[Senate Hearing 119-038]
[From the U.S. Government Publishing Office]
S. Hrg. 119-038
IMPROVING WELLNESS AMONG SENIORS:
SETTING A STANDARD
FOR THE AMERICAN DREAM
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
JANUARY 15, 2025
__________
Serial No. 119-01
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
59-938 PDF WASHINGTON : 2025
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SPECIAL COMMITTEE ON AGING
RICK SCOTT, Florida, Chairman
DAVE McCORMICK, Pennsylvania KIRSTEN E. GILLIBRAND, New York
JIM JUSTICE, West Virginia ELIZABETH WARREN, Massachusetts
TOMMY TUBERVILLE, Alabama MARK KELLY, Arizona
RON JOHNSON, Wisconsin RAPHAEL WARNOCK, Georgia
MIKE CRAPO, Idaho ANDY KIM, New Jersey
TIM SCOTT, South Carolina ANGELA ALSOBROOKS, Maryland
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McKinley Lewis, Majority Staff Director
Claire Descamps, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Rick Scott, Chairman................ 1
Opening Statement of Senator Kirsten E. Gillibrand, Ranking
Member......................................................... 2
PANEL OF WITNESSES
Charlotte County Sheriff Bill Prummell, President, Florida
Sheriffs Association, Punta Gorda, Florida..................... 3
Maria Alvarez, Executive Director, New York Statewide Senior
Action Council, Long Island City, New York..................... 6
Dawn Carr, Ph.D., Director, Claude Pepper Center, Florida State
University, Tallahassee, Florida............................... 8
Susan L. Hughes, Ph.D., Founding Director, Center for Research on
Health and Aging, University of Illinois Chicago, Chicago,
Illinois....................................................... 10
APPENDIX
CLOSING STATEMENT
Closing Statement of Senator Jim Justice......................... 33
Prepared Witness Statements
Charlotte County Sheriff Bill Prummell, President, Florida
Sheriffs Association, Punta Gorda, Florida..................... 39
Maria Alvarez, Executive Director, New York Statewide Senior
Action Council, Long Island City, New York..................... 42
Dawn Carr, Ph.D., Director, Claude Pepper Center, Florida State
University, Tallahassee, Florida............................... 45
Susan L. Hughes, Ph.D., Founding Director, Center for Research on
Health and Aging, University of Illinois Chicago, Chicago,
Illinois....................................................... 49
Questions for the Record
Charlotte County Sheriff Bill Prummell, President, Florida
Sheriffs Association, Punta Gorda, Florida..................... 55
Maria Alvarez, Executive Director, New York Statewide Senior
Action Council, Long Island City, New York..................... 57
Dawn Carr, Ph.D., Director, Claude Pepper Center, Florida State
University, Tallahassee, Florida............................... 59
Susan L. Hughes, Ph.D., Founding Director, Center for Research on
Health and Aging, University of Illinois Chicago, Chicago,
Illinois....................................................... 60
Statements for the Record
John A. Hartford Foundation Testimony............................ 65
IMPROVING WELLNESS AMONG SENIORS:
SETTING A STANDARD
FOR THE AMERICAN DREAM
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Wednesday, January 15, 2025
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:30 p.m., Room
106, Dirksen Senate Office Building, Hon. Rick Scott, Chairman
of the Committee, presiding.
Present: Senators Rick Scott, McCormick, Justice,
Tuberville, Johnson, Gillibrand, Kelly, Warnock, Kim, and
Alsobrooks.
OPENING STATEMENT OF SENATOR RICK SCOTT, CHAIRMAN
Chairman Scott. The U.S. Senate Special Committee on Aging
will now come to order. This is my first committee meeting as
Chair. I have been up here six years. How about you?
Senator Gillibrand. First one, and I have been here
fifteen.
Chairman Scott. I just got lucky. I want to thank everyone
for being here. It is a pleasure to serve as the Chairman for
the Senate Special Committee on Aging for the 119th Congress. I
look forward to working with Ranking Member Gillibrand and all
our colleagues in this Committee to highlight the issues facing
older Americans and how the Federal Government can be more
accountable to the American people.
This is something I have been focused on since my time as
Governor of Florida, and I am excited to have the opportunity
to continue this work as Chairman of the Special Committee on
Aging.
My goal for this Committee is to make sure every American
senior is able to answer yes to this question, to these
questions: "Are you well?" because they have secured these four
things: their physical health, financial security, a safe
community to live in, and family and community support. If you
have all four of these things, your senior years can be the
best time of your life.
Now, I would like to welcome all the new members, or all
the members of the Committee, Ranking Member Gillibrand of New
York. Also, we have got new members: Dave McCormick from
Pennsylvania, Coach Tommy Tuberville, fellow Governor Jim
Justice, we have got Andy Kim from New Jersey, and we have got
some others that I am sure will be here a little bit later.
Aging is not a partisan issue. Whether or not we would like
to admit it or not, we are all aging, and it impacts every
single one of us regardless of political party. I think we are
all trying not to age. I believe we have a big opportunity in
this Committee to work in a bipartisan manner to support and
improve the lives of America's current senior citizens and
create change that will improve both the lifespan and health
span of future generations.
It is pretty exciting when you look at the conversation
about what we are talking about, food safety, medicine safety,
and all these things. It is an exciting time.
I think about how my work here will impact my grandkids. I
think all of us think about our kids and our grandkids, and it
drives what we do. I want them to have every opportunity to
live the American dream and have long and have long and healthy
lives, mostly around me.
My staff and I are excited to work together with all the
members here to find common ground and ways we can advance our
shared goals.
I would like to recognize Ranking Member Gillibrand now for
her opening remarks.
OPENING STATEMENT OF SENATOR
KIRSTEN GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Thank you so much, Mr. Chairman. It is
a delight to be on this Committee. Thank you for all the new
members for selecting this Committee. I think it is one that is
highly relevant for everyone in the United States, but looking
at the Senate itself, it is quite relevant for us. I am
grateful that you are here.
I am excited to serve as Ranking Member in this 119th
Congress. I want to thank Senators Casey and Braun for their
committee leadership during the 118th Congress. The Committee
examined many of the important issues that we are hoping to
continue to work on together.
Senator Scott, congratulations on your position as Chair.
It is a big deal, and it is very exciting to get to serve with
you. We have a lot of ideas in common about what we want to do
with the Committee, and I think your agenda that you have laid
out is really inspiring and really important, and really
urgent.
I am pleased to welcome both new and returning Committee
members, and I am really excited to hear your perspectives,
what you have learned from your State, what you have learned
from your own families, what you have learned in your own
lives. I think having interested and committed Aging Committee
members makes a huge difference in what we accomplish as a
committee, so I am very grateful for your leadership.
This Congress, I hope to continue to work on lowering the
cost of prescription drugs, guarding against financial scams,
protecting the programs that older adults and people with
disabilities rely on, like as Social Security, Medicaid, and
Medicare.
Today, we are discussing how to promote wellness among our
older Americans. We will address issues like accessible
housing, financial security, and engagement in the community.
This conversation is about making sure that we are creating and
supporting a society that gives people the tools to live, and
to live well. Those tools are different for everyone, but
include resources like nutrition assistance, Area Agencies on
Aging, Centers for Independent Living, supportive housing
programs, Medicare and Medicaid, and Social Security.
I believe that it is our job to make sure these resources
exist and are robust enough to support those who need them.
I look forward to hearing from our witnesses and discussing
ways to improve wellness for older adults and people with
disabilities.
Thank you, Mr. Chairman.
Chairman Scott. Thank you, Ranking Member Gillibrand. I
will now introduce the first witness. I would first like to
welcome Sheriff Bill Prummell from Charlotte County. The
sheriff serves as the President of the Florida Sheriffs
Association and has over 25 years of experience in law
enforcement, beginning his career with the Charlotte County
Sheriff's Office in 1992. In 2015, when I was Governor of
Florida, I had the opportunity to appoint him to serve as a
commissioner on the Criminal Justice Standards and Training
Commission, and he sits as a member of the Officer Discipline
Penalty Guidelines Task Force.
Thank you for being here to discuss the importance of
public safety and ensuring older Americans in Florida and
across the Nation can achieve wellness is their senior years.
STATEMENT OF CHARLOTTE COUNTY SHERIFF
BILL PRUMMELL, PRESIDENT, FLORIDA SHERIFFS
ASSOCIATION, PUNTA GORDA, FLORIDA
Sheriff Prummell. Thank you. Chairman Scott, Ranking Member
Gillibrand, and members of the Committee, thank you for
inviting me to testify. Today I would like to outline ways in
which the Charlotte County Sheriff's Office is working to serve
and protect our senior population.
Charlotte County does have a very large senior population.
Our average age is about 58 years old. We implement several
programs within the Charlotte County Sheriff's Office. Now, the
ones I am going to discuss here, they are not going to give you
the wow factor, but they are programs that make a difference in
my community.
One of our programs we do is a Senior Outreach Program,
where we have a volunteer unit call members within our
community twice a week. We have also provided Christmas gifts
and birthday cards with these weekly phone calls. The
participants are over 60 years of age, disabled or living
alone, with little or no contact to the community, so we are
making sure that somebody is contacting them each week, and if
we do not hear from them, there is a scheduled time in which we
contact them. If we are unable to get in touch with them, we
send somebody out to their house to make sure that they are
okay.
You know, we also have the population, they tend to wander
at their age, and we have the Take Me Home Program. It is
designed to assist deputies in locating loved ones who have
gone missing or lost. Information about your loved one, a
recent photo, and description is registered in our system. If
the individual wanders or goes missing, this information is
shared with the road patrol deputies immediately upon dispatch
in an effort to locate and reunite the family. Any office
member can register a participate to this program.
In addition to that we have our DNA Scent Kits. It is a
program that enables participants to keep a DNA scent article
at their home in the event a loved one goes missing. Charlotte
County K9 deputies use that pure scent to begin a track in
order to locate the loved one and reunite them with family.
These are handed out by the Community Affairs Team, our Mental
Health Unit, and our patrol members.
Project Lifesaver serves as a premier search and rescue
program locally operated by the Charlotte County Sheriff's
Office and is strategically designed for "at risk" individuals
who are prone to wandering. The program uses a GPS tracing
bracelet to locate the wandering party quickly.
Another thing that we have that we do on a regular basis,
we have these in each one of our offices, is our Operation Pill
Drop. It allows individuals to drop off expired and unwanted
medication in drug receptacle boxes at participating district
office locations. This keeps family members and others that
might have access to a senior's medicine cabinet from getting
those old, unused medications.
We have special vehicle decals. We provide free decals for
individual vehicles to alert deputies of a possible presence of
someone that may require special attention within the vehicle,
such as a hearing impairment or autism. This way the deputy
knows how to approach the vehicle and there may be somebody
with a disability inside of it.
A real simple program we have is often seniors misplace or
leave items behind, such as their keys. Through our local Lock
Out Program, key tags are provided to help return lost keys to
the owners. The tags are registered with a special code in our
system with the owner's information, so if they are found, they
are turned into the Sheriff's Office, and we contact the owner
through that registration number. We educate them not to put
their name and address on the keychain in order to protect
themselves.
Then we have our Citizen Police Academy, which is big for
our entire community but it is attended mostly by our seniors.
The classes are mostly seniors, to learn behind-the-scenes and
promote our volunteer program. The class lasts about nine weeks
long, and they learn a lot about our different programs within
our community policing class.
A lot of our outreach, we do spend a lot of time visiting
local retirement homes to advise of the local scams and
problems that we see. In addition, we rely heavily on Facebook,
Instagram, our blog, and press releases. We know that many
seniors do not monitor this, but many family members and those
that work or live around seniors do. This helps us get the word
out to them to watch out for their neighbors.
In addition to that, we get out there and we educate banks
and large retailers in reference to the different scams going
on, because often the seniors will go to the banks to make
large withdrawals, or they will go to these retailers, like
Walmart and Target, and start buying large gift cards or phone
cards, and by educating these individuals they know to alert us
when somebody is trying to do that.
Last, we focus our effort on speaking to neighborhood
watches, local churches, and various organizations, such as the
Parkinson's Group. We average about one or two speaking
engagements a week. We work closely with OCEAN, which stands
for Our Charlotte Elder Affairs Network, which is a group of
business owners in the senior arena that want to specifically
help seniors.
Currently we are seeing several different methods in which
criminals are attempting to scam our senior population. This
includes scammers visiting our website, looking up recent
arrests, and then calling family, pretending to have the
ability to bail out the arrestee. We are also seeing what is
referred to as "romance schemes," which can be long-running and
generally include a person asking for money while pretending to
love someone. Other schemes that have become more pronounced
center around sweepstakes lotteries, where individuals have to
play to win. In these cases, the scammers will ask for gift
cards to pay the taxes to get people their winnings.
The Charlotte County Sheriff's Office has partnered with
Charlotte Behavioral Health Care for the addition of a
caseworker to be assigned to the CCSO. This caseworker receives
referrals from deputies who, during the course of their
business, identify a senior who might be in need of services as
well as calls from the public. This caseworker will refer and/
or provide services through Charlotte Behavioral Health Center
and/or make additional referrals to outside entities, depending
on the elder's needs.
Our office provides a number of resources, including case
management assistance by giving brief overview of the program,
provide the contact number, and in some cases, provide hands-on
assistance. The case manager follows up by phone, if required,
and the case manager provides case management contact
information for additional assistance, if needed. Some of the
organizations we use are home care providers, transportation,
Family Service Center, St. Vincent De Paul, Active Age--it is a
daytime senior care--Senior Placement Services, Social Service
Resource Center, Florida Rural Legal Services, Meals on Wheels,
Senior Friendship Meals, CapTel, Dementia/Alzheimer's Caregiver
Support Group, and the Dubin Center, which is also a support
group for caregivers.
We have more than 90 partners that provide an array of
services to our seniors and disabled. The needs of our seniors
are not one dimensional. If there is a need and we cannot
provide it, we find somebody that can. I think by a lot of the
programs we do we hit those four bullet points that you
mentioned earlier, when you opened.
Thank you, Chairman Scott and Ranking Member Gillibrand,
for holding this hearing and focusing on senior population. I
look forward to working with members of this Committee to
develop proactive and effective ways to protect our communities
from crime.
Chairman Scott. Thank you, Sheriff.
Now I would like to recognize Ranking Member Gillibrand to
introduce the next witness.
Senator Gillibrand. Thank you, Mr. Chairman. Maria Alvarez
is the Executive Director of the New York StateWide Senior
Action Council, Inc., a grassroots, consumer-directed and
governed nonprofit that has been serving communities for over
52 years. She has worked with senior citizen groups as an
organizer, advocate, and director of housing and caregivers
program for over 30 years. She has designed and implemented
educational, social service, and leadership programs for older
adults, and she has worked with me on my Working Group on
Aging, contributing to important policy priorities.
In addition to her work with StateWide, Ms. Alvarez is a
board member of Ponce Bank, which serves underserved
communities in New York and New Jersey.
Under Ms. Alvarez's leadership, StateWide has played a role
in bringing awareness to the importance of economic security
for elders, age-friendly banking, enacting the New York State
Observation Status Law, the Safe Patient Handling Law, and
refunding of the New York State Elderly Pharmaceutical
Insurance coverage.
Recently, Ms. Alvarez has advocated for funding for New
York's Patient Rights Help Line and the state's Managed Care
Consumer Assistance Program. Under Ms. Alvarez, StateWide's
federally funded Senior Medicare Patrol has served to alert and
assist millions of New Yorkers to avoid Medicare fraud.
Ms. Alvarez has also weighed in with the New York State in
favor of home and community-based services through local Area
Agencies on Aging.
Ms. Alvarez also holds a bachelor's degree from Marquette
University, and a master's degree in nonprofit management from
the New School for Social Research, where she is a Sloan
fellow.
Thank you very much for coming today and thank you for your
advocacy and expertise and leadership on such crucial areas
important to this Committee for the older New Yorkers who are
able to age with dignity and security. I am honored to have you
take the time to be my first witness on this Committee.
STATEMENT OF MARIA ALVAREZ, EXECUTIVE DIRECTOR,
NEW YORK STATEWIDE SENIOR ACTION COUNCIL,
LONG ISLAND CITY, NEW YORK
Ms. Alvarez. Thank you so much, Chairman Scott and Ranking
Member Gillibrand, for inviting me here to come speak with you
today.
As a participant of the White House Conference on Aging in
both 1995 and 2005, I can tell you that there have been
dramatic improvements in the system of preventive care and
health promotion, but we still have a long way to go. With your
leadership and advocacy, we can continue to make improvements
for the seniors of today and for future generations.
Since 1995, the fabric of the older population has changed
dramatically. This means that systems to promote healthy aging
also need to change and modernize to better serve elders today.
There has been a significant increase in the size of the
older, non-white, senior citizen population, which is on pace
to make up half of the elderly population by 2060. Fortunately,
though, many elderly can remain in the community despite
managing multiple chronic conditions. I suggest that one step
in the right direction would be to make sure that the 2025
White House Conference on Aging is held to help the country
chart a course for addressing the needs of this group, as 20
percent of this country is now of the age of 65 and over.
Prior to 1995, Medicare and most private insurance would
cover treatment of an illness but not cover the cost of the
diagnostic test or prevention. Thanks to action by Congress to
improve Medicare in 1997 and 2003, and the implementation of
the Affordable Care Act in 2010, coverage of preventive
services has steadily increased. Now most preventive tests and
immunizations are available without copays, and Medicare
provides an annual wellness exam to help beneficiaries identify
health risks, schedule preventive tests, and identify social
determinants of health.
