[Senate Hearing 119-261]
[From the U.S. Government Publishing Office]
S. Hrg. 119-261
RENEWING OUR COMMITMENT: HOW THE
OLDER AMERICANS ACT UPLIFTS FAMILIES
LIVING WITH AGING-RELATED DISEASES
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
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NOVEMBER 5, 2025
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Serial No. 119-17
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
62-490 PDF WASHINGTON : 2026
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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
ASHLEY MOODY, Florida ANDY KIM, New Jersey
JON HUSTED, Ohio 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
Erick Montealegre, Family Caregiver, Broward County, Florida..... 4
Stephen Sappington, Patient Advocate, Harford County, Maryland... 6
Duana Patton, USAging President, CEO, Ohio District 5 AAA,
Ontario, Ohio.................................................. 8
APPENDIX
Prepared Witness Statements
Erick Montealegre, Family Caregiver, Broward County, Florida..... 26
Stephen Sappington, Patient Advocate, Harford County, Maryland... 28
Duana Patton, USAging President, CEO, Ohio District 5 AAA,
Ontario, Ohio.................................................. 30
Questions for the Record
Erick Montealegre, Family Caregiver, Broward County, Florida..... 35
Duana Patton, USAging President, CEO, Ohio District 5 AAA,
Ontario, Ohio.................................................. 36
Statements for the Record
AARP Statement................................................... 39
American Foundation for the Blind (AFB) Statement................ 42
Alzheimer's Association and Alzheimer's Impact Movement Statement 44
Defeat Malnutrition Today Statement.............................. 47
National Academy of Elder Law Attorneys Statement................ 50
National Association of Nutrition and Aging Services Programs
Statement...................................................... 52
National Rural Health Association Statement...................... 54
VISIONS/Services for the Blind and Visually Impaired Statement... 58
RENEWING OUR COMMITMENT: HOW THE
OLDER AMERICANS ACT UPLIFTS FAMILIES
LIVING WITH AGING-RELATED DISEASES
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Wednesday, November 5, 2025
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:30 p.m., Room
216, Hart Senate Office Building, Hon. Rick Scott, Chairman of
the Committee, presiding.
Present: Senator Scott, McCormick, Moody, Husted,
Gillibrand, Warnock, Kim, and Alsobrooks.
OPENING STATEMENT OF SENATOR
RICK SCOTT, CHAIRMAN
The Chairman. The U.S. Senate Special Committee on Aging
will now come to order. Today, we are once again talking about
an incredibly important issue that affects millions of American
seniors and their families, the reauthorization of the Older
Americans Act, OAA, and its impact on seniors with age related
conditions like Alzheimer's and Parkinson's.
The OAA is one of the most quietly impactful laws this
country has ever passed. It is the reason a senior in Naples
gets a warm home-delivered meal through Meals on Wheels. It is
the reason a daughter in Pennsylvania can take a few hours of
respite after spending the night caring for her father with
Alzheimer's.
It is the reason a man in West Virginia with Parkinson can
still get to a physical therapy appointment using
transportation services. It is the reason senior centers across
the country, including New York, can help coordinate with all
of these things to support older Americans and their families.
These are just a few examples of the faces of this law.
When we talk about reauthorization, we are talking about
protecting the people who raised us, served our country, built
our communities, and now simply need a bit of our support.
Across the United States, more than seven million older
Americans are living with Alzheimer's, including more than
580,000 in my home State of Florida.
Alzheimer's steals memories and independence, often turning
spouses and children into full-time caregivers overnight.
Nearly one million Americans live with Parkinson's disease,
which slowly robs people of movement, balance, and speech, but
not of their determination or dignity. Each year about 90,000
new cases are diagnosed, and behind each one is a family
learning to adjust, adapt, and to persevere.
Behind each of these numbers is a caregiver, a husband, a
wife, a son, or a daughter providing care around the clock.
More than 11 million Americans provide unpaid care for people
living with Alzheimer's or another Dementia. Together, they
give 19.2 billion hours of informal assistance valued at $413
billion, and that doesn't even include caregivers for
Parkinson's, ALS, or other chronic diseases of aging.
These are people holding down jobs, raising children, and
still finding time to feed, bathe, and comfort a loved one who
depends on them. They do it out of love, and they deserve our
support. That is why the Older Americans Act is so vital. It
works because it is not a big Government approach. It is
directing resources to local communities. It is neighbors
helping neighbors.
