older 
Americans Act: Supporting Efforts to Meet the Needs of Seniors,'' and 
thank you for convening this important hearing.

    Founded in 2010, the DEC advocates for policies and programs that 
improve aging in our communities as racially and ethnically diverse 
people; American Indians and Alaska Natives; and lesbian, gay, 
bisexual, transgender, and queer/questioning (LGBTQ+) people. Our 
member organizations--National Asian Pacific Center on Aging (NAPCA), 
National Caucus and Center on Black Aging, Inc. (NCBA), National 
Hispanic Council on Aging (NHCOA), National Indian Council on Aging 
(NICOA), SAGE (Advocacy and Services for LGBTQ+ Elders), and Southeast 
Asia Resource Action Center (SEARAC)--are experts in the distinctive 
needs of the racial, ethnic, political, and cultural communities they 
represent. Through their actions in their respective communities, they 
are viewed as trusted members who provide services and resources for 
diverse caregivers and their aging loved ones. Together, we are 
uniquely positioned to effectively reach our communities in rural 
areas, cities, and regions throughout the United States. 

  Six Decades of Supporting Older Americans, but Funding Not Keeping 
                                  Pace 

    Older people across the United States aged 60 years and above rely 
on critical programs and services funded by the Older Americans Act 
(OAA)--originally passed by Congress in 1965--to help them live safely 
in their homes and communities as they age. Between 2010 and 2020, the 
number of Americans age 60 and older increased by 33 percent from 57.5 
million to 76.5 million. In just a few short years, it is projected 
that one in five people in the U.S. will be age 65 or older by 2030. By 
2034, older adults will outnumber children for the first time in U.S. 
history. Increasing our investment in cost-effective OAA programs and 
services is a critical step in responding to the needs of our aging 
America.

    The vital OAA dollars administered to states and communities every 
year provide a wide range of services that prevent unnecessary nursing 
home placement, promote healthy aging, and help people age with 
independence and dignity where they want to be, in their homes and 
communities. The OAA helps millions of older adults each year by 
providing in-home supportive services; family caregiver supports 
offered through OAA assist those who help older individuals. On that 
note, we encourage the Committee to ensure the OAA aligns with the 
National Strategy to Support Family Caregivers as enacted through the 
Recognize, Assist, Include, Support, & Engage (RAISE) Family Caregivers 
Act.

    Unfortunately, OAA funding is lagging far behind senior population 
growth, as well as economic inflation. Meanwhile, 10,000 people turn 65 
every day. We urge Congress to incrementally increase annual 
authorization levels over the 5-year reauthorization period to account 
for the rise in the older population, the greater need for services, 
and the impact of inflation on the cost of delivering these services. 

           A Growing and Diversifying Older Adult Population

    Not only is the U.S. older adult population growing rapidly, but it 
is also becoming increasingly diverse. According to the most recent 
U.S. Census, the share of Americans 65 or older rose by more than a 
third from 2010 to 2020, the fastest increase in 130 years. Over the 
next two decades, the White (non-Hispanic) older population is expected 
to increase by 26 percent, while older racial and ethnic minority 
populations are expected to grow by 105 percent, including:

          Hispanic by 148 percent;

          African American (not Hispanic) by 73 percent;

          American Indian and Alaska Native (not Hispanic) by 
        58 percent; and

          Asian American (not Hispanic) by 93 percent.

    Over one-third of adults ages 65 and older have some form of 
disability, and many need assistance with daily activities such as 
bathing, eating, toileting, housework, medication management, financial 
management, and grocery shopping. In fact, nearly half of Americans 
ages 75 and older and a quarter of those ages 65 to 74 report having a 
disability, according to estimates from the Census Bureau's 2021 
American Community Survey (ACS). With respect to adults from racial and 
ethnic groups, the numbers with disabilities are:

          3 in 10 American Indians/Alaska Natives;

          1 in 4 Blacks;

          1 in 5 Whites;

          1 in 6 Native Hawaiians/Pacific Islanders;

          1 in 6 Hispanics; and

          1 in 10 Asians.

    An estimated 3-5 million LGBTQ+ people have disabilities, and 
finding affordable, accessible, and inclusive health-care services is 
more challenging for them. This is particularly true for those living 
in rural areas, where LGBTQ+ elders are more likely to have 
disabilities and be at a higher risk for isolation and discrimination, 
due to a lack of LGBTQ+ inclusive and fully accessible service 
providers in their communities. Furthermore, LGBTQ+ people with 
disabilities often report difficulties in having their identities fully 
recognized. For example, in spaces focused on disability, their unique 
experiences as LGBTQ+ people may not be accounted for--underscoring the 
need for intersectional approaches. 