In addition, the country has invested resources through
Part III D of the Older Americans Act to provide evidence-based
health promotion programs through the Area Agencies on Aging
and community-based agencies. Today, most communities have
programs like Chronic Disease and Diabetes Self-Management
Program and Falls Prevention. Many have been adapted to meet
the needs of older persons of different races and ethnicities.
These programs are cost-effective approaches and should be
expanded.
At one time, Federal and State policymakers considered
services like congregate and home-delivered meals,
transportation, case management, and housing assistance as nice
but soft services that were not as important as health care. It
took years of advocacy and research to get the medical system
to finally recognize the importance of social determinants of
health, which are critical to the ability of older persons to
follow needed courses of treatment and maintain healthy
lifestyles. These are all important improvements that we can
buildupon, but we cannot ignore the need to recognize that
having health care and preventive services available is not
sufficient if they are not affordable or if discrimination,
actual or perceived, persists.
Many problems still exist. Income security continues to be
a problem in a country where there is so much abundance. The
reality is that one in three senior citizens are not making
ends meet. Their incomes are under 200 percent of the Federal
poverty level, roughly $30,000 a year, and it is not keeping
pace with the increasing cost of living.
Lest, you think that this is only one segment of the
population, I will tell you that we increasingly see people who
look good on paper, who consider themselves to be middle-
income, sliding into poverty at dizzying rates. According to
several reports, we are about to experience the largest amount
of homelessness in the elderly population ever. We are already
seeing it in New York City. More Section 202 housing must be
developed with social services attached to them. This will
ensure that seniors not only have an adequate place to live but
they have access to all of the programs and services for which
they qualify.
I cannot end my time without telling you that along with
Social Security, Medicare, and Medicaid, the Older Americans
Act is a law that has had a seismic effect on the elderly
population. All of those programs form the framework that
seniors can rely on to continue to thrive and live in dignity.
Now that this generation makes up 20 percent of the country, we
need to strengthen and improve them, in their structures as
well as in their funding, to reflect the fabric of our country
today.
I have many other points to make, and five minutes is just
not enough. I hope that you ask me about them during the time
that we have together and consider us a resource to you in the
future. I have also included a full list of programs and
recommendations with my formal testimony. Thank you.
Chairman Scott. Thank you and thank you for being here.
Next I would like to welcome Dr. Dawn Carr. Dr. Carr is the
Director of the Claude Pepper Center at the Florida State
University and serves as Professor of Sociology. Her mission as
a scholar and gerontologist is to identify and leverage factors
that bolster older adults' ability to remain healthy and active
as long as possible.
Before joining Florida State University in 2016, she was a
researcher at the Stanford Center on Longevity, a postdoctoral
fellow in the Carolina Program for Health and Aging Research at
the Institute on Aging at the University of North Carolina
Chapel Hill, and a researcher at the Scripps Gerontology
Center.
Thank you for being here today to discuss the impact of
community engagement on the physiological and emotional well-
being of seniors.
STATEMENT OF DAWN CARR, PH.D., DIRECTOR,
CLAUDE PEPPER CENTER, FLORIDA STATE UNIVERSITY,
TALLAHASSEE, FLORIDA
Dr. Carr. Thank you, Chairman Scott and Ranking Member
Gillibrand, and the rest of the Committee. It is an honor to be
here today and to have an opportunity to share my testimony
with you.
I am the Director of the Claude Pepper Center, and this is
a wonderful center at Florida State University that is named
for one of the strongest advocates for aging policy in U.S.
history, Senator Claude Pepper. I think he would be very
excited about the work that you are doing here today.
Today I am here to discuss with you the importance of
expanding the scope of U.S. aging policy to increase chances
that future generations of older adults not only survive into
old age but they can thrive once they get there.
Health problems in later life are strongly influenced by
events, exposures, and behaviors that occur well before we
reach our later years. Although the consequences of regular
harmful exposures and habitual behaviors accumulate to erode
health over time, there is growing evidence that if we
intervene early, we can significantly modify health
trajectories. Current clinical care is not designed with this
approach, and there will be significant consequences if we do
not change our current approach.
Older adults who are navigating the period of old age when
health problems interfere with daily function, a period
sometimes referred to as the "Fourth Age," often experience
poor quality of life, and they lose the ability to live
independently. The needs of this group vary starkly with older
people who are healthy and able to engage in a variety of
active, meaningful, and purposeful social roles. This is the
period sometimes referred to as the "Third Age."
This distinction is important because there are stark
differences in the needs of a typical 65-year-old and a typical
85-year-old, but also systematic differences in the health and
function of older adults of the same chronological age. Much of
our current ageing policy is focused on problems related to the
Fourth Age.
Further, middle-aged adults today face more significant
health problems and disabilities than previous generations. In
the absence of significant changes, they are likely to face
more complex health issues in later life than previous
generations, and they are likely to enter the Fourth Age even
earlier.
Our society could, instead, be enriched by a large and
growing group of healthy Third Agers if we leverage an aging
policy framework that emphasizes health maintenance at every
stage of life, targeting risks related to aging-associated
diseases and disabilities, engages older adults' unique
strengths that benefit society, and addresses barriers to
healthy aging that create inequalities in health outcomes as
people age.
I believe the following four areas are especially
important: employment, social engagement and social
integration, health literacy and lifestyle behavior supports,
and health care access and early treatments.
First, regarding employment and financial security, working
in later life is protective of health as people move into and
through the Third Age. However, older workers are less likely
to be hired, offered opportunities for upward mobility, or
offered opportunities for training. In addition, individuals in
physically demanding or hazardous jobs are more likely to
become disabled or retire early, with significant financial
consequences.
Implementing health-protective occupational interventions,
where possible, and midlife retraining for transitions to new
career paths can increase the chance that workers remain
healthy and fully employed until they reach full retirement
ages. Further, making phased retirement or transitions to part-
time work opportunities available to all workers will make it
possible to remain engaged in paid work longer.
Second, social isolation and loneliness accelerate
physiological aging. Isolating older adults within communities
is not only detrimental to the health and well-being of older
people. It also prevents communities from benefiting from their
skills and wisdom. There are very few programs designed to
reach isolated older adults. Effective programs like meal
delivery programs are low cost and have the added potential of
improving access to high-quality, nutritious foods. Expanding
these programs is likely to delay onset of disability.
In addition, increasing engagement in volunteering not only
is health protective, it also helps people of all generations
work collectively to solve social problems. Investing in
volunteer infrastructure is not only beneficial to health
outcomes, it can provide exponential returns economically. For
instance, the Senior Corps volunteer programs have shown an
estimated return of between $3.50 and $5.08 for each dollar
invested, with the added bonus of reducing burden on the health
care industry.
Third, most adults in the U.S. do not have access to
scientifically accurate information or resources they need to
gain access to a Third Age. One important solution is expanding
the number of community health workers, which offers one of the
most effective solutions for facilitating healthy behaviors
across the life course, by helping community members of all
ages build trust with the health care system and navigate
health care services to support healthy aging.
Recent research suggests that there is a $2.47 return for
every dollar invested in community health workers for the
Medicaid program alone. Further, lack of access to high
quality, nutrient-dense foods is a persistent problem
reinforced by ultra-processed, unhealthy foods being subsidized
so they are low cost. Making healthy foods financially
accessible and disincentivizing consumption of ultra-processed
foods is key to increasing healthy aging.
Last, most adults do not see a doctor regularly unless they
are facing health problems. We need scientific investments to
identify ways to halt disease progression early. This means
recalibrating health benchmarks at all stages of life to
support long-term, optimal health trajectories. For instance,
aggressively treating metabolic and lipoprotein health in
middle-aged adults has been shown to reduce risk of dementia,
diabetes, heart disease, and cancer, the most costly and
consequential aging-associated health conditions.
This approach will require more frequent interactions with
health care providers, but it has potential to significantly
pay off. A recent study showed that a metabolic and lipoprotein
pharmaceutical intervention provided a five-year return on
investment of nearly $10.00 for every dollar invested.
In conclusion, to build a future that is enriched by a
robust population of healthy Third Agers requires us to expand
our aging policy priorities to intervene during critical
inflection periods so we can modify health trajectories and
bolster physiological resilience as we age. If it becomes
possible for all adults to remain productively and socially
engaged in meaningful ways into late life, old age could become
a period of life that we all look forward to, and our society
as a whole will benefit.
Thank you.
Chairman Scott. Thank you, Dr. Carr.
Next I would like to recognize Dr. Susan Hughes. Dr. Hughes
is a professor at the School of Public Health and directs the
Center for Research on Health and Aging at the University of
Illinois Chicago.
Dr. Hughes is a gerontologist and health policy analyst
whose research focuses on the design and testing of evidence-
based health promotion programs for older adults.
Thank you for being here to discuss the impact of physical
activity on the overall health of older Americans.
STATEMENT OF SUSAN L. HUGHES, PH.D., FOUNDING
DIRECTOR, CENTER FOR RESEARCH ON HEALTH AND AGING,
UNIVERSITY OF ILLINOIS CHICAGO, CHICAGO, ILLINOIS
Dr. Hughes. Thank you so much, Chairman Scott and Ranking
Member Gillibrand, other members of the Committee, for this
wonderful opportunity to talk with you and testify today about
this very, very important topic of older adult wellness. It is
an honor to be here.
In terms of my background, I directed the Center for
Research on Health and Aging at the University of Illinois
Chicago, where I led five successive iterations of our NIA
Roybal Center. Like other Roybal Centers, we design evidence-
based health promotion programs for older adults.
Today I would like to address the limitations of our
funding for health promotion programs for older adults and
strongly recommend the use of Medicare for that purpose going
forward.
Medicare, as everyone knows, is a wonderful program that
serves millions and millions of people and greatly improves
access to acute and subacute care. However, the designers of
Medicare missed a major opportunity to cover wellness programs
that have the potential to pay for themselves many times over.
Medicare Advantage plans are managed care options that
encompass 54 percent of beneficiaries. Medicare Advantage plans
must offer all of the plans that regular Medicare offers, but
they can supplement that package any way that they choose. The
ability to supplement services makes these plans logical
providers of health promotion programs. However, plans will
only cover evidence-based programs if they see an advantage to
doing so.
The good news is the Administration for Community Living
and CDC have developed criteria for evidence-based health
promotion programs. We need help from Congress to develop
incentives for Medicare Advantage plans to include these
programs as covered benefits. This will take time. In the
meantime, the only source of funding for our growing number of
evidence-based programs is Title III D of the Older Americans
Act (OAA). Fiscal year 2024 funding for Title III D was $33.6
million nationally. That amounts to $671,000 per State, or
$0.23 per senior in the State of Illinois. These funds support
care management and falls programs. Currently, there is no set-
aside funding for physical activity programs despite
overwhelming evidence supporting their impact.
Eighty-four percent of older adults in the United States
are sedentary and at high risk for obesity, diabetes, heart
disease, and all-cause mortality. We know that any physical
activity is associated with lower mortality risk. My work with
homebound older adults found that arthritis was their most
common chronic condition and the condition that interfered most
frequently with their functioning. Our follow-up disability
study found that persons who had lower extremity joint
impairment were much more likely to become disabled.
Once we understood the pivotal role of lower extremity
joints we developed an intervention to improve their function.
Fit & Strong! lasts eight weeks. It provides flexibility,
aerobics, and systematic lower extremity strength training, and
uses group problem-solving with peers to promote physical
activity. Our trials found significant gains in physical
activity at eight weeks that were maintained at 18 months and
accompanied by significantly improved joint pain, lower
extremity strength and mobility, and decreased anxiety and
depression at the same time points.
Medicare spent $43,000 per total hip and knee replacement
combined in 2023. Fit & Strong! costs $300 per participant. It
has no harmful side effects and large effect sizes. Drugs have
a clear pipeline from bench to uptake. Our growing number of
evidence-based programs have no similar pipeline for
distribution. We have no way to communicate program benefits to
clinicians who can recommend them and no way to reimburse
program providers.
Currently, Title III D of the OAA is critical but
insufficient to meet growing demand caused by the fact that
more programs are coming online. We need to reauthorize the
OAA, increase funding for Title III D, and create a new title
for physical activity. Currently, NIA and CDC are creating
great programs that unfortunately have nowhere to go in terms
of a route for distribution.
To impact older adult wellness, Congress needs to improve
coverage of evidence-based health promotion programs by
Medicare Advantage plans. This effort would require a full-
fledged partnership between the National Institute on Aging,
CDC, the ACL, and CMS to speed up the process of disseminating
programs that meet clear criteria for suitability for adoption.
Thank you again for this opportunity to share our work with
you. I hope this has been helpful, and I look forward to your
questions.
Chairman Scott. Thank you, Dr. Hughes.
Now we will go to questions. I am going to go ahead and
pass my time to Senator McCormick.
Senator McCormick. Great. Thank you, Mr. Chairman, and
thank you, Ranking Member Gillibrand, for kicking this off. It
is great to be here in my first meeting of the Special
Committee on Aging. This is a big issue for Pennsylvania, where
I am from, and my predecessor was the Chairman of this
Committee, so it is an issue very near and dear to the hearts
of Pennsylvanians.
My first question is for you, Dr. Carr. You alluded to the
research on part-time work opportunities in your written
testimony. What are the benefits of someone choosing to remain
in the workforce, and what are some of the barriers that older
workers face as they seek to remain in the workforce?
Dr. Carr. Thank you for the question. One of the clear
benefits of part-time work is obviously being able to be paid
longer, and oftentimes it is not possible to work full-time or
it is very challenging as we get older because there may be
some physical health problems that people need to address,
making it more difficult to maintain that full-time work load,
or caring for other family members.
There are a lot of reasons why part-time work is helpful,
and it is meaningful. I mean, all of us in this room, I think,
have jobs that are extremely meaningful, that we would be very
sad to give up because it gives us a lot of sense of meaning
and purpose in our lives. Those things are both helpful because
they make us feel good but also, they improve our physical
health.
A lot of work I have done over the years with my colleagues
has shown remarkable protective effects on physical health as
well as cognitive health with continued engagement in paid
work, so that alone, I think, is an important piece by itself.
We also find that the health effects, health benefits of
working, are roughly the same for part-time work and full-time
work as we move into later life. If you think about effect
sizes, part-time work is quite potent in lots of ways.
Regarding the barriers that you mentioned to continued
part-time work, there are a lot of different kinds of things,
and certain groups of people face more barriers than others. It
is easy if you are in, I will say, a high-ranking kind of role
to negotiate a singular opportunity to maybe consult or move
into a part-time job mentoring others, doing things of that
nature, but for a lot of workers, there are not many choices
that pay sufficiently or are meaningful enough for it to kind
of be worthwhile or even available as an option, except hourly
work or maybe stepping back and doing work that is not very
cognitively engaging, so that lack of opportunity, we do not
have a lot of, I will say, institutionalized opportunities for
people to take on or transition to an intended part-time role.
It is more haphazard or one-on-one basis.
Senator McCormick. Yes. Thank you. Sheriff, a question for
you. You made mention of scammers taking advantage of all of us
but in particular focusing on the elderly. What are some of the
protective measures that you would recommend, particularly for
hoaxes that are telephonic? What can people do to protect
themselves and recognize the potential scam call?
Sheriff Prummell. Well, you know, the best defense is a
better offense, because we have got to get out in front of this
because a lot of these scams are very, very difficult to track
down. Many of the offenders are not just outside your State,
normally, but they are outside the country.
What we try and do, especially with the jail scams, your
IRS scams, things like that, we try to tell everybody to give a
safe word. This way if somebody is calling you saying, "Hey,
Little Johnny, I'm arrested in jail. I need bail money," there
is some sort of safe word that they both know, that that person
is going to use. The scammer, of course, is not going to know
that safe word, so they are not going to know to use it, and
the person on the other end will catch on to that and realize
it is a scam.
The most part is we just educate, educate, educate, in
every way possible and to everyone possible, because as you
stated, everyone is being scammed, but our seniors are
especially being targeted.
Senator McCormick. Thank you.
Chairman Scott. Thank you, Senator McCormick. Next I will
turn it over to Ranking Member Gillibrand.
Senator Gillibrand. I would like to defer my time to
Senator Alsobrooks.
Senator Alsobrooks. Good afternoon. First of all, thank you
to Chair Scott and to Ranking Member Gillibrand for convening
this really important meeting. I am enthusiastic about joining
the Senate Special Committee on Aging and really pleased to be
here today. I want to thank all of our witnesses who came
today. Thank you so much for your presentations and your work
and all the information that you shared.
As the daughter of two aging parents, I have witnessed,
like so many, some of the challenges that our seniors face. Our
seniors have spent their entire lives, many of them, working to
earn benefits such as Social Security and Medicare, and I view
these programs as a promise that we have made to our seniors. I
am committed to ensuring that every senior, regardless of their
background or circumstances, has access to resources and
opportunities that they need to thrive.
With that I will begin my questions. I would like to say to
Ms. Alvarez, direct the first question to you, that like so
many Americans I am a part of what they call the "sandwich
generation," which means that I am both caring for a 19-year-
old daughter as well as my aging parents. While I am really
grateful for the opportunity to support my parents and
understand the rewards that come with caregiving, I also
recognize how challenging it is to bear the full weight of
caregiving responsibility.
Now we know that many Federal programs that are so critical
to our seniors and that guarantee the support and stability
that they need, are really in jeopardy.
In Maryland we have over 1.2 million residents who are over
60, and the Maryland Department of Aging oversees a range of
these programs, but Maryland also relies heavily on Federal
funding. I wonder, do you believe that volunteer-based
organizations who we rely on very often have either the
capacity to adequately fill the gaps that would be left by
reduced Federal funding, and do you believe that these
organizations likewise have the obligation to provide that
care, particularly in states like Maryland, where Federal
programs are vital to seniors?