In Florida, I have seen the impact firsthand through our
Area Agencies on Aging, our senior centers, and the volunteers
who deliver meals, install ramps, and check on seniors who live
alone. For families living with Alzheimer's, Parkinson's, and
other age-related diseases, these programs are not luxuries,
they are lifelines. They meet a hot meal, a safe home, a few
hours of rest for a caregiver, or a ride that keeps someone
connected to their community.
When we talk about reauthorizing the Older Americans Act,
we are not just debating policy. We are renewing our commitment
to America's seniors. A commitment that in the United States,
we will stand by our parents and grandparents as they age, and
that when disease or disability strikes, families will not have
to face it alone.
Every service made possible by this law represents
compassion made real. That is what governments should do,
empower communities to care for one another and let them direct
resources to meet their local needs because they understand
their communities far better than anyone in Washington, D.C.
does.
I have said it before and I will say it again, our seniors
have spent their lives building and serving this country, and
this bill is one way we ensure they continue to be supported,
respected, and valued. I am proud to be leading the
reauthorization of the Older Americans Act this year with
Ranking Member Gillibrand, helping committee Chairman Cassidy
and Ranking Member Sanders.
I urge all my colleagues to support this important
legislation so we can continue to honor, protect, and care for
America's seniors and the families who stand beside them each
and every day, and now I would like to recognize Ranking Member
Gillibrand for her opening statement.
OPENING STATEMENT OF SENATOR
KIRSTEN E. GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Chairman Scott, thank you for calling
today's hearing, and thank you to our witnesses for being here.
I am greatly looking forward to our discussion on how our
Older Americans Act provides vital life sustaining supports to
older adults and people with disabilities that allow them to
live with dignity and independence in the community of their
choice.
Many Americans don't realize that the OAA even exists, even
though an estimated one in six older adults and millions
nationwide are helped by OAA funding and programs that it runs
each year. In 2024 alone, the OAA allowed older Americans to
receive over 240 million meals at home or in a community
setting, over 14 million trips to a doctor, the supermarket, or
community events, and over 10 million hours of help with
everyday tasks like dressing or bathing.
The OAA is a bipartisan workhorse program that flies below
the radar. It helps fill the gaps and serves as connective
tissue that improves the efficiency of federal programs like
Medicaid, Medicare, Social Security, SNAP, and LIHEAP. Older
adults and people with disabilities want to live and thrive in
their communities, and the essential supports administered
under the OAA allows them to do just that.
It's just a bonus that it's also cost efficient. Providing
services to the community saves taxpayers billions of dollars
every single year that would otherwise pay for extended stays
in the hospital or institutional care, like nursing homes,
which are far, far, more expensive. In 2024, OAA funding
generated 3.39 times the return on that investment. This means
that every dollar invested in OAA aging services generated
$3.39 in community value and taxpayer savings. Furthermore,
because of the efficient service delivery, older adults avoided
1.9 million days of long-term hospital stays and institutional
care but now is not the time to take our foot off the gas.
Authorization of the Older Americans Act expired last year.
Even though so far there have been limited interruptions in OAA
service delivery because of this lapse, it is vital to pass a
reauthorization this fall to modernize the statute and be
reflective of the evolving needs of older adults.
In June, I was proud to join Chairman Scott and our
colleagues in introducing a bipartisan Older Americans Act
Reauthorization of 2025. This bill reflects our bipartisan,
bicameral agreement that was included in last December's final
appropriations package, which unfortunately ultimately fell
apart.
Particularly as the aging population is growing at the
fastest rate in our Nation's history and more Americans are
being diagnosed with aging related diseases each day, it is
crucial to reauthorize this legislation that allows for greater
flexibility and increased capacity under the law to meet the
need.
In today's hearing, our witnesses will highlight how the
OAA helps families living with aging related diseases by
providing them with a variety of supportive and nutritional
services, health promotion programs, and support for family
caregivers. However, OAA services are just one essential piece
of this puzzle. It helps these families live well in their
communities now.
Other bipartisan landmark laws, like the National Plan to
End Parkinson's Disease, and the National Alzheimer's Project
Act, which are currently being implemented by HHS, help to
chart the path for the future. They represent a federal
commitment to changing the trajectory of neurodegenerative
diseases that impact millions of American lives.
As we continue this work, it is my top priority to ensure
that the voices and the needs of older adults and people with
disabilities are elevated in federal policy discussions,
particularly about the implementation of key statutes that
impact their lives today and for years to come.