  Compounding Effect of COVID-19 Pandemic on Diverse Older Adults and 
                            Their Caregivers

    The COVID-19 pandemic's implications for social isolation, 
depression, complex risks and health issues for older adults 
underscored the importance of the DEC's research on diverse family 
caregivers (in partnership with the National Alliance for Caregiving). 
Anxiety (58 percent) and increased isolation (56 percent) were the top 
two selections by caregivers across all DEC-hosted webinars when asked 
about challenges they faced during the pandemic. Across all webinars, 
56 percent of polled caregivers selected ``taking care of myself'' as 
their top concern. Additionally, 43 percent of diverse caregivers who 
were surveyed desired more emotional support, further emphasizing the 
mental health strain and social isolation brought on during the 
pandemic. By comparing the DEC's data from surveys, focus groups, and 
key informant interviews, we observed that the COVID-19 pandemic only 
exacerbated pre-pandemic mental health strain on diverse caregivers.

    Along with mental health, participants also selected financial 
strain (35 percent average) as a top challenge during the pandemic. 
Unfortunately, financial challenges that have arisen during the 
pandemic will only worsen family caregivers' pre-existing financial 
burdens. In our research, on average, 4 out of 10 diverse family 
caregivers paid expenses for their loved ones' care.

    We encourage continuous direct engagement with diverse family 
caregivers to ensure services and supports are meeting all communities 
in a way that is in line with personal and family preferences. It is 
without doubt that this much needed dialog with diverse communities 
must address a lack of culturally responsive resources to support 
caregivers' mental health, social isolation, and financial strain, 
without losing sight of the strengths inherent in the ways in which our 
communities exercise resilience. We must have the research, data 
collection, and reporting on all populations to avoid further 
marginalization, to enhance meaningfully multicultural patient and 
family engagement, and to be culturally responsive in a way that 
proactively supports caregivers of older adults, including racially and 
ethnically diverse family caregivers; American Indian and Alaska Native 
family caregivers; and LGBTQ+ family caregivers.

    To that end, we encourage the Committee to consider continuing 
certain flexibilities in reauthorization and amending the OAA to 
sustain pandemic-era innovations that strengthened supports to our 
communities by making access to services more equitable. 

                         DEC Policy Priorities 
                         
    We at Diverse Elders Coalition recently released our Policy 
Priorities, which are intended to serve as a guidepost for Federal 
policymakers in recognizing and addressing the distinct, priority needs 
of diverse older adults and their caregivers when designing effective, 
equitable policy solutions for the communities represented by the DEC. 
As such, we strongly encourage Members of the Committee to consider 
these critical areas as they undertake the OAA reauthorization process 
and examine ways to strengthen OAA programs to better serve our 
communities.

    1. Ensure Equitable Access to the Spectrum of Services and Lifelong 
Needs for Diverse Older Adults

        a. Ensure all federally funded programs include person-
        centered, trauma-informed, culturally appropriate and 
        accessible services to reduce disparities in aging services and 
        supports for diverse older adults. When considering 
        accessibility, programs should take into account the conditions 
        where people live, or social influencers of health--including 
        but not limited to housing, transportation, income, education, 
        pollution, discrimination, lack of family or community support, 
        and violence--that contribute to wide range of disparities and 
        inequities impacting people's health, well-being, and quality 
        of life.

        b. Improve language access by making it easier for older adults 
        with Limited English Proficiency (LEP) to navigate and receive 
        quality language assistance; collecting and better utilizing 
        language data to provide personalized language services across 
        Social Security, Medicare, and Medicaid; and translating 
        applications, notices, and resources into additional languages 
        and improving access to in-language materials.

        c. Close the digital divide for diverse older adults by 
        bolstering programs that offer expanded eligibility and low-
        cost access to broadband services; ensuring digital inclusion 
        through best practices on how to reach these communities; 
        providing skills training to promote digital literacy; 
        increasing uptake and utilization of services among those who 
        already have access to broadband; and increasing the supply of 
        affordable broadband.

        d. Strengthen anti-discrimination protections in all federally 
        funded programs--around race, ethnicity, Tribal affiliation, 
        language, disability, age, sex, sexual orientation, gender 
        identity, sex characteristics, and immigration status--and 
        allow for intersectional analysis. Emerging research has 
        revealed that historical discrimination and racism contribute 
        to increased aging and cognitive decline.

    2. Provide Adequate Resources to Enable Diverse Older Adults to Age 
in a Place of their Choice, within Age-Friendly Communities

        a. Establish Federal standards for measuring and ensuring 
        equitable access to Home and Community Based Services (HCBS) in 
        Medicaid. Medicaid HCBS has turned into a patchwork of programs 
        with wide variation among and within states. This has led to 
        inequities in access and services needed to live in the 
        community, that often leave institutional settings as the only 
        available option for receiving care.

        b. Invest in long-term, linguistically robust and culturally 
        appropriate care to enable diverse older adults to self-
        determine how to age--in place; in congregate care; or as 
        determined by their loved ones. Place special emphasis on 
        Tribal lands, rural areas, and other hard-to-reach communities.