Ms. Alvarez. Thank you very much for that question. To
answer your question, right now if there is a reduction--if
things stayed the same, if the funding stayed just the same,
just by the fact that we have a larger senior population and
more and more aging--in every single day there are 10,000
people who turn 65, every single day in this country, so with
no increased funding and more people to serve, that constitutes
a cut.
Just starting from that point, I would say that we cannot
afford not to increase the funding. Decreasing it would put us
in a crisis, and then when you are talking about the mission of
organizations that manage volunteers, that is their mission,
and my organization also, you know, we are volunteer-based, as
well, and it is our mission to do it, and however being
realistic, we have to be able to marshal our resources
effectively so that we can do a good job and be responsible in
our work.
With less funding, you know, it is not possible, right. We
are constantly thinking of ways that we can get more people,
because there are people out there who are very well meaning
and who want to do the work, but we also have to have the
wherewithal to administer all of this work, with volunteers
coming in, as well as the job at hand, which is an increasing,
you know, senior population.
Senator Alsobrooks. Next, Dr. Carr, I just have a question
also for you. The question is regarding the cost of increasing
prescription drug medications. This is yet another area where I
have seen really so much struggle. I mentioned my parents. My
father is my mother's caregiver, and one of the things I note
in Maryland, and around, is that nearly 90 percent of all of
our seniors take prescription drug medications. We also know
that over 20 percent report that it is extremely difficult to
afford those medications, and we know that access to affordable
prescription drugs is not just about health, but it is about
dignity, as well, and peace of mind.
The question is, how can we ensure that our seniors will
have reliable access to affordable prescription drug
medications?
Dr. Carr. Yes, I agree that making sure that everyone has
access to the medications that they need is extremely
important. I do not have a clear history of studying
prescription drug costs, but I can say that in order for us to
be able to maintain a healthy aging population, inadequate
access to prescription drugs will undermine our efforts. The
scientific advancements in pharmaceuticals are astonishing and
playing a big role in helping with prevention at all ages.
There is lots of room for pharmaceuticals to play a strong
role, in coordination with other health care efforts, to ensure
healthy outcomes.
In terms of financial supports, it would be largely
undermining to the efforts to ensure a healthy aging future if
we did not have financial support for all of the pharmaceutical
needs of order adults.
Chairman Scott. Thank you, Senator. Now we will hear from
Senator Tuberville.
Senator Tuberville. Thank you, Mr. Chairman. I am thrilled
to be on this Committee with you. You laid out great vision for
the Committee: Are Americans doing well? We should have some
great hearings. I think most Americans would respond to that
question with concerns or worries.
Americans who are not just seniors are concerned about
their safety, health care, finance, nutrition, and stability
for communities, the fact that so many Americans are concerned
about their general welfare is unacceptable. We live in the
most abundant country in the world. Anxiety about things like
public safety, harmful chemicals in foods, financial security,
and retirement security should not be at the forefront of
Americans' minds, but they are.
Elites in Washington have ignored these concerns for far
too long, and the American people are tired of it, so when
President Trump's election, Republicans taking back the Senate,
we are going to leave no stone unturned, thanks to our
Chairman.
I want to make sure that when Americans are asked about
their wellness they respond with hope and optimism, not fear
and anxiety. I look forward to digging into these with you, Mr.
Chairman. It should be fun, we should have a good time, and
maybe we can make some progress.
Sheriff, real quickly, I know you hit the spam and the
robocalls. I have gotten several spam texts as we have been
sitting here. It is annoying. I am sure to seniors who are
tired, sitting around, they get absolutely sick of it. You have
worked with this.
What can we do on the Federal level to help this? Is there
anything that we can do to eliminate some of this garbage?
Sheriff Prummell. You know, I do not know if we are ever
going to be able to eliminate it, because with AI and with all
the different technologies that are coming up, they are using
technology to commit the crimes, and we are trying to use the
technology to catch them now, so we are trying to keep up.
The problem is there is a lot of legislation, both on State
levels and Federal levels, that is not keep up with technology.
It is years behind, so that is a big thing that we need to look
at is legislation and technology.
You know, when people receive phone calls and all that, now
they can spoof numbers so they can use a number that is very
familiar with them. I mean, we have people that use the
Sheriff's Office number when they are trying to do the jail
scam, because they can easily spoof the numbers. It is just
trying to keep up with technology. We really need to get a
handle on it.
Senator Tuberville. Yes. Dr. Hughes, we have got a serious
nutrition wellness problem in this country, serious. Can you
speak to the importance of a lifestyle in earlier years to help
our young people understand what they are getting ready to get
into in later life?
Dr. Hughes. Yes. I think that is a great question. I think
we have a real opportunity to educate people early on and
develop a life course perspective to health education, physical
fitness and so on and so forth. It is going to be far more cost
effective in the future if we can get people to adopt healthy
nutrition habits, physical activity, other types of activities
that will really improve their functioning and quality of life
as they age, and into old age.
Senator Tuberville. You know, our young people do not have
it as good as we have had it growing up because we used fresh
food and vegetables. They eat all this processed food now. I do
not know where it is going. I hope we can get a handle on that.
I really do.
Dr. Carr, whether it be friends or family, what is the
significance of community and social engagement?
Dr. Carr. Can you repeat that question? What is the
significance?
Senator Tuberville. I want to read it myself again.
Dr. Carr. Okay.
Senator Tuberville. Whether it be friends or family, what
is the significance of community and social engagement? In
other words, what does the community do? Not just your family
but your community and your social outcome, you know,
boyfriend, girlfriend, husband, wife. I mean, how can that all
work together to make us have a better, longer life?
Dr. Carr. Well, it has been very interesting over the last
20 years because I think for the first time scientific efforts
have been able to show that friends matter a lot. The growing
research showing morality consequences of loneliness and social
isolation have really accentuated our understanding of why
relationships matter.
I think for a long-time things like friendships and family
relationships were thought of as sort of soft, not real health
behaviors.
Senator Tuberville. Make a huge difference.
Dr. Carr. Yes. I think that there is clear evidence, and
sometimes when I talk to people and they say what are the key
issues when you think about longevity, and I put social
broadly, broadly speaking, at the top of that list, and that is
not just you have a good marriage or you have a few good
friends, but the interconnected relationships we have within
our community are heavily related to that. If we are in a
community where we belong and we are able to have our needs met
and work as part of a team, like I mentioned, I think, in my
testimony solving problems together, those are really powerful
relationships that help us feel like we matter and we have a
place in the spaces that we are in.
Senator Tuberville. Yes. I will not ask this to anybody. I
would just like to put it on the record, but you know--and
hopefully we will talk about this in the future--Americans are
suffering from a record-breaking, trillion dollars of credit
card debt, trillion, and what can we do in the future, as a
group, to take----
Chairman Scott. The highest interest rates for credit cards
ever, also.
Senator Tuberville. Pardon?
Chairman Scott. I think it is the highest interest rates
for credit cards ever, in the history of the country, too.
Senator Tuberville. Interest rates and the debt, and we
just keep racking up. People are broke. They do not have cash.
Chairman Scott. Yes. Highest credit card debt in history
and highest interest rates on credit cards ever.
Senator Tuberville. Yes. Thank you, Mr. Chairman. Thank you
very much.
Chairman Scott. Senator Kim.
Senator Kim. Yes. Thank you, Chairman. Thank you, Ranking
Member. Thank you, everybody, for joining up here. I appreciate
it.
Dr. Carr, I think I will just pick up where my colleague
was getting at, you know, this issue about loneliness, issue
about mental health in particular. I think that is something
that is becoming all the more apparent in our society. I think
we have a mental health crisis as a nation right now. It
affects young kids. I have got a seven-year-old and a nine-
year-old, and I am worried about that generation, but just kind
of all throughout this, and from my standpoint it feels like we
do not have the workforce that we need right now to be able to
address this.
I guess I just wanted to get a little bit more a sense from
you of just what are the some of the best practices? Are there
certain states or communities that are doing this better, you
know, things that we can draw on? We do not want to reinvent
wheels here, but if there are certain things we can lift up to
a federal level, you know, I am interested in trying to explore
that. I just thought I would kind of tease that out a little
bit more from you.
Dr. Carr. Yes. I mean, I agree with you that we do not have
the resources we need to address the growing mental health
issues that we are facing as a Nation, and it is getting worse,
and the pandemic was a big spike, that has not really recovered
fully in that regard.
In terms of specific case example, I actually think that is
a wonderful suggestion for the work that we should be doing is
identifying some communities that are getting it right. I am
not familiar with any specific individual communities.
I will say that communities in which there are
opportunities for people to have all of their basic needs met
are doing much better than ones that are suffering in terms of
issues with high levels of unemployment and poverty. That is
partially because there is this connection with having
meaningful roles and connections and being able to connect with
other people within the community. Volunteering is one of the
ways that a lot of people have been able to maintain those
relationships above and beyond having those basic needs met. I
think that places where there is a lot of intergenerational
engagement, this is particularly useful to a healthy, sort of
social fabric.
With this recommendation I am going to be looking for some
great communities that provide excellent examples that we
should be able to look at.
Senator Kim. I would love to stay in touch with you about
them. Mr. Chairman, I think that is something that this
Committee might be able to do, is really try to draw upon these
different issues of mental health and financial situations. It
is hard here in Congress to come up with something completely
from scratch, a new, completely novel idea, but if there are
pilot projects, if there are other examples that we can draw
upon, scale, try to exemplify, that is something that we can
lift up here in this work. I hope that we can have a chance to
work together on that.
Ms. Alvarez, a similar-ish type question. If you don't mind
I will be a little personal here. I was listening to one of my
colleagues talk about she is part of the sandwich generation. I
am, as well. My father had a major accident last summer, and is
not able to walk anymore, and now having significant cognitive
decline.
We are really struggling with this, and I think, Ms.
Alvarez, one thing I wanted to raise with you is the thing that
really stood out to me was the difficulty of our family trying
to get a sense of like where we can turn. What is my father
eligible for? What other types of services are available,
resources that are out there? Even navigating Medicare. I mean,
I am a United States Congressman at that time, and I was having
so much trouble just trying to navigate. I cannot imagine what
other Americans have to deal with.
From your standpoint, working in New York, what have you
seen as sort of the best examples of getting that information
out there. The challenge is often that it is, at least from my
family and may I talk to, you are often experiencing some of
this in an emergency situation, where things have changed
dramatically in your life. Are there ways that we can try to
ramp up better, try to prepare people better, so that it is not
just under this crucible of pressure and emotion in terms of
trying to get to it? I wanted some of your thoughts here.
Ms. Alvarez. Yes. Thank you so much for bringing that up.
At StateWide we operate three help lines. A lot of our work, we
are a grassroots organization, and a lot of our work is going
out into the community, and many times there are hard-to-reach
populations. They might be ethnic minorities. There might be
rural areas.
We are constantly thinking of ways in which to outreach to
different areas. We have gotten to the point where we are doing
a lot of ads in the newspapers, because we know that seniors
like to read the newspaper. We do radio interviews, and a ton
of outreach into the community through tabling events, fairs.
Anywhere they invite us, we are statewide, as the name
connotes, but it is also important, not only to reach the
senior but the caregiver.
Senator Kim. Yes, the families.
Ms. Alvarez. What you are talking about is the family, the
caregiver, the friend. It is very important because many times
those are the people who are assisting or even making
decisions, depending on what State the person is in.
I will say, in response to, if you are looking for a
community project that works, we are very proud of a project
that we have with our Senior Medicare Patrol Program, where
what we have done is to reach out to community organizations,
community-based organizations, that are trusted sources in the
community, and working with them. What we do is we train people
that they identify, people who are active in the community, and
so we train them on different issues, who then go speak with
their peers.
I always find that the most effective way of reaching out
to others is through your peers. You are going to listen to
your friends, and we ask them. We do not dictate what it is
that we want to do. We have the content that we want to
communicate, of course, which is the fraud and health and
things like that, but how they want to be communicated to, that
is up to the community. We go to the community and we ask them.
They know best, and that is not only that they know and they
are trusted, but also that they are then empowered with
information. They can go out, and they can become leaders, and
they are empowered to go out, so it is a mixture of a lot of
things, and the other thing I wanted to followup a little bit
on what Senator Alsobrooks----
Senator Kim. If you don't mind, keep it very brief. I don't
want to go too long over. Otherwise, the Chairman, I don't want
to cause trouble in my first hearing.
Ms. Alvarez. It is on me. The family caregivers--no, it is
a statistic, very important, I want to say--is that family
caregivers, on an average, spend about 20 percent of their own
income on the person that they are caring for, the senior, and
it is important, you know, we were talking about financial
issues before, it is important to note that because then that
might put the person caring for the elderly person, or whoever,
in jeopardy, and they are not able to build wealth or they will
be in more debt, moving forward, and they will be worse off
than the person they are caring for when they finally need it.
That is all I wanted to say.
Senator Kim. Well, thank you so much. I appreciate it. I
yield back.
Chairman Scott. You know who should be helping you, your
health plan should have a health care advocate that should be
able to help you navigate that whole system.
Senator Kim. Yes.
Chairman Scott. Most of these, especially these bigger
companies, all have a whole program now of advocates that are
supposed to be helping, because how would you know? I used to
be in the business, and people call me all the time because I
was in the business, but other than that, I mean, you are not
going to become an expert. That is where it should be done.
Senator Johnson.
Senator Johnson. Thank you, Mr. Chairman. As you are well
aware, I am kind of a late entrant onto this Committee, and I
mainly joined because you became the Chair, and I think you
laid out a pretty good vision for what you want to do with this
Committee.
It will come as no surprise to you, and I think my
Committee members will quickly learn that I am not a real fan
of the Federal Government. I think it causes or exacerbates
more problems than it solves. I think the question you will
hear repeatedly out of me--I have certainly heard a lot of
support for government programs. I think my overriding question
always is what is the negative, unintended consequence of a
well-intentioned program.
I will lay one out. I am currently working on a program, or
my project, we are trying to make sure everybody is aware of
how much the Federal Government spends. In 2019, total
government spending was $4.4 trillion, and we had the pandemic,
and it shot up to $6.6 trillion.
How if you are a normal family, if you have an illness,
your spending dramatically increases and you get well, you go
down to the previous level. We did not do that. For the last
five years we have averaged $6.5 trillion. Last year we spent
about seven.
It is completely unsustainable. The result has been the
devaluation of our currency. A 1998 dollar is now worth 51
cents. A 2014 dollar is now worth 74 cents. A 2019 dollar is
now worth 80 centers. I could ask you the question, you know,
how much more devastating is that devaluation of a senior's
wealth compared to the loss of one government program.
The mismanagement of Social Security is profound. Social
Security, when it was first established, I think the retirement
age was set at 65 and life expectancy was less than 62. Now,
being 69 myself, I am really glad life expectancy has
increased, but with that increasing life expectancy you end up
with Alzheimer's, you end up with more cancers, you end up with
some really difficult problems that we are all trying to solve
here.
I appreciated Senator Tuberville's comment about social
interaction and community. I think it has been a recurring
theme that that is like sort of the number one solution. Strong
families, supportive communities. That does not come from the
Federal Government.
I guess I just kind of want to at least have everybody
think of the Federal Government programs you are advocating
for, the costs of those things, helping drive the $1.8 trillion
deficit. I mean, if we want to prioritize spending on seniors--
and again, we are a compassionate society and we want to help
people who cannot help themselves, and seniors are often in
that category--what other spending can we put down the priority
scale and not do?
My mission as a U.S. Senator is to wean as many Americans
off the government as is possible, so we can rely on our
families, we can rely on our communities, because that is
really where the solution lies here. I just kind of want your
comments.
Part of the isolation we are finding is if everybody thinks
they can just get a quick check from the government, nobody has
to really feel responsible for Mom and Dad, so as people become
more and more isolated, the less and less they are connected to
their community, or even dependent on their family and their
community.
I will start with you, Dr. Hughes. Can you comment on some
points I made there?
Dr. Hughes. Okay. I think that there are a number of things
that we can do. I understand where we are headed, you know,
with the current deficit, and obviously it is huge. It is not
trivial. You are correct that we have issues with maintaining
Social Security in the future. However there are also a lot of
people out there working on this problem, and what I have read
is that it is not an insurmountable one.
There is a group at Boston College that is headed by Alicia
Munnell. She is an economist who has spent her whole life
working on this issue, and she has basically come up with some
relatively simple, straightforward ways of kind of getting us--
--
Senator Johnson. Can I----
Dr. Hughes. Yes. Go ahead.
Senator Johnson. Well, I mentioned the mismanagement of
Social Security. You realize we took all that surplus money,
and we had lots of surplus money for years, because there were
tens of workers for every retiree. Now we are down to under
three to one.
Dr. Hughes. Right.
Senator Johnson. We did not invest that money. We spent it.
It is gone, and in its place are government bonds, which really
have no value to the Federal Government.
Dr. Hughes. Right.
Senator Johnson. Now, had we invested those in something
like a Dow Jones Index Fund, which did not exist back then--
this is a couple of years ago--we would have $8 trillion in
hard assets, but we did not do that. We spent it.
Dr. Hughes. Right.
Senator Johnson. It is gone. It was mismanaged. Again, that
was the Federal Government did that, and the other unintended
consequence of that, we led seniors to believe, boy, just get
to the age of 65 and we are going to pay for your retirement.
We are going to pay for your health care. I do not know any
senior that can really get by on just Social Security benefits.
That is a poverty-stricken life, but we kind of lead people to
believe that, because we really do not educate them. We do not
educate our kids and go, "Hey, save for your retirement,
because you are not going to want to live off what Social
Security provides, and oh, by the way, we have kind of
bankrupted it anyway, and it is not going to be able to provide
all those benefits in about 10 years anyway."
Professor Hughes.
Dr. Hughes. Well, I would disagree that the program is
going to be bankrupt anyway, respectfully. I think that there
are things that we can do to keep the program solvent. I am,
unfortunately, not a health economist. This is not my area of
expertise. I know there are people out there who are working
very hard on this, and have some very good ideas about how we
can increase the share from people who have more wealth, for
example, in terms of their contributions to Social Security. We
have already increased the retirement age. There are other
things that we can do along that line as people become
healthier and have a longer life expectancy.
I think it is, of course, a very, very, very important
issue, and one that everybody should be very concerned about
and working very hard on.
Senator Johnson. Well, I will just relentlessly point out
how the government has screwed up time and time and time again,
and again, the definition of insanity is doing the same thing
over and over again, expecting different results. I mean,
continuing to rely on the Federal Government to solve these
problems. I think we have to find different solutions.
Thank you, Mr. Chairman.
Chairman Scott. Thank you, Senator Johnson. Senator Kelly.
Senator Kelly. Thank you, Mr. Chairman, and congratulations
on your new role, and the same to you, Ranking Member
Gillibrand. I am glad to be returning to the Aging Committee
this Congress. Almost one-fifth of Arizona's population is 65
and older, and that number continues to grow. I think it is
pretty simple. Arizona is a great place to live, to raise a
family. It is also a great place to retire, has great weather,
especially this time of year. I am looking forward to
continuing to work with my colleagues on this Committee to make
sure that that stays the case. One of the things we could do is
adequately fund senior programs and services, making health
care more affordable and accessible, and by giving people the
ability to choose where and how they age.
I want to take this opportunity to remind any of my
constituents, who happen to be watching, that my office here
and in Arizona, we are here to help. If you need some help with
a Federal agency, and that includes a problem with your Social
Security benefits or an issue with the VA, we are here to help.
Please go to my website or give us a call if you need
assistance.
I know we have got two big years ahead of us in this
Congress, and I am looking forward to making some positive
change for Arizonans and folks across the country.
My first question here is for Dr. Carr. First I see in your
bio that you are an ASU grad. One of my kids went to ASU. The
other is at U of A.
In your testimony you mentioned meal delivery as an example
of a low-cost program that has a very valuable impact on older
adults, especially those who are socially isolated, and this is
something we heard a lot about as we worked on the
reauthorization of the Older Americans Act. Many of our Area
Agencies on Aging in rural areas of Arizona have a lot of
interest in home-delivered meals, and yet they have to put
folks on a waitlist for these services, and for some
organizations this is the first time they have ever had to use
a waitlist for meals.
That is one reason why I was glad that our bipartisan
Senate passed Older Americans Act reauthorization included more
flexibility for how local agencies can use their nutrition
funding, allowing them to move more money toward delivering, if
that is what the community, the local community, needs.
In the same spirit of meeting people where they are, last
Congress, then-Ranking Member Braun and I introduced
legislation to help food banks be able to provide delivery
services for the Senior Food Box. This got a great reception in
Arizona, and I would like to put it out there that if any of my
colleagues on this Committee would like to work with me on
this, this year, I am more than willing to do that.
Dr. Carr, could you talk about why these kinds of programs
are so valuable, and from your perspective, why are they
important for Congress to continue to support?
Dr. Carr. Thank you for that question, and yes, I am an
Arizona State grad, and my brother went to the University of
Arizona, so you can imagine what that is like sometimes.
I also want to start by just saying, one of my earliest
memories is going in the car with my grandmother door-to-door,
delivering meals with these programs, and it was a big part of
our family growing up, making sure to volunteer and to help
support other people in the community in the Tempe area. Where
we grew up.
I think of the home-delivered meals programs as kind of the
secret sauce of kind of a foundation for healthy aging, because
it does a whole bunch of things at once. It has the opportunity
to help make sure that people have food, which we know is
important. It promotes social engagement.
We know with some colleagues I know at other universities
who are really big experts in this field have shown that the
more frequently a person gets a home-delivered meal delivered
to their house, the better the outcomes, because there is more
frequent interaction, and those small bits of social engagement
are potent in terms of their benefits for feeling less isolated
and more connected and feeling more valued in the community,
and the person delivering the meal also gets benefits from the
volunteering and engagement in the community, and they feel
valued.
There is almost no program I can think of that has those
combinations of things that are so collectively relevant. I
think if there was a program that could have more impact, I
cannot think of one that is as inexpensive as this one could
be, to expand.
Senator Kelly. Yes, it is interesting you get an added
benefit from doing this. I mean, the food is the goal. I
experienced this as I delivered meals during COVID, and I saw
seniors multiple times. I could tell that they were getting
something out of this beyond just this delivery of lunch and
dinner.
Thank you. I am going to have a couple of questions for the
record, Mr. Chairman. Thank you.
Chairman Scott. Thank you, Senator Kelly. Senator Warnock.
Senator Warnock. Thank you very much, Chair Scott, and
congratulations on holding the first Aging Committee hearing of
the year. I look forward to working with you and also with
Ranking Member Gillibrand together this Congress.
Far too many seniors are struggling with high out-of-pocket
costs for medications that they need to live. That is why I
have been laser-focused on reducing prescription drug costs and
improving access to health care. I am proud that my bill,
included in the Inflation Reduction Act, lowers the cost of
insulin to no more than $35 per month of out-of-pocket costs
for seniors, and that as of January 1st of this year, seniors
will not pay more than $2,000 in out-of-pocket costs for their
prescription drug coverage each year. I can tell you, as a
pastor, that I have seen the impact that this has on the lives
of ordinary people. I have seen it up close.
I am proud that this spending cap was made possible, again,
and included in the Inflation Reduction Act.
Dr. Hughes, how does lowering out-of-pocket prescription
drug costs actually help seniors who live on a fixed income? I
think often in government we talk about these things in
theoretical terms, but give us a clear picture of the human
impact of this.
Dr. Hughes. Well, you know, we all depend right now on
prescription drugs. Prescription drugs have almost replaced
regular routine medical care in terms of their lifesaving and
health maintenance effects, so they are a lifeline, and for
people who are, because of income constraints, now able to get
a medication renewed and/or have to make a choice between rent
or food or something else and the needed medications, that
should not happen. It should not happen to older adults. It
should not happen in the United States of America. I just think
that this legislation, the Inflation Reduction Act has been
very important in terms of helping older adults to manage their
prescription cost. It is a great piece of legislation, and I
think it has enormous potential to help a lot of seniors.
Senator Warnock. I agree with you. I think it makes a huge
difference. I agree that seniors should not have to choose
between prescription drugs, which they need, and food on the
table, which they also need. I look forward to building on this
and working on it, not only as a member of this Committee but
also as a member of the Finance Committee, where a lot of these
issues related to costs and seniors comes up through the
various programs that we have.
I am grateful for Senator Casey's work last Congress to
champion the issue of Medicaid home and community-based
services. Medicaid provides coverage for home and community-
based services that allow older adults and people with
disabilities to receive the care that they need from the
comfort of their home without going broke paying for it.
However, in Georgia, over 7,000 people are on waiting lists
to access these services, so we had the Better Care, Better
Jobs Act last Congress to enhance Medicaid funding for folks
who are still on the Medicaid list.
Dr. Carr, how would cuts to Medicaid proposed by some of my
colleagues affect access to home and community-based services
for our seniors?
Dr. Carr. Yes, so Medicaid and home and community-based
services are an actually more cost-effective way to help care
for older adults with disabilities than nursing homes, and one
of the challenges is if people do not have the care they need
it can spill over onto caregivers, family members, who are
providing the best care they can, which can be problematic
because then they may also be unable to work themselves, which
I think has ripple effects that are consequential for families.
Then I think we would anticipate that in the absence of
receiving care people need at home, they are more likely to go
into a nursing home, and even if people do have money saved and
they are not yet on Medicaid, within six months they are
usually spent down to Medicaid, and that is very expensive for
our system, and it does not meet people's needs that they want,
which is to stay in the community.
I think the consequences of not allowing people to have the
services they need to stay in their home and get care for as
long as possible is the most cost-effective way for us to
protect Medicaid costs, among other things, not the least of
which is supportive of qualify of life for older people.
Senator Warnock. Thank you so much. It is fair to say that
this has an adverse impact certainly on the seniors but also on
their families, and not only on families, an impact on all of
us through the ripple effect.
Thank you so much for your testimony, and I look forward to
continuing to work on this Committee and also the Senate
Finance Committee to make sure that we protect Medicaid and
other critical programs that our seniors rely on.
Chairman Scott. Thank you, Senator. Sheriff, what role do
you see for law enforcement promoting healthy aging and
supporting older adults to remain active and engaged in their
communities? Do you think there is any role for law enforcement
to be involved?
Sheriff Prummell. Yes, I do. Like I said, we are out there
engaged with our community. My philosophy is that you deal with
quality of life issues within your community, and if you deal
with the quality of life issues they will not explode into
crime issues, and we have one of the lowest crime rates in the
State, but you have to stay engaged with your population,
whether they are kids or whether they are seniors.
We have a great volunteer program, and we encourage all of
our retirees to come join our volunteer program, and we have a
volunteer program about 70 members, so they come in and, as
stated, they have a purpose. They are out there helping the
community. They are giving back to the community. They are
staying engaged with us, and in the same sense, they have
become part of our family, and we check on them. Even when they
come to the point where they decide to retire out of our
volunteer program, they are still a part of our family. We are
still checking on them. We are still making sure that they are
okay and they are getting what they need.
Chairman Scott. That is great. Ms. Alvarez, your
organization runs the Senior Medicaid Patrol for the State of
New York. What are some of the fraud trends that you have seen?
Ms. Alvarez. There are so many frauds that we have a Fraud
of the Month. That is how much fraud there is that exists, so
recently we just had the durable medical equipment fraud, where
somebody might call you and ask you if you want a back brace.
Somebody just calls you on the phone. Well, we know that a back
brace is something very personal, that should be prescribed by
a doctor that knows you.
Then recently we had somebody who received like 50 back
braces, because somebody got a hold of their Medicare number
and charged it to their account.
There are other forms. You know, if there is anything
happening in society, there is a fraud for it. For example,
when COVID start, fraud really skyrocketed. One of the things
that they were saying was that because there is COVID you will
get a new Medicare card, and we will send you a text along with
it, and we are going to send you a laminated card. We are going
to send you all sorts of different--the reality is that there
is no new card, right. You get the card and that is what you
have.
I mean, it goes on and on. Anything that is happening,
there is a fraud for it. I always say that while we get up in
the morning to do that valuable work, a scam artist, that is
their job, and if they were doing something productive with
their time, they would be very successful.
Chairman Scott. Thank you. Dr. Carr, how does participating
in activities like paid work or volunteering impact the
psychological or physical health of older Americans?
Dr. Carr. Well, there is a lot of evidence that both are
protective of physical, psychological, and cognitive health.
With regard to volunteering, there is not a lot of specific
research that says here is the thing about volunteering that
makes you better or improves your health, and there have been a
lot of researchers that have been trying to figure out sort of
why it works, one of which, there is some initial evidence is
related to the fact that when you help other people, you
actually respond better physiologically to stress, so there is
sort of a buffering effect of being engaged in your community
to feeling better when you face everyday challenges.
That is not the only issue. Imagine just like working. You
are more physically, cognitively, and socially engaged, when
you are engaged in volunteering, and that is largely the reason
why we think that remaining engaged in those activities are so
good for your health over time.
I had mentioned earlier, 20 hours a week of work is pretty
protective, and it really depends on what kind of work that is.
If you are engaged in a really physically demanding or
dangerous work, it is not health protective. It has to be work
that allows people to be able to maintain their health and be
able to be engaged, so it is important to keep that in mind.
Chairman Scott. Ranking Member Gillibrand.
Senator Gillibrand. Thank you. I just want to congratulate
the Chairman on such a wonderful panel. Each one of you has had
such important information to contribute, and I think all of
the Senators feel that you were exactly the right people to
answer their questions, so thank you very much for your
expertise.
I just have a couple. I want to focus a bit on the
financial security issue, even though we have talked a lot
about it. Obviously, Social Security is one of the most
successful and popular programs ever enacted, and tens of
millions of older adults use their Social Security benefits to
buy groceries, to buy their medicines, to pay for housing, to
just basically live on.
For many older adults, their Social Security benefits are
insufficient, and they have a difficult time making choices,
and we have talked about some of those choices, those choices
between heat and food and medication and not taking their
medication or spreading out their medication inappropriately. I
have heard about a lot of real horror stories of people just
trying to make ends meet, and we heard some more today.
Ms. Alvarez and Dr. Carr, can you amplify a little bit some
of these tough choices they have to make? How does it affect
their well-being? And particular, I imagine it affects their
mental health. When you are struggling on the basic needs that
you need to survive, that must provoke enormous anxiety. I want
to talk a little bit about how we can amplify or expand upon
financial security to take away some of those burdens, and I
would just like your insights on that.
Ms. Alvarez. Well, first of all, seniors are constantly
juggling. If you are on a fixed income any time, they are
constantly juggling their finances. You know, they say, well,
can I get away with not paying for my prescription drugs, and
cutting them in half, things like that, for a month. Can I get
away with not paying my rent for a month. We all know that that
constant juggling, at one point, is going to come to a head,
where if you just simply do not have enough money coming in and
you have to pay bills, things are going to collapse.
The programs that the Older Americans Act actually has,
those are all programs that shore up people who do not make
ends meet. We work with this Elder and Economic Security Index,
and basically, in New York State, I mean, not New York State,
in the country, in the United States, the average Social
Security income is $29,678, so that is a little bit less than
200 percent----
Senator Gillibrand. Poverty. Mm-hmm.
Ms. Alvarez. It costs more money than that to actually
live, on an average, in any community in the United States.
When we have heating, when we have the SNAP program, when
we have the MSP program, the Medicare Savings Program, when we
have those things people are able to then benefit from programs
that will keep money in their pockets.
One concrete thing I want to say is that the Medicare
Savings Program helps with out-of-pocket costs for your health
insurance, and your prescription drugs. It pays for your
copayments, things like that, and it is calculated that if a
person is not accessing one Federal program, they are not
accessing four other Federal programs. That is an average of
$7,000 that somebody could have in their household, that they
do not have to spend money on, so because we have these
programs, that is what is going to keep people in the community
with dignity, if they do not have those programs.
Senator Gillibrand. Dr. Carr? And could you please expand
on the Older Americans Act and why that matters?
Dr. Carr. Sure. Well, I will say a couple of brief things.
One, I do not think we want to live in a society where we allow
old people to suffer in poverty, and these programs are really
critical to ensuring that that is the case, but they do not
solve the problems entirely.
Second, being poor is really bad for you, in every aspect,
and last, poverty is not the consequence of something you do
wrong in old age. It is a life-long effect, so a lot of these
things that we see with older adults is due to things that have
accumulated over the course of their lives, and in later life,
we do not have the ability to, many times, go out and recover
financially when things go wrong and we run out of money,
despite our greatest efforts.
These are really protective of the most vulnerable people
who have needs and want to stay in the community, and the Older
Americans Act is critical to ensuring that we do not have a
massive group of people living in nursing homes because they
have no other choices, and I think that in the absence of other
opportunities, we cannot place these burdens on families or
communities in other ways, so helping support people with these
relatively small interventions by allowing them to stay in
their homes is beneficial to the larger community.
Senator Gillibrand. Agreed. Dr. Hughes, you look like you
want to add something. Would you like to add something?
Dr. Hughes. I am sorry. Could you repeat that?
Senator Gillibrand. Do you want to add something to the
conversation of why fixed income is such a challenge,
especially at $30K a year, and Older Americans Act being
important?
Dr. Hughes. Thank you. I appreciate the opportunity to
speak to this. The Older Americans Act is part of the fabric of
our society in terms of the services that it provides and
funds, and there are so many communities in the United States
that really depend on these services.
I think part of the problem is that people do not
understand where the money is coming from. If they knew where
it was coming from and why, I think that there would be a much
greater groundswell----
Senator Gillibrand. Support, yes.
Dr. Hughes [continuing]. of support for these programs,
going forward.
Senator Gillibrand. Makes sense, yes.
Dr. Hughes. I think that the meals, there is no question
about the home-delivered meals being hugely valuable. They were
hugely valuable in Illinois during the pandemic. There is
research showing that they reduce emergency department use.
They improve nutrition. They do all kinds of things.
What is really amazing is how much the Older Americans Act
has achieved with so little, in terms of resources. I think
that that is an amazing success story, and my testimony was
really attempting to build on that and just provide more
documentation.
Senator Gillibrand. I agree. Thank you, Dr. Hughes. With
the Chairman's permission, may I ask Sheriff Prummell one
question about fraud? So Sheriff, I really appreciate your
testimony about the work you do in your community, and it is so
much appreciated. I have heard so many stories about seniors
who have fallen for these scams, the grandchild scam, the IRS
scam, the cryptocurrency scam. They are literally endless, and
they are heartbreaking, because our seniors are duped, and they
either take money out of their bank account, they send money
through multiple means, but it is so rare that we get this
money back.
I have also talked to law enforcement up and down my State
and across the country, and they have very few tools to go
after these transnational criminals, because they are
sophisticated criminal networks that are using the internet,
using the phone, using data information like who just got
arrested, as you testified.