    3. Address the Needs of Diverse Caregivers for Older Adults

        a. Ensure that the eligibility criteria for programs and 
        services designed for caregivers offer an inclusive definition 
        of ``family'' to include siblings, aunts, uncles, cousins, 
        nieces, nephews, grandparents, grandchildren, domestic 
        partners, youth, members of the same tribe, friends, and/or 
        community members that are not related by blood, but whose 
        close association with the care recipient is the equivalent of 
        a family relationship.

        b. Expand access to programs, services, and resources for 
        diverse caregivers, including low-income and LEP individuals, 
        those with disabilities, and people in rural areas. Respite 
        care, for example, is particularly important for caregivers for 
        people with dementia. Likewise, recognize that a lack of 
        technological literacy in rural, urban, and suburban areas 
        alike may present a challenge for caregivers accessing formal 
        supports.

        c. Provide comprehensive, universal paid family and medical 
        leave to family caregivers that includes a broad and inclusive 
        definition of ``family.''

    4. Expand Data Collection, Disaggregation, and Reporting both among 
and within Diverse Populations

        a. Create and promote a Federal demographic data collection 
        standardization requirement, modeled after DEC Members' and 
        expert partners' best practices. Apply these standards to 
        establish demographic data collection, analysis, and reporting 
        to better understand how all programs along the continuum of 
        care are serving individuals, particularly those who are most 
        marginalized, including LEP older adults.

        b. Disaggregate available data in order to collect more 
        detailed information on population subgroups. The absence of 
        specific subgroups for race, ethnicity, LGBTQ+ status, and 
        disability has meant that many diverse older adults have fallen 
        through the cracks. Disaggregated and intersectional data 
        collection and reporting are crucial to identify community 
        needs and target programs effectively and efficiently. 
        Oversampling should also be given strong consideration in all 
        government surveys to help identify the needs of smaller sub-
        ethnic groups.

        c. Provide strong consumer protections by safeguarding the data 
        that has been collected to ensure that it cannot be used for 
        discriminatory, profiling-related actions such as immigration 
        or law enforcement, redlining or targeting of specific groups. 
        Implement strict Federal standards around maintaining collected 
        data safely and securely. 
        
                               Conclusion

    The Older Americans Act can--and should--ensure that the aging 
network has the tools it needs to better meet the needs of all older 
people, including individuals of every sex, sexual orientation, gender 
identity, race, religion, national origin, disability, and ethnic 
background. We look forward to working with Members of this Committee 
and other lawmakers to build upon the long history of bipartisan 
support for OAA-funded programs that serve older adults and their 
caregivers, particularly in hard-to-reach and underserved communities 
across the United States.

    On behalf of the Diverse Elders Coalition, thank you again for the 
opportunity to submit a statement for the record. Should you have any 
questions, please contact DEC Director of Policy and Advocacy Didier 
Trinh.
                                 ______
                                 
                        elder justice coalition 
                        
    The Elder Justice Coalition commends Chairman Sanders and Ranking 
Member Cassidy for convening this first hearing for the Reauthorization 
of the Older Americans Act. Next year we will celebrate the 60th 
anniversary of this remarkable program and the 33rd anniversary of 
Title VII, which houses the Act's elder justice activities.

    We are a nonpartisan coalition of 3,000 individuals and 
organizations dedicated to ending elder abuse, neglect and exploitation 
via Federal policy. In a reauthorized OAA, funding all of Title VII, 
especially tribal elder justice programs, is necessary to build and 
maintain the capacity to respond to abuse reports, and we call on the 
Committee to better recognize the reality of abuse, neglect, and 
exploitation of older adults and people with disabilities and provide 
adequate funding levels to address them. We have received multiple 
stories of older adults who could benefit from a fully funded program. 
One woman in Michigan whose daughter created an unnecessary 
guardianship to take money and jewelry. Or an elderly veteran in North 
Carolina taking care of her sick spouse taking out a $90k loan for her 
neighbor's credit debt, only to be financially exploited.

    Our coalition has always recognized that APS agencies have a 
pivotal role as the primary line of defense for elder abuse victims, 
offering crucial assistance, support, and help in prevention. We 
believe that robust support and funding for APS agencies is integral to 
effectively meet the needs of elder abuse victims and their cases. 
Across the country, states have communicated current struggles with 
inadequate funding and staffing within their APS programs. Higher 
authorization levels can start to address these issues to ensure the 
effective implementation of APS initiatives.

    Funding and support for the National Adult Protective Services 
Technical Assistance Resource Center (APS-TARC) and the National Long-
Term Care Ombudsman Resource Center (NORC) should continue in the next 
reauthorization, as they are crucial to providing support, technical 
assistance, and training to state Long-Term Care Ombudsman Programs and 
Adult Protective Services.