What can we do to crack down on the scams more, and is
there any way, or anything we should be doing to get justice?
Let's just say we cannot defeat the Chinese network of
scammers. But shouldn't we be doing something to make sure the
victim is given some measure of relief? Should we create a fund
for that? What would you recommend, because you are dealing
with the crime and not being able to arrest or put someone in
jail most times.
Sheriff Prummell. Yes, and that is the problem, because
like I opened with is most of your criminals, they are not just
outside the State. They are outside of the country, and they
are outside the reach of local law enforcement. Your federal
agencies, they have a little bit more far reach, but they will
not touch a case unless it reaches a certain dollar amount,
which I understand because their plate is full with all the
other responsibilities.
Senator Gillibrand. Do you know what the dollar amount is?
Sheriff Prummell. I think it is close to a million dollars.
Senator Gillibrand. Oh. That is not going to help anybody.
Sheriff Prummell. No. That is not going to help anybody.
Senator Gillibrand. Every scam I have ever heard is a
$5,000 scam or a $10,000 scam. I have heard a few where bank
accounts have been completely eliminated, but it is usually
$100,000 or $200,000.
Sheriff Prummell. Yes. It usually does not reach that
dollar amount, but I understand because you cannot flood the
FBI and the Secret Service with all these fraud cases either
because they have other responsibilities, you know. The problem
is, too, is it is heartbreaking because you do see a lot of
people that are duped out of their life savings. They worked
hard for that money, for retirement, and then now all of a
sudden it is gone, and 99 percent of the time, it is not
recovered.
You will have some of the financial institutions, very
rarely, depending on the dollar amount, will reimburse the
victim, partial or all of it, but that is rare, but there is no
set fund, at least that I am aware of, that will help reimburse
or get that victim back on their feet.
Senator Gillibrand. Thank you, Mr. Chairman.
Chairman Scott. Can I just followup? So I think what
Ranking Member Gillibrand and I both care about is all these
frauds, right. I was talking to, oh, I do not know who it was,
the other day, but they said if you go to 50 years ago,
whatever timeframe, the FBI put a lot of effort into bank
robberies and things like that, because the local sheriff's
offices, like yours, would not have had the resources to do it.
Today, if there was a bank robbery, you do not really need the
Federal Government to help you guys, right.
Sheriff Prummell. Mm-hmm.
Chairman Scott. What you really need is you need help on
issues like this, so has there been any conversation by law
enforcement to say, you know, that was great that the FBI,
Department of Justice, whoever, helped us 50 years ago. We do
not really need their help anymore. Maybe Union County in
Florida does, a small county, but you do not need it, right,
and they ought to focus on these things that you do not really
have the resources to do, and you do not have the authority to
handle. Has there been any conversation with law enforcement on
that?
Sheriff Prummell. There has really been no discussion that
I am aware of. You know, we are involved with a lot of the
Federal agencies with regard to investigations that do cross
over the borders, but mostly they are focused on terrorist type
investigations and drug enforcement type investigations, but as
for the fraud investigations, we really do not have a task
force. They have some task forces with the Secret Service, but
I do not hear much coming out of it.
Chairman Scott. I think for both of us, if you, and the
organizations you are involved in, if you have--if there is a
discussion, or if you think we ought to have a hearing on that,
where we could have a real conversation about where should
people focus their time. Because there is not unlimited
dollars. I mean, nobody wants to pay more in taxes, so there is
not unlimited dollars, but you do not need all the Federal help
in your county for a lot of things that they probably want to
come and help you on.
Sheriff Prummell. No. I mean, most of the stuff within my
county we can handle, but like I said, when you are dealing
with these major fraud cases that cross not just State lines
but the country lines, we do not have an arm that reaches that
far, and we do not have really the technology to trace them.
They can spoof these numbers. They can hide IP addresses, so it
is not as easy to trace them anymore either.
Chairman Scott. Right, but they do not take their resources
and stop doing stuff that they do not need.
Senator Gillibrand. Yes.
Chairman Scott. I want to change the subject a little bit.
Dr. Carr, and I think all of you have talked a little bit about
we will get a return on investment if we spend this money,
right, on something. What about spending money on healthy
eating? How much money would we save if we got everybody to eat
healthy all their life, or start even when they are 65? Has
anybody done any studies about the problems of ultra-processed
food or excess sugar intake or things like that, that would
actually save us money on the other side?
I told Senator Gillibrand, the problem that we always have,
like in my business life, if somebody comes to me and says,
"Okay, if you spend money here I will save money over there,"
it was easy. I would just cut the money over there, okay, and
spend it over here, because I can make it happen. You know, in
my job as Governor of Florida and now my job here, nobody has
come up with a program that actually saves money. They all cost
more money. Unfortunately, how many of you guys want to vote
for tax increases? Nobody does, right. Nobody wants our taxes
to go up.
We have to figure out how to do this in a manner that--and
healthy eating seems like a logical way. I do not know if you
have done any research on that or if you have seen any
research.
Dr. Carr. I am not an expert in nutrition but nutrition is
one of the things that we know matters for lifestyle, broadly
speaking, related diseases, and almost all of the major
illnesses of aging are related to lifestyle. Nutrition is hard
to study because we cannot put people in a hospital for 30
years and watch them eat a certain diet and compare it over
time, but we have learned a lot, and I think you are right to
say that ultra-processed foods, as I noted in my testimony, is
detrimental to health, and costs us immensely.
There are certain kinds of things, you mentioned sugar.
There are lots of different studies looking at the consequences
of poor nutrition across a whole variety of different
categories, you know, inadequate protein consumption as we age,
which becomes more important, and other varieties of things.
If you are talking about a nutrition intervention as a
solution to save money, I cannot help but assume that it would,
long term, save money if we found a way to make healthy foods
accessible, easy to, I will say, encourage people to consume
instead of the things that companies have helped us, you know--
--
Chairman Scott. I am not anti-sugar.
Dr. Carr. Right.
Chairman Scott. I mean, I am like everybody else. I like a
nice chocolate dessert, but, you know, there is a way to do
this. There is a way to have healthier sugars, too, right?
Dr. Carr. Yes, but I agree with you, and I think that the
challenge that we have in terms of saving money over time,
which I agree with you, we need to be paying more attention to
these ways to save money by improving health over the long
term, this is a long game when you are talking about these
things, and if the Federal Government is positioned to start
helping us play a long game with healthy aging, I am really
excited about that, and I think nutrition is part of that
equation.
Chairman Scott. Dr. Hughes, the National Institute of Aging
funded your research, the Fit + Strong program. You have shown
that it is successful. What does NIA do with that data? You
know, what do they do with it? Did they just do the report, or
did they do something with it?
Dr. Hughes. We have been working with the Illinois
Department of Public Health. We were very, very fortunate to
get ARPA funding from them, and we have been able to basically
disseminate the program all throughout the State of Illinois,
including many rural areas. We also were able to beef up the
presence of the program in Chicago through the same source, the
Illinois Department of Public Health money from CDC, and the
city of Chicago Area Agency on Aging that had ARPA funding from
the AOA. We were able to use that money to get the program out
to a lot of people in rural areas, to African Americans, we
have a Hispanic version of the program, to people who really,
really do not customarily access health promotion programs.
In terms of national presence, we have worked really hard
on disseminating the program. We now offer the program in 32
states, nationally. Some of that is due to our partnership with
the National Recreation and Parks Association to offer the
program in collaboration with them, again, with CDC funding.
What I was trying to get at with the testimony is the fact
that everybody now who has an evidence-based program has to
reinvent the wheel. You have to do it all by yourself, and
there is no playbook. There is no cookbook. There is nothing to
help people who are developing these programs, and developing
them to help older adults improve their wellness and improve
their functioning. Investigators are spending years of their
lives developing these programs. We are in a School of Public
Health. It has always been important to us, if we find
something that works to get it out into the community where
people can benefit from it.
This has been a motivating force for what we do. This
hearing is a very important opportunity to think creatively
about what we can do to maximize health promotion
interventions. We, for example, came up with a hypothetical
case when we had to present before the Boston Consulting Group,
to get our funding from the Illinois Department of Public
Health. We basically said, okay, if we were able to demonstrate
a three percent reduction in use of total joint replacement
surgery, the program would pay for itself over and over and
over again.
We know that these programs save money, and they benefit
people, and they are very, very cheap, and people like them,
and, you know, it is just----
Chairman Scott. You are doing good for people, too.
Dr. Hughes. Pardon?
Chairman Scott. You are doing something good for people. It
is not like you are selling something that is bad for them.
Dr. Hughes. Right.
Chairman Scott. Do you have anything else you want to add?
Senator Gillibrand. No. I just want to thank the Chairman
and I want to thank each of our panelists for their excellent
testimony and for their outstanding insights on the challenges
that so many of our seniors are facing right now. You are a
real blessing. Thank you.
Chairman Scott. I would like to thank everyone for being
here today and participating. I look forward to continuing to
work with members across the aisle and down the dais.
If any Senators have additional questions for the witnesses
or statements to be added, the hearing record will be open
until next Wednesday at five p.m. Thank you, everybody, for
being here.
[Whereupon, at 5:20 p.m., the hearing was adjourned.]
CLOSING STATEMENT OF SENATOR JIM JUSTICE
Chairman Scott, Ranking Member Gillibrand, and members of
the Committee, thank you for the opportunity to participate in
this vital conversation about improving the health, safety, and
opportunities for seniors in our nation. I am honored to serve
on this Committee and contribute to such an important cause.
In West Virginia, where nearly 20% of our population is
over 65, seniors are the heart of our families, neighborhoods,
and economy. They are the grandparents who raised us and the
mentors who guide us. Yet, like many older Americans, they face
significant challenges, including high rates of heart disease
and diabetes. Additionally, our state's rural, mountainous
landscape presents unique obstacles, such as social isolation
and limited access to reliable transportation.
However, if there is one thing that defines West
Virginians, it is our undeniable commitment to taking care of
one another. Our close-knit communities and programs offering
financial support and care are what help our seniors thrive. In
my new position as a U.S. Senator, I am committed to advancing
policies that reflect these values. By prioritizing initiatives
that enhance safety, promote well-being, and foster meaningful
engagement, we can ensure seniors across the nation not only
live longer but live fuller, richer lives. Thank you.
=======================================================================
APPENDIX
=======================================================================
Prepared Witness Statements
=======================================================================
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Prepared Witness Testimony
Sherrif Bill Prummell
Chairman Scott, Ranking Member Gillibrand, and Members of
the Committee, thank you for inviting me to testify. Today, I
would like to outline ways in which the Charlotte County
Sheriff's Office is working to serve and protect our senior
population.
We implement several programs at the Charlotte County
Sheriff's Office, including phone calls on Mondays and
Thursdays, Christmas gifts and Birthday cards as well as weekly
phone calls between trained volunteers and participants over 60
years of age, disabled, or living alone with little or no
contact with the community.
Additionally, our Take Me Home Program is designed to
assist deputies in locating loved ones who have gone missing or
are lost. Information about your loved one, a recent photo, and
description is shared with all road patrol officers in an
effort to locate and reunite the family. Any office member can
register a participant for this program.
Our DNA Scent Kits is a program that enables participants
to keep a DNA scent article at their home in the event a loved
one goes missing. Charlotte County K9 deputies use that pure
scent to begin a track in order to locate the loved one and
reunite them with family. These are handed out by our Community
Affairs Team, Mental Health Unit, and patrol members.
Project Lifesaver serves as the premier search and rescue
program locally operated by the Charlotte County Sheriff's
Office and is strategically designed for "at risk" individuals
who are prone to wandering. The program uses a GPS tracking
bracelet to locate the wondering party quickly.
Operation Pill Drop allows individuals to drop off expired
or unwanted medication in drug receptacle boxes at
participating district office locations. This keeps family
members and others that might have access to a senior's
medicine cabinet from getting those old and unused medications.
Special vehicle decals provide free decals for individual's
vehicle to alert deputies of the possible presence of someone
that may require special attention within the vehicle, such as
a hearing impairment or autism.
Often seniors misplace or leave items behind such as keys.
Through our Operation Lock Out Program, key tags are provided
to help return lost car keys to the owners. The tags are
registered with a special code in our system with the owners'
information. We educate them not to put their name or address
on the key chain in order to protect themselves. If the keys
are turned in to us, we are able to then return the keys to the
owner.
We offer Citizen's Police Academy classes for mostly
seniors to learn behind the scenes and promote our volunteer
program. Classes are held for seven or nine weeks throughout
the year.
We also spend time visiting local retirement homes to
advise on local scam problems.
In additional, we rely heavily on Facebook, Instagram, Our
blog and press releases. We know that many seniors do not
monitor this, but many family members and those that work or
live around seniors do. This helps us get the word out to them
to watch out for their neighbors.
Lastly, we focus our effort on speaking to neighborhood
watches, local churches, and various organizations, such as the
Parkinson's Group, averaging 1-2 speeches per week. We work
closely with OCEAN, Our Charlotte Elder Affairs, a group of
business owners in the senior arena that want to specifically
help Seniors.
Currently, we are seeing several different methods in which
criminals are attempting to scam our senior population. This
includes scammers visiting out website looking up recent
arrests and then calling family pretending to have the ability
to bail out the arrestee. We are also seeing what is referred
to as "Romance Schemes" which can be long running and generally
include a person asking for money while pretending to love
someone. Other schemes that have become more pronounced center
around sweepstakes lotteries where individuals have to play to
win. In these cases, the scammer will ask for gift cards to pay
the taxes to get people their winnings.
The Charlotte County Sheriff's Office has partnered with
Charlotte Behavioral Health Care (CBHC) for the addition of a
case worker to be assigned to the CCSO. This case worker
receives referrals from deputies who, during the course of
business, identify a senior who might be in need of services,
as well as calls from the public. This case worker will refer
and/or provide services through CBHC and/or make additional
referrals to outside entities depending on the elders needs.
Our office provides a number of resources, including:
Area Agency on Aging - Provides a variety of assistance
for qualifying seniors (home and community-based care,
enrollment in Medicaid long-term supports, Elder help-line) CM
assist by giving brief overview of the program, provide the
contact number and in some cases provide hands on assistance.
CM follows up by phone if required and CM provides CM's contact
information for additional assistance if needed.
Home care providers (such as Highest Honor Home Care,
Home Instead Senior Care, Right at Home) - Provides in home
non-medical assistance based on individual's needs (personal
care, meal prep, light housekeeping). CM assist by giving brief
overview of the program, provide the contact number and in some
cases help call the provider. CM follows up by phone if
required and CM provides CM's contact information for
additional assistance if needed.
Transportation - (Charlotte County Transit, F.I.S.H
(Englewood only) CM assist by giving brief overview of the
program, provide the contact number. CM follows up by phone if
required and CM provides CM's contact information for
additional assistance if needed.
Family Service Center - Has programs that assist with
paying bills, Housing services, home repair. CM assist by
giving brief overview of the programs, provide the contact
number. CM follows up by phone if required and CM provides CM's
contact information for additional assistance if needed.
St Vincent De Paul - Programs that help with food,
utilities, rent payment assistance, equipment (wheelchairs,
refrigerators, stoves). CM assist by giving brief overview of
the programs, provide the contact number and in some cases
provide hands on assistance by contacting the provider on
behalf of POC. CM follows up by phone if required and CM
provides CM's contact information for additional assistance if
needed.
Active Age (Daytime Senior Care) - Daycare program for
seniors. CM assist by giving brief overview of the program,
provide the contact number. CM follows up by phone if required
and CM provides CM's contact information for additional
assistance if needed.
Senior Placement Services (housing) - Assistance with
locating and placement into assisted living, memory care
facilities. CM assist by giving brief overview of the programs,
provide the contact number and in some cases provide hands on
assistance by calling the provider on behalf of POC. CM follows
up by phone if required and CM provides CM's contact
information for additional assistance if needed.
Social Services Resource Center - Provides Guardian and
POA services. CM assist by giving brief overview of the
programs, provide the contact number. CM follows up by phone if
required and CM provides CM's contact information for
additional assistance if needed.
Florida Rural Legal services - Provides legal services.
CM assist by providing the contact number. CM follows up by
phone if required and CM provides CM's contact information for
additional assistance if needed.
Meals on Wheels - Provides meals to seniors. CM assist
by giving brief overview of the program, provide the contact
number and in some cases provide hands on assistance. CM
follows up by phone if required and CM provides CM's contact
information for additional assistance if needed.
Senior Friendship Meals (Congregate meals, and Volunteer
Services) - Provides congregate meals at a variety of sites in
Charlotte County, offer volunteers that visit with home bound
seniors. CM assist by giving brief overview of the programs,
provide the contact number and in some cases provide hands on
assistance. CM follows up by phone if required and CM provides
CM's contact information for additional assistance if needed.
CapTel - Captioned telephone for hearing impaired. CM
assist by giving brief overview of the programs, provide the
contact number and in some cases provide hands on assistance.
CM follows up by phone if required and CM provides CM's contact
information for additional assistance if needed.
Dementia/Alzheimer's Caregiver support group - Support
Group for caregivers. CM assist by providing the contact
number. CM follows up by phone if required and CM provides CM's
contact information for additional assistance if needed.
The Dubin Center - Support Group for caregivers. CM
assist by providing the contact number. CM follows up by phone
if required and CM provides CM's contact information for
additional assistance if needed.
Thank you, Chairman Scott and Ranking Member Gillibrand,
for holding this hearing and focusing on senior population. I
look forward to working with members of this Committee to
develop proactive, and effective ways to protect our
communities from crime.