    As we have commented in past reauthorizations, we believe Title VII 
activities should be integrated further into Title III nutrition 
programs and call for elder abuse training for all who work in OAA 
programs. This is already taking place in states where nutrition 
providers are mandatory reporters, but all older adults could benefit 
from increased recognition and reporting of elder abuse.

    We appreciate that the recently issued final OAA regulations 
established of expectations for legal service providers to help in 
elder abuse prevention and clarified that the aging network has a role 
to defend against the imposition of guardianship and in promoting 
alternatives. We appreciate that the first-ever APS Regulations will 
soon be released.

            Sincerely,
                                              Bob Blancato,
                      National Coordinator Elder Justice Coalition.
                                 ______
                                 
   the national association of nutrition and aging services (nanasp) 
   
    The National Association of Nutrition and Aging Services (NANASP) 
commends Chairman Sanders and Ranking Member Cassidy for convening this 
first hearing for the Reauthorization of the Older Americans Act. Next 
year we will celebrate the 60th anniversary of this remarkable program. 
This is the time in its 59th year to renew, reinvigorate, and modernize 
its programs and services for the future.

    Our 1100+ members provide nutrition services to over 4 million 
older adults a year in both congregate and home delivered settings. In 
a reauthorized OAA, it is vital that both Titles III-C1 and C2 maintain 
their identity. This could be accomplished through a straight 
consolidation of funding, perhaps better achieved through a parity of 
funding, or by providing a higher transfer authority between C1 and C2. 
As with past reauthorizations, we would like transfers between Title 
III-C and III-B to give priority to nutrition-related services.

    Authorization levels need to better reflect the realities on the 
ground including some aftermath issues from the pandemic. While the 
pandemic required an almost full shift to home delivered meals, prior 
to the pandemic, two thirds of older adults in the program were served 
in congregate settings. There is a strong desire among nutrition 
providers to get more congregate programs back into communities because 
these programs provide more than just a meal. Congregate sites offer 
important nutrition education and invaluable socialization 
opportunities. Congregate nutrition programs and senior centers both 
in-person and virtual are real solutions to the increased isolation and 
loneliness among older adults. We are supportive of separate and 
dedicated funding for both socialization programs and the senior 
centers which provide them.

    We appreciate that the recently issued final OAA regulations 
continued many of the successful pandemic-era flexibilities for senior 
nutrition programs. We believe others could be included such as 
allowing carryout, groceries, or less frequent deliveries.

    We believe it's important to ensure OAA funded meals are of high 
nutritional value to promote healthy aging while ensuring continued 
participation. We believe the current language that meals must meet 
both 1/3 Dietary Reference Intakes and will comply with the most recent 
Dietary Guidelines for Americans (DGA) should be updated to follow only 
the DGA as they focus on older adult nutrition needs.

    We also support all efforts at the state and area level to 
incorporate malnutrition prevention programs. We would like to include 
malnutrition screenings in Title III-D health screenings and 
malnutrition in nutrition education provided in Title III.

    In brief, some other early principles we would like to advance and 
provide greater depth in the future:

          We call on data collection to specifically define and 
        include both waiting list and unmet need to ensure better 
        allocation of resources

          We support greater recognition and support for 
        medically tailored meals and culturally appropriate meals, the 
        latter being important to helping to achieve better targeting 
        in the nutrition program

          We would also like to explore the inclusion of 
        language allowing Title III reimbursement of assistive 
        technology which has been enhancing service older adults in the 
        OAA since the last reauthorization

            Sincerely,
                                              Bob Blancato,
                                         Executive Director NANASP.
                                 ______
                                 
                   philadelphia corporation for aging 
                   
    Dear Esteemed U.S. Senate HELP Committee Members:

    Good morning, my name is Najja Orr, and I am the President and CEO 
of Philadelphia Corporation for Aging, also known as PCA. PCA wants to 
thank Chairman Sanders, Ranking Member Cassidy and the Members of the 
Senate Committee on Health, Education, Labor, and Pensions for the 
opportunity to provide input on the critical reauthorization of the 
Older Americans Act. PCA also wants to commend Senator Casey, 
Pennsylvania's senior Senator, and Chair of the Special Committee on 
Aging for his leadership on the Older Americans Act and issues facing 
older Pennsylvanians.

    First and foremost, PCA wants to express its strong support for the 
reauthorization of the Older Americans Act to continue the essential 
work provided to older adults through the Aging Network. Area Agencies 
on Aging (AAAs) as authorized through the Older Americans Act serve a 
critical function in communities across the Nation. AAAs play an 
essential role in promoting the health, independence, and well-being of 
older adults, as well as supporting their caregivers and advocating for 
policies that benefit the aging population.

    Philadelphia Corporation for Aging (PCA) is a 501c3 non-profit 
organization which has served for the past 50 years as the designated 
AAA for Philadelphia, Pennsylvania. PCA is the largest AAA in the 
Commonwealth of Pennsylvania and advocates on behalf of more than 
316,000 older Philadelphians. Older Philadelphians are diverse with 44 
percent identifying as white, 56 percent identifying as minority and 16 
percent identifying as foreign born. Nearly 20 percent of 
Philadelphia's total population is over 60 and 28 percent of them are 
75 or older. Older Philadelphians, like the overall population of the 
city, generally have a lower income with 30 percent below 150 percent 
of the Federal poverty level and more than 20 percent below 100 percent 
of the Federal poverty level. Philadelphia has consistently been among 
the cities with the highest proportion of impoverished older adults of 
the 10 largest cities in the United States.

    As the state-designated AAA for Philadelphia County, PCA is 
responsible for coordinating and administering Federal, state, and 
local funds for older Philadelphians and adults with disabilities. The 
agency provides more than 30 services, including advocacy, care 
management for long-term care programs, protective services, home-
delivered meals, and the administration of senior centers. PCA has 
coordinated a broad range of services for more than 140,000 older 
Philadelphians annually to fulfill our mission to improve the quality 
of life for older Philadelphians and people with disabilities, and to 
assist them in achieving their maximum level of health, independence, 
and productivity.

    In fiscal year 2024, PCA projects to provide more than 1.27 million 
home-delivered meals and more than 315,000 congregate meals; serve more 
than 15,000 community members at senior community centers; provide 
approximately 325,000 personal care service encounters, approximately 
1,100 home support visits, and approximately 1,700 adult day care 
sessions; subsidize more than 100,000 trips through our Shared Ride 
Program; and respond to more than 9,100 reports of need for suspected 
elder abuse.

    Pennsylvania's State Unit on Aging is currently developing a Master 
Plan on Aging called ``Aging Our Way, PA,'' with the support of the 
AAAs and other stakeholders throughout the Commonwealth. As a part of 
this process PCA coordinated 17 listening sessions in 14 different zip 
codes in Philadelphia. Six of the listening sessions had interpreters 
present to conduct the session in Spanish, Mandarin, or Korean. The 
agency also offered sessions for the LGBTQ+ elder community and 
professionals in the aging field. Many of the comments expressed were 
repeated across the city including the importance of safety in the 
community, affordable accessible housing, and reliable transportation. 
Older Philadelphians also underscored the need to feel respected by the 
community and health care providers, have access to interpretation 
services, and the desire for employment and volunteer opportunities.

    It is important to note that the underlying core issue of ongoing, 
deep poverty is the driving force behind many of the concerns heard 
throughout the listening sessions and is seen daily in our work across 
the city. In reauthorizing the Older Americans Act PCA urges the 
Committee to ensure the continuing focus on addressing systemic poverty 
among older adults. This will alleviate the pressure on health systems, 
home and community-based services, and food insecurity as well as 
confront the realities of safe housing, and secure communities.

    It is critical that the Older Americans Act continue to provide 
clarity regarding which factors may be used by states to demonstrate 
``greatest economic need,'' and ``greatest social need,'' especially 
for use in intra-state funding formulas. PCA believes states should 
have a formalized process that provides transparency in the evaluation 
and selection of all measures beyond income and should include an 
explicit requirement that AAAs be included in this process.

    Given the enormous body of research on the linkage of racial and 
ethnic status to disparities in health and social well-being, there 
should be an explicit separate requirement that racial or ethnic status 
be a factor in this definition as outlined in the Older Americans Act. 
Evidence of this can be seen in Philadelphia where, according to 
Philadelphia's Department of Public Health, 2023 Health of the City 
Report, African Americans experience worse health outcomes, have lower 
life expectancy, and are dying at higher rates than other racial and 
ethnic groups in Philadelphia. \1\
---------------------------------------------------------------------------
    \1\  Philadelphia Department of Public Health (2023). Health of the 
City Report. Retrieved from https://
philadelphiapublichealth.shinyapps.io/health-of-the-city.

    Additionally, as the Committee considers the reauthorization and 
funding of services that benefit older adults, PCA urges you to address 
the alarming nationwide trend of at least 1 in 10 older adults 
experience some form of elder abuse, neglect, or exploitation, 
according to the National Center of Elder Abuse Report, Prevalence of 
Elder Mistreatment. \2\ In Philadelphia, protective services reports of 
need have grown from approximately 5,000 in fiscal year 2016 to over 
9,000 during fiscal year 2023. The challenge faced in funding 
protective services and other PCA services is in many ways compounded 
by two other major factors. First, many of PCA's core functions have 
been level funded for the past decade. Second, PCA, like all other 
human services and health agencies, is grappling with the dramatic 
changes in the labor market including the shortage of key personnel.
---------------------------------------------------------------------------
    \2\  National Center of Elder Abuse (2024). Prevalence of Elder 
Mistreatment. Retrieved from https://ncea.acl.gov/
prevalenceofeldermistreatment#gsc.