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Prepared Witness Testimony
Maria Alvarez
Chairman Scott, Ranking Member Gillibrand, and members of
the Senate Special Committee on Aging, thank you for the
opportunity to testify before you today to discuss Wellness
Among Seniors. My name is Maria Alvarez. I am the Executive
Director of New York StateWide Senior Action Council, Inc., a
consumer directed and governed grassroots organization serving
the community for 52 years. It has been an honor for me to
serve as the Executive Director for the past fifteen years.
Thank you for inviting me to speak with you today.
As a participant of the White House Conference On Aging
(WHCOA) in both 1995 and 2005, I can tell you that there have
been dramatic improvements in the systems of preventive care
and health promotion, but we still have a long way to go. With
your leadership and advocacy, we can continue to make
improvements for the seniors of today and for future
generations.
I want to also note that in the three decades that have
elapsed since the 1995 WHCOA, the fabric of the older
population has changed dramatically. This means that the
systems to promote healthy aging also need to change and
modernize to better serve our current older population. There
has been a significant increase in the size of the older non-
white population which is on pace to make up half of the
elderly population by 2060. Fortunately, though, many elderly
can remain in the community despite managing multiple chronic
conditions. I suggest that one step in the right direction
would be to make sure that the 2025 WHCOA is held to help the
country chart a course for addressing the needs of the growing
older population as 20 percent of this country is now over the
age of sixty-five.
Prior to 1995, Medicare and most private insurance would
cover treatment of an illness but not cover the cost of the
diagnostic tests or prevention. Thanks to action by Congress to
improve Medicare in 1997 and 2003 and the implementation of the
Affordable Care Act in 2010, coverage of preventive services
has steadily increased. Now most preventive tests and
immunizations are available without copays and Medicare
provides an Annual Wellness exam to help beneficiaries identify
health risks, schedule preventive tests, and identify social
determinants of health.
In addition, the country has invested resources through
Part III D of the Older Americans Act to provide evidenced base
health promotion programs through the Area Agencies on Aging
and community-based agencies. Today most communities have
programs like the Chronic Disease and Diabetes Self-Management
Program and Falls Prevention. Many have been adapted to meet
the needs of older persons of different races and ethnicities.
These programs are cost-effective approaches and should be
expanded.
At one time, federal and state policy makers considered
services like congregate and home delivered meals,
transportation, case management, and housing assistance as nice
but "soft services" that were not as important as health care.
It took years of advocacy and research to get the medical
system to finally recognize the importance of social
determinants of health, which are critical to the ability of
older persons to follow needed courses of treatment and
maintain healthy lifestyles.
These are all important improvements that we can build
upon, but we cannot ignore the need to recognize that having
health care and preventive services available is not sufficient
if they are not affordable or if discrimination, actual or
perceived, persists. Many problems still exist.
Income Security continues to be a problem in a country
where there is so much abundance. The reality is that one in
three senior citizens are not making ends meet. Their incomes
are under 200% of the Federal Poverty Level (roughly $30,000),
and it is not keeping pace with the increasing cost of living,
let alone their out-of-pocket healthcare costs, food,
transportation, and housing among other expenses.
Lest you think that this is only one segment of the
population, I will tell you that we increasingly see people who
look good "on paper", who consider themselves to be middle
income, sliding into poverty at dizzying rates.
According to several reports, we are about to experience
the largest amount of homelessness in the elderly population
ever. We are already seeing it in New York City. More Section
202 Housing must be developed, with social services attached to
them. This will ensure that seniors not only have an adequate
place to live, but they have access to all of the programs and
services for which they qualify.
I cannot end my time without telling you that along with
Social Security, Medicare and Medicaid, the Older Americans Act
is a law that has had a seismic effect on the elderly
population. All of those programs form the framework that
seniors can rely on to continue to thrive and live in dignity.
Now that this generation makes up 20 percent of the country, we
need to strengthen and improve them - in their structures as
well as their funding - to reflect the fabric of our country
today.
I have many other points to make, and five minutes is not
enough. I hope that you ask me about them during the time that
we have together. I have also included a full list of programs
and recommendations with my formal testimony.
Thank you.
Recommendations:
Reauthorize the Older Americans Act in 2025
We were honored to work with Senator Gillibrands workgroup
on the Older Americans Act. Some of the recommendations were
able to help inform the update of the regulations in 2024.
However, the reauthorization of the act did not occur and that
should be a primary objective of the new Congress I 2025. It
provides the foundation for the network of evidenced based
wellness programs offered across the country.
Convene a 2025 White House Conference on Aging (WHCOA)
This summit is critical to help the nation chart a course
for addressing the health and wellness needs of the growing
older population.
Help Communities Achieve Health Aging 2030 Objectives
Improve health and well-being for older adults by helping
communities achieve the Older Adults Objective in the Office of
Disease Prevention and Health Promotion's Healthy People 2030
Plan.
[https://odphp.health.gov/healthypeople/objectives-and-
data/browse-objectives/older-adults]
Expand the Patients' Bill of Rights:
The family member can often detect negative changes in a
patient's affect long before hospital staff yet they are often
powerless to get the hospital to attend to their concerns. We
recommend that Congress expand the patients' bill of rights to
allow patients or their care givers to obtain a rapid response
second opinion if they believe the current treatment is not
effective. Massachusetts and South Carolina have already
implemented this requirement and it can be a life saver in
times or acute care crisis.
[https://casetext.com/regulation/code-of-massachusetts-
r'segulations/department-105-cmr-department-of-public-health/
title-105-cmr-130000-hospital-licensure/subpart-d-
supplementary-standards-particular-services/section-1301600-
rapid-response-method]
Identify Discrimination
Provide patients with the opportunity to report experiences
of racism or other types of discrimination when completing
standard patient satisfaction surveys.
Develop a Diverse Health Workforce
Promote cultural competency in the health care system and
address the lack of diversity in the workforce especially in
underserved communities.
Please see attached StateWide's Legislative Goals and
Priorities and Insufficiency Tables - Attached.
Extra Comment
Affordability is still a barrier
While Medicare and the Affordable Care Act have made health
care more affordable one in six older Black adults (16%) and
one in seven older Hispanic adults (14%) report problems paying
for health care.
[source: https://www.kff.org/racial-equity-and-health-
policy/issue-brief/older-adults-health-care-experiences-by-
race-ethnicity/]
Discrimination is a problem. It is disheartening to see
that amongst advanced countries:
Older adults in the United States are by far the most
likely to report that their health system treats people
differently because of their race or ethnicity.
Nearly half of older Black women say the health care
system often treats people differently because of their race or
ethnicity.
One in four Black and Latinx/Hispanic older adults report
racial or ethnic discrimination when seeking health care.
about one in seven (15%) older Black adults report
experiencing unfair or disrespectful treatment in the past
three years compared to smaller shares of older White (7%),
Hispanic (7%), and Asian (8%) adults.
[source: https://www.commonwealthfund.org/publications/
issue-briefs/2022/apr/how-discrimination-in-health-care-
affects-older-americans]
about one in seven (15%) older Black adults report
experiencing unfair or disrespectful treatment in the past
three years compared to smaller shares of older White (7%),
Hispanic (7%), and Asian (8%) adults.
[source: https://www.kff.org/racial-equity-and-health-
policy/issue-brief/older-adults-health-care-experiences-by-
race-ethnicity/]
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Prepared Witness Testimony
Dr. Dawn Carr
Thank you to the Committee and chairman Scott for providing
me with the opportunity to testify before you. My name is Dawn
Carr. I am a professor of sociology and I direct the Claude
Pepper Center, a translational policy center at Florida State
University, which was named and funded in honor of one of the
strongest advocates for aging policy in U.S. history- Senator
Claude Pepper.
Since its inception in 1961, this Committee has worked to
evaluate critical problems and potential policy solutions to
address the immediate needs of a rapidly growing population of
older adults in the United States. As we navigate our later
years, we are inevitably at higher risk of disability, loss of
independence, social isolation, and poverty. In addition,
middle-aged adults today face more significant health problems
and disabilities than previous generations, and as they move
into their later years over the next several decades, they are
likely to face more complex health issues than previous
generations of older adults.
However, in addition to ensuring that older adults and
their families today have the supports they need to manage the
challenges of daily living, we need to expand the scope of U.S.
aging policy to ensure that future generations of older adults
not only survive into old age, they thrive once they get there.
Health problems in later life are strongly influenced by
events, exposures, and behaviors that occur well before we
reach our later years. Although the consequences of regular
harmful exposures and habitual behaviors accumulate to erode
health over time, there is growing evidence that if we
intervene during critical inflection periods, we can modify
health trajectories and bolster physiological resilience as we
age.
Current clinical care is not designed with this approach,
and with Medicare and Medicaid paying over $400 billion per
year spent on long-term care alone, there are significant
consequences if we maintain current practices. For example,
genetic variations and lifestyle factors may place a thirty-
year-old at higher risk of advanced heart disease three decades
later, but if routine evaluation of blood-based markers shows
"normal range" cholesterol, early interventions that could
offer significant lifelong protection are unlikely to be
discussed. Instead, treatment typically begins when a person is
facing more advanced disease progression and irreversible
damage has already occurred. Further, what is considered
"normal function" is based on population averages, and in a
population facing earlier onset of disease and disability,
averages are unlikely to provide meaningful benchmarks for
long-term treatments that increase the likelihood of extended
years of healthy aging. If our goal is to reduce disability and
aging-related disease progression, we need to shift our focus
from identifying problems based on deviations from the mean to
leveraging a range of strategies that support maintenance of
optimal health and function outcomes at all stages of life.
Identifying problems early and addressing health risks is
not only important for the quality of life of individuals and
their families, the benefits to society are also significant.
If people reach later life with fewer years disabled, and
several disability-free decades ahead of them, our families,
communities, and businesses will benefit. We develop unique
skills and abilities as we age that are largely under-utilized.
Relative to younger people, older adults are better at
processing complex emotions and dealing with interpersonal
conflicts. Our goals shift and we prioritize relationships,
legacy, and ways that we can make a difference, supporting the
wellbeing of future generations. We are more willing to take
risks and put our values on the line for the greater good.
Multi-generational teams of workers are more effective and more
productive than those that include only younger adults. Having
a larger group of healthy older adults who have an active and
meaningful role in society could help us solve some of the most
pressing social problems of our time.
A New Framework for Aging Policy
To create a society enriched by a large group of healthy
older people requires a new framework for aging policy, guided
by several key principles:
1. An emphasis on health maintenance at every stage of life
targeting risks related to aging-associated diseases and
disabilities;
2. Acknowledgement of the developmental changes that occur
as people move into and through later life, including the way
older adults' unique strengths benefit society; and
3. An emphasis on the barriers to healthy aging that result
in significant inequalities in health outcomes as people age.
Old age is often defined as age 65 or older, an age that is
also often synonymous with retirement. Aside from 65 being the
eligibility age for Medicare, this age is arbitrary and
provides relatively little information about what people can
do. Treating the period in which we are age 65 or older as a
monolithic stage of life and age demographic does not make it
possible to consider the stark differences in the needs of a
typical 65-year-old and a typical 85-year-old, or the
systematic differences in the health and function of older
adults of the same chronological age.
Older adults who are navigating the period of old age when
health problems interfere with daily function, a period
sometimes referred to as the "Fourth Age," face significant
challenges. Although many people living with certain
disabilities lead high quality lives despite their health
limitations, the significant losses that come with accelerated
physiological aging often lead to poor quality of life, and
loss of the ability to live independently. The needs for of
this group vary starkly with older people who are healthy and
able to engage in a variety of activities and are seeking to
engage actively in meaningful and purposeful social roles. This
is the period sometimes referred to as the "Third Age."
Increasing the proportion of our lives spent as Third-agers
and reducing the number of years in which people live in the
Fourth Age could have a profound benefit for older people
individually and for society. Third-agers have the ability to
remain engaged in paid and unpaid (e.g., caregiving,
volunteering) work. They help their families by providing care
to children or adults who are sick, they have the time and
wisdom to take on important leadership roles in their
community, and they have a drive to leave a legacy, and mentor
others. Although we have social programs designed to provide
Third-agers with ways to stay busy, these opportunities often
are not designed to leverage or support development of the
unique capacities of healthy older people, and may even silo
older people from younger people who can benefit from their
abilities and wisdom. That is, Third-agers have a pool of
talent that often goes unacknowledged and untapped.
Despite the potential of an expanded population of Third-
agers, having access to a Third Age is not equally distributed.
On the one hand, people who have spent their careers working in
physically demanding jobs, have been exposed to dangerous
materials on a regular basis, or who did not have access to
high quality medical care across their adult lives, not only
may stop working well before age 65 by necessity, they may not
even survive that long. Alternatively, those who have had
access to regular medical care across their adult lives and
have had "good jobs" may be healthy enough to choose to use
their time and abilities to engage in meaningful paid or unpaid
roles even two decades beyond typical retirement ages.
Our current aging policy plays a critical role in
addressing the needs of adults in the Fourth Age and should
remain central priorities of this Committee. Issues such as the
enormous costs and challenges we face with long-term care as we
prepare for a rapidly aging population, and new cohorts of
middle-aged adults who, in the absence of major interventions,
will continue to experience accelerated physiological aging,
including early entry into the Fourth Age. Important Fourth Age
policies also include those providing safety nets for poor and
low-income older adults who rely on a fixed income because they
are no longer able to work, and face increasingly complex
health problems coupled with rising healthcare costs.
Expanding Aging Policy to Include Third Age Policy Priorities
To increase the chances that future generations of older
adults can spend the majority of their later years in the Third
Age will require an expansion of our current aging policy
efforts. Aging policies that target the complex factors that
shape our third-age life expectancy (i.e., the number of years
we are in the Third Age) will ensure that future generations
are both healthier and better positioned to utilize their
health resources in ways that benefit our families, communities
and society as a whole. These policies address issues such as
occupational pathways that facilitate financial security in
later life for all workers across the life course, access to
high quality food, engagement in healthy behaviors (e.g.,
exercise), and medical care that is informed by evidence-based
research that promotes optimal health function at each life
stage. These policies should also prioritize integration of
older adults as valued members of our communities, their
families, and as they choose, in paid and unpaid social roles.
Consequently, a healthy aging policy framework is one that
emphasizes health maintenance at every stage of life, targeting
those at highest risk for accelerated aging. I believe the
following four key areas are the most pressing: 1) employment;
2) social engagement and social integration; 3) health literacy
and lifestyle behavior supports; and 4) healthcare access and
early treatment.
Employment and Financial Security
Working in later life is protective of health as people
move into and through the Third Age. However, in many
industries, older workers are less likely to be hired, and more
likely to be excluded from opportunities for upward mobility
and offered fewer opportunities for training/re-training. In
addition, those in physically demanding or hazardous jobs are
unlikely to be able to sustain their work into their 50s and
60s without significant health consequences, leading to early
departure from work and retirement prior to full Social
Security retirement age.
Hazardous work environments may be inevitable for a certain
population of workers, but implementing occupational
interventions where possible, and mid-life re-training for
transitions to new career paths can increase the chance that
workers remain healthy and fully employed until they reach full
retirement ages. Part-time jobs are rarely institutionalized as
a standard option in U.S. firms. However, making phased
retirement or transitions to part-time work opportunities
available to all older people would allow older workers to
remain engaged in paid work longer. For example, schoolteachers
might stay in the labor force longer if they are able to
transition from running their own classrooms to splitting a
classroom with another part-time teacher.
Social Engagement and Social Integration
Social isolation and loneliness accelerate physiological
aging. Isolating older adults within communities is not only
detrimental to the health and wellbeing of older people, it
also prevents communities from benefiting from their skills and
wisdom. There are very few programs designed to reach isolated
older adults. Effective programs like meal delivery programs
are low cost and have the added potential of improving access
to high quality nutritious foods. Expanding these programs
could have a significant impact on healthy aging trajectories.
In addition, increasing engagement of adults at all ages in
their communities through activities like volunteering not only
is health protective to volunteers, it facilitates social
integration in the community and helps people of all
generations work collectively to solve social problems.
Developing a vibrant volunteer work force will require
investment in new infrastructure within our communities, an
investment that has been shown to provide exponential returns
economically and support healthy aging outcomes. For instance,
the Senior Corps volunteer programs have shown a conservatively
estimated return of between $3.50 and $5.08 for each dollar
invested, reducing burden in the healthcare industry.
Health Literacy and Lifestyle Behavior Supports
Most adults in the United States do not have access to
scientifically accurate information or resources they need to
maintain lifestyles that greatly increase their chances of
achieving a healthy old age and a long Third Age. Expanding the
number of community health workers (CHWs) is one of the most
effective tools for facilitating healthy behaviors across the
life course, helping community members of all ages build trust
with the healthcare system and navigate healthcare services to
support healthy aging. Recent research suggests that there is a
$2.47 return for every dollar invested in community health
workers for the Medicaid program alone. For instance, CHWs
increase engagement with behavioral health intervention
programs which have profound benefits for mental and physical
health and increasing health literacy and adherence to healthy
lifestyle behaviors. Lack of access to high quality, nutrient
dense foods is a persistent problem reinforced by ultra-
processed unhealthy foods being subsidized so they are low
cost. Making healthy foods financially accessible and
disincentivizing consumption of ultra-processed foods is key to
increasing healthy aging.
Healthcare Access and Early Treatment
Most adults do not see a doctor regularly to evaluate their
health unless they are facing health problems. This is heavily
influenced by clinical guidelines and insurance reimbursement.