    PCA would like to take this opportunity to echo many of the 
recommendations provided by USAging in their Policy Brief, 
Recommendations for the Reauthorization of the Older Americans Act \3\ 
including:
---------------------------------------------------------------------------
    \3\  USAging (2024). Policy Brief: Recommendations for the 
Reauthorization of the Older Americans Act. Retrieved from https://
www.usaging.org//Files/USAging-OAAReauth-Recommendations-Final-
Version.pdf.

    ``Recommendation 1.1: Significantly increase authorized funding 
levels to meet the real and urgent needs of a rapidly growing older 
---------------------------------------------------------------------------
population and the rising costs of service delivery.''

    As the older adult population continues to grow and needs increase 
in complexity, coupled with the rising costs of service, it is 
important that funding levels continue to meet the real needs of those 
AAAs are entrusted to serve and to protect the most vulnerable in our 
community including those at risk for elder abuse.

    ``Recommendation 1.3: Allow Title III D health and wellness 
programs to be evidence-informed--not just evidence-based--to expand 
the Aging Network's ability to reach older adults with emerging 
interventions and to extend the reach especially in rural areas and 
other areas which have limited funding for this important work.''

    PCA believes it is critical to call attention to the strict 
definition of evidence-based programs. There is no doubt that it is 
necessary to utilize programs that apply best practices and are 
validated, however the high bar of evidence-based can inhibit 
innovation and ability to utilize programs that address the unique 
needs of diverse communities. The Aging Network should be provided with 
the flexibility to use evidence-informed programming which will allow 
more opportunities to develop affordable and innovative programming.

    ``Recommendation 2.1: Unify and modernize the Title III C nutrition 
funding streams and programs to reflect recent innovations, the 
changing needs of consumers and the goal of local decision-making 
inherent in the Act.''

    Lessons learned from COVID-19 taught us of the importance of being 
flexible, adaptive, and innovative in our practices. Due to flexibility 
in funding allowed as a result of the pandemic, AAAs across the country 
devised incredibly innovative and unique models to ensure nutrition 
services were provided to their constituents. Allowing continued 
flexibility of funding will ensure local providers can meet the needs 
of their communities including person-centered approaches and cultural 
considerations in meal provision.

    ``Recommendation 3.1: Increase the administrative funding ceiling 
by 2 percentage points to ensure appropriate program development, 
oversight and network management amid rising costs and eroding Federal 
OAA funding.''

    Administrative funding is essential for AAAs to be able to explore 
opportunities for innovations, to bridge the gap between state and 
Federal funding and the increasing cost of labor, goods, and services, 
as well as to conduct strategic planning and research to ensure that 
growing communities in need are being reached.

    Finally, PCA would also like to echo the Older Americans Act 
Modernization Priorities from The National Council on Aging to protect 
and strengthen the Senior Community Service Employment Program (SCSEP) 
and update eligibility requirements. \4\ As mentioned previously, PCA 
heard from older Philadelphians a desire to find employment 
opportunities, and given the poverty faced by older adults in 
Philadelphia and across the Nation, there is a need for a strong 
support system.
---------------------------------------------------------------------------
    \4\  National Council of Aging (2024). NCOA Older Americans Act 
Reauthorization Priorities. Retrieved from https://www.ncoa.org/
article/ncoa-older-americans-act-reauthorization-priorities.

    Thank you for providing this opportunity to share my perspective 
about the important services enabled by the Older Americans Act and for 
your dedication to supporting older adults. The reauthorization and 
strengthening of the Older Americans Act will ensure that older adults 
will continue to have the opportunity to age in their communities of 
---------------------------------------------------------------------------
choice with dignity.

            Sincerely,
                                    Najja R. Orr, MBA, DBA,
                                                 President and CEO.
                                 ______
                                 
                                usaging 
                                
                              Introduction 
                              
    Thank you to the Senate HELP Committee for the opportunity to 
provide written testimony regarding the reauthorization of the Older 
Americans Act (OAA). I write to you from the vantage point of my two 
roles. One as the Chief Executive Officer of Senior Resources of West 
Michigan, an Area Agency on Aging, and the other as President of 
USAging, the national association representing Area Agencies on Aging 
and advocating for the Title VI Native American Aging Programs. Senior 
Resources provides services to three diverse counties on Michigan's 
west coast. We serve a rural county, one of the healthiest counties in 
the state and another county that is one of the unhealthiest counties 
in the state. However, one of the Act's guiding principles--local 
flexibility--supports our AAA's ability to identify, plan for and meet 
the needs of a diverse aging population in our service area.

    In fiscal year 2023 the services we provided or funded through 
local community partners served nearly 13,000 participants. In keeping 
with the Act's charge to leverage funding to meet the needs of older 
adults and caregivers, our services are supported by Federal OAA 
dollars, state Older Michiganians Act funds and a county senior 
millage. We primarily utilize OAA funds to help older adults, 
especially those in greatest economic and social need, remain in their 
preferred home setting and community through the provision of home and 
community-based services, which include information and referral/
assistance, care coordination, in-home services, nutrition, 
transportation, legal services, evidence-based health and wellness 
programs, caregiver support services and more.

    The demand for these services significantly exceeds available 
funding and with the increased costs for direct care workers, food, 
transportation and business operations, our agency is currently unable 
to serve as many older adults and caregivers as we have in prior years. 
This is despite the fact that the aging population is growing in 
Michigan and nationwide due to dramatic demographic growth of those 
older than age 65, including the fastest-growing population in the 
country, which are those age 85 and older. This is why a significant 
increase in authorized OAA funding levels, followed by actual increased 
Federal appropriations, is sorely needed.

    In addition, and separate from our OAA programs and services, our 
AAA is a 1915c Medicaid Waiver provider for approximately 1,300 
participants; this is frequently true of other AAAs around the country. 
One of our most innovative recent programs is our Primary Care at Home 
service which is designed to address the medical needs of patients who 
have difficulty leaving their homes for medical appointments. We also 
offer Behavioral Health at Home services, participate in the VA Home 
and Community Based Services program and are currently developing an 
Institutionally Equivalent Special Needs Plan with two other AAAs to 
provide another long-term care option for older adults in the 
communities we serve. Our program development and innovation is rooted 
in the intent of the OAA and everything we do is with an eye to our 
mission to ensure that older adults can age with optimal health, 
independence and dignity and how we can better reach and serve older 
adults to achieve that goal.

    That is why in addition to increased authorization levels and 
appropriations for the OAA, my agency and our national association, 
USAging, are calling for changes to the OAA that currently impede the 
development of outside-of-OAA revenue sources so that AAAs can serve 
more older adults and better meet their missions. We must have clarity, 
transparency and flexibility so that the OAA's mission and assets are 
protected and prioritized, yet AAAs and providers in the Aging Network 
must be able to engage with health care entities to bridge the gaps 
between acute care and social care, to address the social drivers of 
health, support the healthy aging of older adults and ensure there are 
more home and community-based services available in every community in 
the Nation.

    The health care system is shifting its focus to health equity and 
health-related social needs (HRSNs), and this has been reinforced and 
encouraged by the Biden administration in their recent efforts. These 
HRSNs are often, if not always, addressed by social care organizations, 
such as AAAs, and health care organizations are increasingly relying on 
AAAs to provide these services. It is important to ensure that there 
are no barriers in place to prevent AAAs from providing HRSN services 
to individuals, especially older adults, so that they can receive the 
social care they need to maintain their overall health and well-being.

    OAA authorization will expire at the end of fiscal year 2024 and 
today, the vision and mission of OAA is even more important than it was 
nearly six decades ago, as our Nation faces an unprecedented 
demographic shift. Enabling aging in place should be a bipartisan 
national priority. Fostering a society in which aging at home and in 
the community is not only the collective desire but also the national 
expectation requires us to recognize, protect and bolster the 
foundation upon which this goal was built. The OAA is that foundation, 
and as Federal policymakers consider the Act's reauthorization, USAging 
urges Congress and the Administration to work toward policy decisions 
that honor the longstanding intent of the OAA while seeking legislative 
updates that enable continued innovation, flexibility and greater 
capacity to meet the needs of this Nation's rapidly growing aging 
population and their caregivers.

    The following USAging recommendations reflect members' five decades 
of experience, innovative work and commitment to the needs of today's 
older adults and caregivers. 

            USAging 2024 OAA Reauthorization Recommendations 
            
              (Details available at www.usaging.org/OAA). 

      Goal 1: Serve More Older Adults Who Need to Age Well at Home 
      
    Recommendation 1.1: Significantly increase authorized funding 
levels to meet the real and urgent needs of a rapidly growing older 
population and the rising costs of service delivery. USAging's over-
arching top priority for the 2024 reauthorization is that Congress 
significantly increase authorization levels for all titles of the Act. 
These are woefully underfunded programs and services that are needed by 
older adults, caregivers and families, now more than ever. A strong 
statement by reauthorizers to appropriators as to the value of these 
cost-effective services and the importance of investing in OAA to avoid 
higher health and long-term care costs is essential in this 
reauthorization.

    Recommendation 1.2: Ensure that AAAs and other Aging Network 
community-based organizations are able to further meet their missions 
by securing health care or other private funding to serve more older 
adults. Nearly all AAAs' mission-driven programs and services go beyond 
just their duties under the OAA. Despite a growing older adult 
population, Federal OAA funding has eroded, forcing AAAs to seek other 
funding streams and relationships to supplement their OAA funding to 
better meet their missions. We urge Congress to clarify and rectify the 
conflicting and ambiguous language in multiple sections of the Act to 
ensure that when OAA funds are leveraged for health care contracts or 
establish private-pay programs, State Units on Aging have a clear, non-
burdensome and appropriate oversight process for the AAAs' activities.