Scientific investments designed to identify disease progression
in the earliest stages and effective interventions for halting
disease progression is critically needed and can have a
significant impact on healthcare costs even over a short period
of time. We need to recalibrate health benchmarks so they
reflect optimal health thresholds rather than population
averages and identify critical biomarkers early enough that we
can implement long-term treatment plans. For example, one in 10
adults over 65 has Alzheimer's Disease (AD), with the average
person who gets AD living with it for eight years. AD is among
the most expensive aging-associated diseases, with AD treatment
costs estimated at $321 Billion in 2022, with costs projected
to increase. In addition, about half of all family caregivers
care for an adult with dementia, collectively contributing
close to 16 billion hours a year, worth about $270 billion,
which doesn't count costs related to their foregone wages.
However, growing evidence suggests that aggressively treating
metabolic and lipoprotein health in middle aged adults will not
only significantly reduce the number of adults who go on to get
dementia, it will also reduce the number who go on to get
diabetes, heart disease, and cancer, the most costly and
consequential aging-associated health conditions.
Developing new metrics and strategies for treating early
indicators of disease progression such as metabolic and
lipoprotein health into the standards of clinical care is key
to increasing our Third Age life expectancy. Although more
frequent interactions with healthcare providers will be needed
to monitor health, MDs are not needed for all stages of
successful lifestyle interventions. Most lifestyle-related
treatments can be monitored and carried out by nurse
practitioners, physician assistants, and other healthcare
providers, and with support from lower cost telemedicine
monitoring technologies. The benefits to this approach are not
only related to long-term health outcomes, but a recent study
showed that a metabolic and lipoprotein health intervention
leveraging pharmaceutical interventions alone provided a five-
year return on investment of nearly $10 for each dollar
invested.
Next Steps
Reframing aging policy to promote healthy aging will
require an expansion of our current aging-related policy goals.
It will emphasize supporting healthy aging at every phase of
the life course with a focus on expanding the Third Age and
compressing the Fourth Age into fewer years. It means expanding
healthy aging research, improving healthcare literacy and
access, and incentivizing health behaviors and health
interventions based on optimal health function goals. Finally,
it also means thinking about viewing older people as a critical
resource that improves our society, rather than as a barrier to
societal progress. If future generations of older adults have
access to a lengthy Third Age, and older adults can remain
productively and socially engaged in meaningful ways into late
life, old age could become a period of life we all look forward
to, and our society as a whole will benefit.
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Prepared Witness Testimony
Dr. Susan Hughes
Good morning. I am Dr. Susan Hughes. I am the Founding
Director of the Center for Research on Health and Aging at the
University of Illinois Chicago. I have served as the Director
of five successfully funded iterations of our National
Institute on Aging Midwest Roybal Center for Health Promotion
and Translation.
I am also a Professor in the Division of Community Health
Sciences in the UIC School of Public Health where I taught Long
Term Care Policy for 20 years. My work involves the design and
testing of evidence-based health promotion programs that
improve the functioning of older adults and can be brought to
scale nationally.
Let me start by thanking you very much for this opportunity
to talk with you today about this vital topic of Improving
Wellness Among Seniors.
Today, I would like to address the limitations of our
current funding for health promotion programs for older adults
and recommend a transformational re-thinking of our current
focus on acute and post acute care using an example of UIC s
Fit & Strong! program for persons with arthritisWhen Medicare
was designed in 1966, it addressed a compelling need among
seniors to access acute hospital care. The designers modeled
the program after the Blue Cross and Blue Shield plans of the
60 s to help seniors pay for acute care from reduced post-
retirement incomes.
Medicare has served this purpose beautifully but has two
important missing pieces. The first is the capacity to provide
long-term care to older adults with chronic conditions and
disabilities. The second is a tragically missed opportunity to
invest in wellness programs that have the potential to pay for
themselves many times over. Medicare did not provide
reimbursement for even the most basic form of health promotion-
screenings- until 1990 when it first covered pap smears,
followed in 1991 by mammograms (Gornick et al 1996). Recently,
Medicare mandated the implementation of a single annual
wellness visit which is a necessary step in the right direction
but horribly insufficient in terms of dose needed to achieve
behavior change.
As you all know, Medicare Advantage (MA) plans are
voluntary options for Part B services for older adults who
prefer managed care to customary fee for service care.
Enrollment in these plans now encompasses 54% of beneficiaries
(Kaiser Family Foundation, 2024). MA plans must offer all of
the customary screenings provided by fee for service Medicare
but they can supplement that package any way that they choose.
Many plans offer vision services, glasses or other covered
benefits to attract enrollment.
This ability to offer supplementary services makes these
plans very logical providers or payors of health promotion
programs, assuming that they perceive advantages, either in the
form of reimbursement, savings, marketing and/or quality
rankings, that will redound to themselves by doing so. The
Administration for Community Living (ACL) and the
Administration on Aging (AoA) aging services network have
vetting procedures in place for evidence-based and best
practice health promotion programs. Although it is important to
preserve consumer choice regarding enrollment, this Committee
can work on making the offering of evidence-based programs
customary practice among MA plans. The recently mandated
inclusion of systematic screening for exposure to Social
Determinants of Health during the annual wellness visit could
be a way to assess the need for these programs and facilitate
referral to them.
Changing Medicare will take time. In the meantime, it is
critically important to reauthorize the third leg of the
programs passed in 1966 to help seniors; namely, the Older
Americans Act (OAA). OAA services are administered at the local
level and engage multiple types of community providers. The
federal funding for and impact of these programs is multiplied
by large amounts of private funding contributed by community
organizations. During the pandemic, home delivered meals were
used very creatively in Illinois and saved thousands of seniors
from hunger. Research has also shown that these meals can
significantly reduce Emergency Department visits (Berkowitz et
al., 2018).
The renewal of OAA is part of a contract with seniors in
which we, as a society, acknowledge that we are indebted to
them for their service. Included in the OAA renewal is an
important opportunity to expand the funding for Title III D and
create a new title that explicitly supports PA programs. Total
national FY24 funding for Title III D was $55.5 million
dollars. This amounts to an average of $671K per state. Divided
by the total number of persons over age 60, this amounts to 31
cents per senior in Illinois. That amount is used to fund all
programs including falls prevention and chronic disease
management programs (Colello & Napili, 2024). Physical activity
can only be funded as an adjunct to those programs despite its
demonstrated direct and independent impact on mortality, falls,
mobility, brain health, etc. This is an untenable situation
that must be fixed.
Why do we care? Despite overwhelming evidence supporting
the importance of physical activity for healthy aging,
participation in and maintenance of physical activity is still
sub-optimal. Overall, 13.9% of adults aged 65 and older met
federal physical activity guidelines for both aerobic and
muscle-strengthening activities in 2022. Only 5.0% of older
adults with disabilities met the guidelines; while 10.2% of
Black older adults and 10.5% of Hispanic older adults met the
guidelines (Elgaddal et al. 2022). Moreover, 30.9% of older
adults over 65 reported performing NO physical activity in the
past 30 days (America s Health Rankings, 2025).
We know that 84% of older adults (65+) are sedentary (Yang
et al 2019), a condition that is associated with obesity,
diabetes, heart disease, and all-cause mortality (Biswas et
al., 2015). The good news is that we also know that any, I
repeat any physical activity is associated with lower mortality
risk (Ekelund et al., 2019; US Department of Health and Human
Services, 2018). We also know that short bouts of physical
activity are as effective as hours on a treadmill (Saint-
Maurice et al., 2018). These findings matter because we can use
them to create more positive messages to persuade older adults
to engage in activity.
What else can we do? We can foster a culture that makes
engagement in and maintenance of PA as easy as possible. This
culture can start in grade school; we can have kids walk to
school whenever possible. These efforts can be maintained in
worksites over the life course. We know that older adults
prefer destination over recreational walking opportunities. We
can design senior housing that is in proximity to downtowns and
provide sidewalks in communities for seniors whenever possible.
We can also examine causes of sedentary behavior in older
adults. I began my research career working with homebound older
adults in Chicago who reported that arthritis was their most
common chronic condition AND that it interfered most frequently
with their functioning. To learn more, we conducted a
longitudinal study over four years with 600 older adults. Our
study found that persons who had osteoarthritis (OA) in their
lower extremity joints at baseline were much more likely to
become disabled four years later.
Once we understood the pivotal role of lower extremity
joints, we developed an intervention to break the disability
chain. Our program- Fit & Strong! meets three times per week
for eight weeks. It is different from other programs because it
combines flexibility with low impact aerobics and systematic
lower extremity strength training. Every session uses group
problem solving to reinforce the importance and feasibility of
using physical activity to manage OA symptoms (Hughes et al.,
2004; 2006).
Our clinical trials of F&S found gains in physical activity
engagement at eight weeks that were maintained out to 18
months. If you maintain engagement in PA over time other good
things happen. We found improved joint pain, and timed
performance measures of lower extremity strength and mobility
(risk factors for falls) as well as improved anxiety and
depression at the same time points (Hughes et al., 2010).
During this trial, we were asked by program participants on the
south side of Chicago to include more information in the health
education sessions about diet and weight management. We
responded to this request by testing a new version of the
program Fit & Strong! Plus that combined physical activity with
diet. The new program demonstrated a decrease in BMI and
improved mobility and arthritis symptoms at eight weeks that
were maintained at six and twelve months (Hughes et al., 2020;
Fitzgibbon et al., 2020).
Medicare spent $11.3 billion on lower extremity joint
replacement surgery in 2017 (Liang et al., 2017). Our program
clearly benefits people with OA and costs $300 per participant.
It has no harmful side effects and large effect sizes. However,
our program and others like it that are cost-effective and
popular have no place to go. NIA is investing millions of
dollars developing and testing high-quality, low-cost programs
that demonstrate impact. Drugs have a clear pipeline from bench
to uptake. We have no way at present to communicate the
benefits of effective health promotion programs to clinicians
who can recommend them or ways to market the programs directly
to patients themselves.
We also have no effective way to reimburse Senior Centers
and other organizations that market and offer the programs to
seniors. Finally, we have no pass through funding mechanism
that supports teams that are needed to manage the programs. The
aging network is beginning to contract with Medicare Advantage
plans to offer home and community based long term care services
but collaborations to offer health promotion programs are very
rare. Newly funded ACL Community Care Hubs are attempting to
bridge the divide between aging and health care services by
centralizing administrative functions like managing referrals,
information security, data collection and reporting. They could
be key players in this effort to disseminate and support EB
programs in the future.
Meanwhile, Title III D of OAA is the only reliable source
of funding for our program right now. At a minimum, we need to
reauthorize the Older Americans Act. We also need to increase
funding for Title III D and create a new title explicitly for
physical activity programming.
Ultimately, however, we will see much bigger returns if we
develop demonstrations and/or regulations or reimbursement
mechanisms that support the dissemination of and access to EB
health promotion programs as extensively as possible through
Medicare.
To conclude, my recommendations are, in the near term,
renew OAA, increase funding for Title III D and create a
specific funding line for PA. Longer term, use whatever means
you can find to promote wellness through MA programs that
include assessments, referrals and reimbursement with EB
programs.
Thank you, again, for this opportunity to share our work
with the Committee. I look forward to your questions.
Citations
America's Health Rankings analysis of CDC, Behavioral Risk
Factor Surveillance System, United Health Foundation,
AmericasHealthRankings.org, accessed 2025.
Berkowitz, S. A., Terranova, J., Hill, C., Ajayi, T., Linsky,
T., Tishler, L. W., & DeWalt, D. A. (2018). Meal delivery
programs reduce the use of costly health care in dually
eligible Medicare and Medicaid beneficiaries. Health Affairs,
37(4), 535-542.
Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver,
M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time
and its association with risk for disease incidence, mortality,
and hospitalization in adults: a systematic review and meta-
analysis. Annals of internal medicine, 162(2), 123-132.
Colello, K. J., & Napili, A. (2021). Older Americans act:
Overview and funding. Congressional Research Service.
Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H.,
Jefferis, B., Fagerland, M. W., ... & Larson, M. G. (2019).
Dose-response associations between accelerometry measured
physical activity and sedentary time and all cause mortality:
systematic review and harmonised meta-analysis. British Medical
Journal, 366, l4570.
Elgaddal, N., & Kramarow, E. A. (2024). Characteristics of
Older Adults Who Met Federal Physical Activity Guidelines for
Americans: United States, 2022. National health statistics
reports, (215).
Fitzgibbon, M. L., Tussing-Humphreys, L., Schiffer, L., Smith-
Ray, R., Marquez, D. X., DeMott, A. D., ... & Hughes, S. L.
(2020). Fit and Strong! Plus: Twelve and eighteen month follow-
up results for a comparative effectiveness trial among
overweight/obese older adults with osteoarthritis. Preventive
medicine, 141, 106267.
Gornick, M. E., Warren, J. L., Eggers, P. W., Lubitz, J. D., De
Lew, N., Davis, M. H., & Cooper, B. S. (1996). Thirty years of
Medicare: impact on the covered population. Health care
financing review, 18(2), 179.
Hughes, S.L., et al., Impact of the fit and strong intervention
on older adults with osteoarthritis. Gerontologist, 2004.
44(2): p. 217-28.
Hughes, S.L., et al., Long-term impact of Fit and Strong! on
older adults with osteoarthritis. Gerontologist, 2006. 46(6):
p. 801-14.
Hughes, S.L., et al., Fit and Strong!: bolstering maintenance
of physical activity among older adults with lower-extremity
osteoarthritis. Am J Health Behav, 2010. 34(6): p. 750-
63.Hughes, S. L., Tussing-Humphreys, L., Schiffer, L., Smith-
Ray, R., Marquez, D. X., DeMott, A. D., ... & Fitzgibbon, M. L.
(2020). Fit & strong! plus trial outcomes for obese older
adults with osteoarthritis. Gerontologist, 60(3), 558-570.
Kaiser Family Foundation. (2024, January 8). Medicare Advantage
in 2024: Enrollment update and key trends. https://www.kff.org/
medicare/issue-brief/medicare-advantage-in-2024-enrollment-
update-and-key-trends/
Liang L, Moore B, Soni A. National Inpatient Hospital Costs:
The Most Expensive Conditions by Payer, 2017. 2020 Jul 14. In:
Healthcare Cost and Utilization Project (HCUP) Statistical
Briefs [Internet]. Rockville (MD): Agency for Healthcare
Research and Quality (US); 2006 Feb-. Statistical Brief #261.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK561141/
Saint-Maurice, P. F., Troiano, R. P., Matthews, C. E., & Kraus,
W. E. (2018). Moderate?to?vigorous physical activity and
all?cause mortality: do bouts matter?. Journal of the American
Heart Association, 7(6), e007678.
US Department of Health and Human Services. Physical activity
guidelines for Americans, 2nd ed. Washington, DC: US Department
of Health and Human Services; 2018. https://health.gov/sites/
default/ files/2019-09/Physical--Activity--Guidelines--2nd--
edition.pdf
Yang, L., Cao, C., Kantor, E. D., Nguyen, L. H., Zheng, X.,
Park, Y., ... & Cao, Y. (2019). Trends in sedentary behavior
among the US population, 2001-2016. Jama, 321(16), 1587-1597.
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Questions for the Record
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U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Questions for the Record
Sheriff Bill Prummell
Senator Jim Justice
Question:
Elder abuse and scams are significant concerns in rural
states like West Virginia, where seniors are often isolated and
more vulnerable. What strategies has your department used to
address scams targeting older adults, and how might they be
adapted to rural, mountainous communities like those in West
Virginia?
Response:
The Charlotte County Sheriff's Office focuses strongly on
Assisted Living Communities, church groups and men's and
women's civic groups where we educate those individuals on the
latest scams and trends. As we know, the scammers are
constantly seeking new ways to operate differently once we
catch on to their latest trickery. We encourage our community
to advise us should they receive strange texts or emails that
may be scams. We then examine those closely.
Additionally, we speak with banking institutions and advise
their staff to be aware of our senior population who may be
withdrawing large sums of money. This should raise concerns
with banking officials. We ask them to question those seniors
who are making withdrawals in the event they are being
pressured to do so.
Lastly, we oftentimes post notices on or near bitcoins
machines to educate on scams. The scammers frequently ask for
payment through bitcoin or gift cards.
These presentations are conducted by our Community Policing
Officers, Crime prevention specialists, during our civilian
police academy (CPA), PSAs through social media, and our
partnerships with the local media conducting interviews about
scams and trends we are seeing.
Senator Mark Kelly
Question:
Sheriff Prummell, thank you for your testimony. My parents
were both cops. We appreciate your service.
In your testimony, you mention a variety of programs and
activities your department undertakes to engage with seniors in
your community. One of those was visiting retirement
communities to talk about scams. Throughout my time on this
Committee, we've heard from a lot of law enforcement agencies
on how they approach fraud and scams against older adults. It's
something I'm interested in engaging more on.
Could you tell us more about what your department does? How
do you collaborate with federal agencies or other law
enforcement entities to prevent or stop senior scams?
Response:
The Charlotte County Sheriff's Office has an extensive
listing of resources associated with Federal agencies who deal
directly with scams and fraud. One of those agencies is the
Federal Trade Commission. They have deep resources in dealing
with scams and fraud issues. Another agency well equipped to
handle fraud is the United States Secret Service. The Charlotte
County Sheriff's Office works closely with these federal
agencies and shares critical information on a constant basis.
The Charlotte County Sheriff's Office crime analyst group
has an extensive network with other law enforcement agencies in
which they attend intelligence meetings to discuss and share
trends other agencies experience. This is also an opportunity
to share how each agency is trying to educate and prevent their
senior population from becoming victims.