    Recommendation 1.3: Allow Title III D health and wellness programs 
to be evidence-informed_not just evidence-based_to expand the Aging 
Network's ability to reach older adults with emerging interventions and 
to extend the reach especially in rural areas and other areas which 
have limited funding for this important work. The higher cost of 
evidence-based programs--due to ensuring fidelity to the proven 
method--makes it extremely difficult for AAAs with either a small 
allocation or a widely dispersed service population to stand up a 
successful program that reaches older adults who could greatly benefit 
from these interventions. Strict fidelity also creates barriers to 
offering culturally relevant programming at times--as the model cannot 
be adapted to best reflect local needs and remain evidence-based. 
Therefore, we are requesting that Congress restore flexibility in III 
D, allowing AAAs to provide evidence-informed, or similar, programming 
as well as evidence-based models.

    Recommendation 1.4: Expand Title VI, Grants for Native American 
Aging Programs, to include a dedicated Supportive Services funding 
stream and boost the capacity of grantees through more robust training 
and technical assistance. Congress should expand Title VI, Grants for 
Native Americans, to allow and authorize funding for a wider range of 
supportive services than is feasible with current funding and capacity, 
such as transportation and health and wellness programs. While Title VI 
Parts A and B allow grantees to offer supportive services similar to 
those authorized under Title III of the Act, the funding is primarily 
spent on nutrition services first, with little funding remaining for 
additional wraparound services such as transportation, in-home care, 
legal assistance and other supports that are so desperately needed. 

     Goal 2: Meet the Needs of Today's and Tomorrow's Older Adults 
     
    Recommendation 2.1: Unify and modernize the Title III C nutrition 
funding streams and programs to reflect recent innovations, the 
changing needs of consumers and the goal of local decision-making 
inherent in the Act. While maintaining the integrity and goals of the 
C1 congregate meals program and the C2 home-delivered meals program, 
it's time to create one funding stream and one nutrition program, with 
approved activities that reflect the history, present and future of 
nutrition service delivery. USAging believes that there should be a 
unified III C Nutrition Services, with several authorized program 
options under it.

    Recommendation 2.2: Reduce social isolation and loneliness among 
older adults by authorizing a national resource center dedicated to 
providing training and technical assistance for Aging Network 
professionals on innovative strategies to build and expand social 
engagement programs and activities. Currently this work is dependent on 
ACL's decision to fund it from its discretionary pool of dollars. And 
as their attention has turned to more consumer-focused social isolation 
campaigns to broader audiences beyond older adults, professional 
resources stand to be lost. Adding authorization for a national center 
focused on the Aging Network professionals who deliver social 
engagement opportunities is not only needed but complements the 2020 
statute additions and ensures that the Act addresses emerging needs 
through proven delivery systems. 

 Goal 3: Maintain Efficient Oversight and Management of Local Service 
                       Delivery to Ensure Quality 
                       
    Recommendation 3.1: Increase the administrative funding ceiling by 
2 percentage points to ensure appropriate program development, 
oversight and network management amid rising costs and eroding Federal 
OAA funding. The Act's current limit of 10 percent for administration 
of the Area Plan (Sec. 304 (d)(1)(A)) is no longer feasible due to many 
years of eroded funding and increased costs of doing business, such as 
but not limited to personnel, liability insurance, information 
technology, data collection and reporting requirements. To ensure the 
highest quality programming and services, AAAs must be able to maintain 
an adequate workforce, conduct quality assurance and oversight of 
providers, and successfully perform their planning and program 
development duties.

    Authorized and actual funding levels have not increased over the 
past two decades to meet the rapidly growing size of the age 60+ 
population and their caregivers who need these services, nor the rising 
costs of labor, food, supplies and infrastructure. Therefore, the 
current 10 percent administrative percentage is insufficient. Given 
eroded funding and cost growth, it is necessary to increase the amount 
AAAs are able to draw from to efficiently and effectively plan, develop 
and administer this wide array of critical OAA programs and services. 
USAging recommends Congress increase the maximum administrative 
percentage to at least 12 percent in the 2024 reauthorization. This is 
well in line with standard administrative rates for other nonprofit 
organizations. 

                               Conclusion 
                               
    USAging has alerted policymakers for decades about this current 
demographic shift and the need to plan, prepare and create options in 
the community that help older adults stay healthy and independent--and 
out of institutions. The time now has come for Congress to recognize 
the value of the OAA as the critical non-Medicaid HCBS resource that 
meets these goals and invest accordingly. We urge Congress to preserve 
the essential infrastructure of the OAA and expand its capacity to 
serve the growing number of Americans who will need the vital services 
it provides. Thank you for the opportunity to share our OAA 
reauthorization recommendations and how they would help the Act better 
meet the needs of older adults and caregivers across the country, 
especially those who most need assistance.
                                 ______
                                 
    [Whereupon, at 12:42 p.m., the hearing was adjourned.]

                                 [all]