We are fortunate to have the Our Charlotte Elder Affairs
Network (O.C.E.A.N.) which was formed in 1991 and now includes
142 members with 66 companies who meet regularly to discuss
issues our elderly population might be dealing with: while
providing education on services available in our county. The
group also acts as an advocate to help provide any unmet needs
or services. (www.ocean-fl.org)
The CCSO additionally has an Economic Crimes Unit that
investigates all types of fraud and utilizes all resources
available to them to assist in bringing cases to successful
conclusions.
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Questions for the Record
Maria Alvarez
Senator Mark Kelly
Question:
Housing is the pretty much the top issue we hear about in
Arizona when it comes to older adults.
Affordable housing is scarce. Folks who are on fixed
incomes are seeing new ownership come into their buildings and
rent is going up. In Arizona, a household needs to make $68,014
annually in order to afford a two-bedroom rental at HUD's fair
market rent, and last year's median home sale price was
$422,717, but in Tucson, where I live, the median household
income for the 65 and older age group was only $59,457. Those
don't match up.
What is the most effective thing Congress can do right now
to help mitigate this senior housing crisis?
Response:
Affordable Housing is one of the biggest concerns people
living on fixed incomes experience, and recognizing that
markets vary from place to place is important. Many times, in
the spirit of progress and development seniors who have lived
in a community and raised their families and have quire frankly
contributed and advocated for a better environment in their
living conditions, get priced out of their own neighborhoods.
Where should they go?
The HUD Section 202 program which provides affordable
housing has not developed new properties for 20 years, and many
of those properties, which are 30 or 40 years old, are in
disrepair.
So, a community needs assessment should be conducted to
identify the needs in different communities where new Section
202 housing should be developed.
In addition, this would be ab opportunity to do an
assessment to upgrade, improve, and expand on existent
properties. There are many 202 buildings that in need of an
overhaul. With the increasing elderly population, these tenants
will become more physically incapacitated as they age. These
units should be retrofitted accordingly. Universal Home
features would be a good place to begin thinking of
modernization models.
Section eight is another successful program that has been
stagnant for many years with no new vouchers being issued for a
long time. This programs was started as a program where the
benefit was attached to a contracted building. The contracts
continue with existent providers, but the Housing and Urban
Development has discontinued it since 1983. Now this benefit is
disseminated through vouchers administered by the states.
Waiting lists - for all segments of the populations - can last
between 10 to 20 years, so this program could also be expanded
so that more low income seniors and families could access
affordable housing units in their communities.
However, one glaring problem exists: Statistics show that
in the United States, a total of 55.1 % of seniors 65 years of
age and over are rent burdened and 25.5 per cent of the seniors
are owner burdened. This means that they pay more than one-
third of their incomes in housing expenses.
Many senior citizens, who largely live on fixed incomes,
cannot afford to age in their communities because their
retirement incomes, including their Social Security benefits
and pensions, are not keeping pace with the cost of living
today.
From a pragmatic perspective, the older adult population
makes up fully 20% of the country. Providing affordable and
supportive housing that enables them to age in place will be
less expensive, far better for their families and their quality
of life than if they were prematurely institutionalized in
expensive nursing homes that will end up costing the government
millions of dollars more.
Recommendations:
HUD Section 202 Program
1. Developing New Properties:
Conduct community needs assessments to identify specific
areas where new developments are most needed.
Increase federal funding to support the construction of
new Section 202 housing developments.
Explore development of a public-private partnership
model to encourage private developers to invest in affordable
senior housing.
2. Renovating Existing Properties:
Designate funding for the renovation and modernization
of aging Section 202 properties.
Implement Universal Home features to ensure buildings
are accessible and safe for elderly residents.
Establish a maintenance fund to support ongoing upkeep
and prevent future disrepair.
Section 8 Program:
1. Expanding Voucher Distribution:
Increase the number of Section 8 vouchers issued
annually to meet growing demand.
Streamline the application and distribution process to
reduce waiting times for applicants.
2. Addressing Long Waiting Lists:
Propose a pilot program to test innovative solutions for
reducing waiting lists, such as prioritizing applicants based
on need or creating a fast-track process for vulnerable
populations.
Collaborate with local housing authorities to develop
strategies for efficient voucher management and allocation.
Addressing Rent Burden:
1. Ensuring Adequate Retirement Incomes:
Advocate for adjustments to Social Security benefits and
pensions to reflect the rising cost of living.
Propose tax incentives or subsidies for seniors to help
offset housing costs.
2. Implementing Rent Control Measures:
Support the adoption of rent control policies to limit
annual rent increases for seniors and low-income families.
Encourage local governments to offer property tax relief
to landlords who provide affordable housing.
Aging in Place:
1. Developing Supportive Housing:
Promote the construction of supportive housing units
that provide on-site services, such as healthcare and social
support, for elderly residents.
Advocate for policies that incentivize developers to
include supportive housing features in new developments.
2. Enhancing Community-Based Services:
Expand access to community-based services, such as home
healthcare and transportation, to help seniors age in place.
Partner with local organizations to provide resources
and support for seniors living independently.
Next Steps:
1. Research: Gather detailed information and statistics on
the current state of HUD Section 202 and Section 8 programs, as
well as rent burden among seniors.
2. Draft Policy Proposals: Use the information collected to
create comprehensive policy proposals that address the issues
identified.
3. Engage Stakeholders: Present the proposals to community
organizations, policymakers, and other stakeholders to gain
support and drive action.
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Questions for the Record
Dr. Dawn Carr
Senator Jim Justice
Question:
West Virginia's strong sense of family offers opportunities
for intergenerational programs. How can such initiatives
promote wellness for seniors while also engaging younger
generations?
Response:
Thank you for this very important question. West Virginia's
focus on family connections is an important component of health
over the life course. Meaningful relationships with family
members play an important role in helping people feel connected
to something larger than themselves and provide an important
function by providing social support systems when people need
help. Intergenerational programs can either be designed to
bring multi-generational family members together around
specific activities, such as volunteering to support the
community, or they can be designed so that older people in the
community work together with younger people, regardless of
their family relationships. Both models have been shown to be
beneficial in a variety of ways.
I will focus on the model that involves unrelated older
people and younger people, for which there is particularly
robust evidence of beneficial effects. Intergenerational
volunteer activities in which older people support young
people, specifically young people who are struggling in school,
have been shown to not only benefit younger adults in their
academic outcomes, it has been shown to be associated with a
wide range of health benefits for older volunteers. This
program, called the Experience Corps program, is now managed by
AARP, and involves significant investment of older people in
volunteering to work with a young person at the local schools,
and they maintain a consistent relationship over long period
(typically a school semester or school year). When young people
have adults in their lives who can see their potential and are
rooting for their success, they are likely to see increases in
self-esteem and development of a sense of meaningful and
purpose that helps guide them towards working towards future
goals. The Experience Corps trial, a large-scale randomized
control trial that was conducted by Johns Hopkins University,
showed long-term robust benefits to cognitive function,
physical health and mental health of older adult volunteers.
Although the Experience Corps trial is the only large scale and
long-term randomized control study on intergenerational
volunteering, other intergenerational volunteer programs have
shown similar health benefits for older volunteers.
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Questions for the Record
Dr. Susan Hughes
Senator Jim Justice
Question:
West Virginia has some of the highest rates of chronic
diseases, such as diabetes and heart disease, among seniors.
What strategies have you found most effective in helping older
adults manage these conditions, and how can these be tailored
to West Virginia's unique healthcare landscape?
Response:
Thank you for the opportunity to reply to these questions,
Senator Justice.
West Virginia is one of the most challenging states to
provide health promotion programs for older adults due to the
mountainous conditions, the number of older adults in rural
areas, and the lack of transportation and internet access.
Despite these challenges, several programs currently exist that
can help.
You asked about programs that could help older adults with
diabetes and heart disease. There are two evidence-based
programs that might help. The first is the Chronic Disease
Self-Management Program (CDSMP) developed at Stanford
University. It is a 6-week program that meets once per week and
helps people with chronic conditions manage them. CDSMP is
broadly available in most states. It is offered at group sites
like senior centers with funding from the Older Americans Act
Title-III D and also is available online and by telephone. The
program is managed by the Self-Management Resource Center. Your
staff should be able to reach a resource person there very
easily to learn more about the availability of the program in
West Virginia.
CDSMP: https://selfmanagementresource.com/programs/small-
group/chronic-disease-self-management-small-group/
The same group at Stanford has developed a diabetes
management program (DSMP) that is currently reimbursed by
Medicare. Information about the diabetes program is available
at the link below.DSMP: https://selfmanagementresource.com/
programs/small-group/diabetes-self-management-small-group/
Arthritis is also common among older adults. Unfortunately,
West Virginia has the highest prevalence of arthritis of any
state (Barbour, 2018). CDC works with the West Virgina
University Research Corporation to raise awareness and promote
physical activity and other lifestyle management programs for
people with arthritis. We know that physical activity can help.
CDC has a roster of recommended physical activity programs for
people with arthritis. Fit & Strong! is on that list located at
the link below.CDC Arthritis Programs: https://www.cdc.gov/
arthritis/programs/index.html
We have worked with the WISH Center in White Sulphur
Springs West Virigina previously to offer Fit & Strong. We
would love to expand the program to other locations in West
Virigina and can be reached at [email protected].
Senator Raphael Warnock
Question:
The Older Americans Act (OAA) was signed into law in 1965
and authorizes critical funding for various programs to support
older adults.\1\ Specifically, Title III-D of the OAA provides
grant funding for evidence-based health promotion programs that
improve seniors' health and well-being.\2\
---------------------------------------------------------------------------
\1\ Kirsten J. Colello and Angela Napili, Older Americans Act:
Overview and Funding, Congressional Research Service (May 6, 2024),
https://crsreports.congress.gov/product/pdf/R/R43414.
\2\ Health Promotion, Administration for Community Living (Nov. 21,
2024), https://acl.gov/programs/health-wellness/disease-prevention.
---------------------------------------------------------------------------
How do services authorized by the OAA enhance the health
and wellness of seniors and older adults?
Response:
Thank you for the opportunity to reply to these questions,
Senator Warnock.
Currently, Title III-D of the OAA is the only reliable
national source of funding for evidence-based health promotion
programs for older adults. Evidence-based health promotion
programs for older adults have improved disease management
(Ory, et al., 2013; Hughes, et al., 2010), improved lower
extremity strength and mobility (Duarte, et al., 2019; Duarte,
et al., 2020; Der Ananian, et al., 2017; Hughes et al., 2010),
and reduced anxiety and depression among older adults (Hughes,
et al., 2010).
Several programs have also impacted healthcare costs.
EnhanceFitness reduced total healthcare costs by 20%
(Ackermann, et al., 2003) with a 41% decrease among
participants with good attendance (Nguyen, et al., 2007). CDSMP
also found potential net savings of $364 per participant which
would yield a national savings of $3.3 billion if 5% of adults
with one or more chronic conditions were reached (Ahn, et al.,
2013)
Support from Title III-D is vital but this Title is
substantially underfunded at present. Fiscal year 2024 funding
for Title III-D was $33.6 million nationally. That amounts to
$671,000 per state, or $0.40 per senior in the state of Georgia
(Consumer Affairs, 2024). Despite their low cost, very few
evidence-based programs have been approved for funding by
Medicare.
Furthermore, Title III-D funding is restricted to the
support of disease management and falls prevention programs.
Despite the huge amount of literature demonstrating the
benefits of physical activity, and the high levels of sedentary
behavior among older adults, Title III-D does not have an
explicit funding line to support physical activity programs.
This is a serious drawback.
I strongly recommend that Congress re-authorize the OAA,
increase funding for Title III-D, and add an explicit line of
funding for the promotion of physical activity.
Question:
Why is OAA reauthorization important to ensure that Area
Agencies on Aging can continue to provide supportive services?
Response:
The supportive services authorized by the OAA enhance the
health and wellness of older adults in multiple ways. The home
delivered meals funded by the OAA are a lifeline to many
disabled older adults, especially during the recent pandemic.
The meals have demonstrated impacts on improved nutrition,
reduced ED visits (Zhu & An, 2013), and increased likelihood of
continued community residence among recipients who were Black,
enrolled in Medicaid, or frail (Berkowitz, et al., 2017; Walsh,
Weaver, & Chubinski, 2023).
The congregate meals funded by the OAA are major reasons
why older adults in local communities use senior centers and
other community organizations that provide multiple
opportunities for older adults to socialize and connect with
important services ranging from health promotion programs and
screenings to foreign language groups, book clubs, and help
with Medicare and other health insurance issues as well as
preparation of income taxes. We all know that social isolation
and loneliness kill older adults (Schutter, et al., 2022; Yu,
et al., 2023). The opportunities to socialize provided by
programs at senior centers, libraries, park departments and
other organizations funded by the OAA are major weapons in
efforts to defeat social isolation and depression.
Reauthorization of the OAA is absolutely necessary to
continue the availability of these services that have become
embedded in the fabric of communities all over the United
States. Older adults and their families have hugely benefited
from OAA funded programs.
Importantly, the core funding for these services that is
provided by OAA is multiplied many times over by philanthropic
contributions from the community. The multiplier effect of the
OAA funding is huge and a very important byproduct of the
program.
I strongly recommend that Congress reauthorize the Older
Americans Act as soon as possible, expand the funding for Title
III-D of the Act, and add a separate Title III-D funding line
for physical activity programs.
I also strongly recommend the initiation of a clearing
house that would include representatives from NIA, ACL, CDC,
and CMS that would have a clear and transparent process to
expedite the scaling up and reimbursement of programs
demonstrated to benefit older adults.
References
Ackermann, R. T., Cheadle, A., Sandhu, N., Madsen, L., Wagner,
E. H., & LoGerfo, J. P. (2003). Community exercise program use
and changes in healthcare costs for older adults. American
journal of preventive medicine, 25(3), 232-237.
Ahn, S., Basu, R., Smith, M. L., Jiang, L., Lorig, K.,
Whitelaw, N., & Ory, M. G. (2013). The impact of chronic
disease self-management programs: healthcare savings through a
community-based intervention. BMC public health, 13, 1-6.
Barbour, K. E. (2018). Geographic variations in arthritis
prevalence, health-related characteristics, and management-
United States, 2015. MMWR. Surveillance Summaries, 67.
Basu, R., Ory, M. G., Towne Jr, S. D., Smith, M. L.,
Hochhalter, A. K., & Ahn, S. (2015). Cost-effectiveness of the
chronic disease self-management program: implications for
community-based organizations. Frontiers in public health, 3,
27.
Berkowitz, S. A., Terranova, J., Hill, C., Ajayi, T., Linsky,
T., Tishler, L. W., & DeWalt, D. A. (2018). Meal delivery
programs reduce the use of costly health care in dually
eligible Medicare and Medicaid beneficiaries. Health Affairs,
37(4), 535-542.
Consumer Affairs. Population over 65 by state. (2024).
ConsumerAffairs.com. Feb. 06, 2024, https://
www.consumeraffairs.com/homeowners/elderly-population-by-
state.html
Der Ananian, C., Smith-Ray, R., Meacham, B., Shah, A., &
Hughes, S. (2017). Translation of fit & strong! for use by
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fuerte!. Journal of aging and physical activity, 25(4), 628-
638.
Duarte, N., Santos, C., Hughes, S. L., & Pa#l, C. (2020).
Feasibility and impact of Fit & Strong! Program in Portuguese
older adults with osteoarthritis: A pilot randomized controlled
trial. Geriatric Nursing, 41(6), 804-811.
Duarte, N., Hughes, S. L., & Pa#l, C. (2019). Cultural
adaptation and specifics of the Fit & Strong! program in
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Hughes, S. L., Seymour, R. B., Campbell, R. T., Desai, P.,
Huber, G., & Chang, H. J. (2010). Fit and strong: bolstering
maintenance of physical activity among older adults with lower-
extremity osteoarthritis. American journal of health behavior,
34(6), 750-763.
Illinois Department on Aging. (2024). Aging Network Reports:
Annual Report. Retrieved on January 31, 2024 from https://
ilaging.illinois.gov/resources/newspublicationsandreports/
agingnetworkreports.html
Nguyen, H. Q., Ackermann, R. T., Berke, E. M., Cheadle, A.,
Williams, B., Lin, E., ... & LoGerfo, J. P. (2007). Impact of a
managed-Medicare physical activity benefit on health care
utilization and costs in older adults with diabetes. Diabetes
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Ory, M. G., Ahn, S., Jiang, L., Smith, M. L., Ritter, P. L.,
Whitelaw, N., & Lorig, K. (2013). Successes of a national study
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998.
Schutter, N., Holwerda, T. J., Comijs, H. C., Stek, M. L.,
Peen, J., & Dekker, J. J. (2022). Loneliness, social network
size and mortality in older adults: a meta-analysis. European
journal of ageing, 19(4), 1057-1076.
Walsh, S. E., Weaver, F. M., & Chubinski, J. (2024). Meals On
Wheels Clients: Measurable Differences In The Likelihood Of
Aging In Place Or Being Hospitalized: Study examines Meals On
Wheels clients aging in place and hospitalization. Health
Affairs, 43(3), 408-415.
Yu, X., Cho, T. C., Westrick, A. C., Chen, C., Langa, K. M., &
Kobayashi, L. C. (2023). Association of cumulative loneliness
with all-cause mortality among middle-aged and older adults in
the United States, 1996 to 2019. Proceedings of the National
Academy of Sciences, 120(51), e2306819120.
Zhu, H., & An, R. (2013). Impact of home-delivered meal
programs on diet and nutrition among older adults: a review.
Nutrition and health, 22(2), 89-103.
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Statements for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Improving Wellness Among Seniors:
Setting a Standard for the American Dream"
January 15, 2025
Statements for the Record
The John A. Hartfod Foundation Testimony
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