I look forward to doing this in my role as ranking member
of the Aging Committee and the Senate co-chair of the
bipartisan congressional Parkinson's Caucus, and the soon to be
formed Americans with Disabilities Caucus. I will always fight
to make sure that older adults and people with disabilities can
age with health, dignity, and independence in their homes, in
their communities, and in the setting of their choice.
I look forward to hearing from our witnesses today about
how we can strengthen and administer the OAA to do exactly
that.
The Chairman. I want to thank Ranking Member Gillibrand for
all of her hard work on all these issues, and I would like to
welcome our witnesses. Our first witness is Eric Montealegre.
Mr. Montealegre is a resident of Broward County in my home
State of Florida.
Along with his sister, he is a caregiver for his father who
was diagnosed with mild cognitive impairment four years ago. He
also serves as a trained volunteer Alzheimer's Association
community educator and previously served as a long-term care
ombudsman. Thank you for being here. You may begin your
testimony.
STATEMENT OF ERICK MONTEALEGRE, FAMILY
CAREGIVER, BROWARD COUNTY, FLORIDA
Mr. Montealegre. Thank you, Chairman Scott, Ranking Member
Gillibrand, and members of the Committee. Thank you for the
opportunity to testify today. My name is Eric Montealegre, and
I live in Broward County, Florida.
I am a family caregiver, a volunteer with the Alzheimer's
Association, and a small business owner in the senior care
field. I have only been in the field for a short time, about a
year and a half, but every day reminds me of just how vital
programs supporting older adults are not just for families like
mine in Florida, but for the nearly 12 million family
caregivers nationwide who are caring for someone living with
Alzheimer's.
Today, I speak to you first and foremost as a son, one of
four adult children doing our best to care for our father,
Alberto, who is living with stage three mild cognitive
impairment. I am proud to have him here today with me. As
November is National Family Caregiver's Month, it makes today's
hearing especially meaningful.
Dad was diagnosed with mild cognitive impairment five years
ago, when we first noticed changes in 2019. Initially he lived
on his own, proud of his independence, but over time it became
clear that he needed more support, and he moved in with my
sister.
We soon found ourselves learning, often through trial and
error, how to balance his independence with his safety, and how
to find resources that would help him stay connected both to
his community and to his family.
Caregiving, as many of us here know, is emotionally taxing,
physically demanding, financially challenging, and it is a
full-time responsibility. With the help of our local Area
Agency on Aging, we accessed services under the Older Americans
Act, which have made a world of difference to his quality of
life.
At first, Dad received home delivered meals, which ensured
he had healthy food and provided the reassurance of a daily
check-in. He then began attending a local adult day center,
which has become the heart of his day-to-day life, and in many
ways the heart is my story. Dad now participates in many
activities that keep him engaged and happy. Like he is learning
to play the piano and he does lots of art.
He is able to exercise regularly and safely at the gym that
they have onsite. He gets to play chess daily, which is
something that he has enjoyed throughout his entire life and
allows him to remain socially and mentally engaged. He is 84
years old, and since attending the center, he started taking up
dancing, which has been a surprise to all of us. It is
encouraging to see him enjoying something new at this stage of
his life and it gives us hope and the ability to hold back the
progression of the disease.
The center provides much more than just recreation. It
gives him cognitive stimulation, physical activity, social
connection, and dignity, and for my siblings and me, it gives
us respite and peace of mind. Knowing that he is in a safe,
engaging environment allows us to focus on our own families,
our own careers, and without constantly having to worry.
I truly believe that the structure, consistency, and
connection that the center provides are key reasons why my
father is doing as well as he is today. It has allowed me to
step back from being his care manager and allows me to spend
time with him just being his son. Dad immigrated to the United
States from Columbia back in the 1970's.
Over the course of the disease, he has lost some of his
English and now speaks primarily Spanish. This can make it
difficult for us to communicate with him on complicated topics
such as retirement benefits and planning. The center employs
bilingual trained staff who can speak to him in his native
language, helping him and us understand the complicated issues
that we need to know to make decisions around his care.
It is hard to overstate what a relief it is to have
caregivers who truly understand him and speak his language.
They can often pick up on like nuances in his speech that even
sometimes I miss. Hispanics are one and a half times more
likely to develop Alzheimer's disease, making it all the more
important to prioritize high quality, culturally, and
linguistically appropriate programs.
Programs funded through the Older Americans Act are doing
exactly that. They are meeting people where they are and
honoring their story. In my culture, caring for our elders is
part of who we are, and I hope that my children see that
example and carry it forward. Reauthorizing and strengthening
the Old Americans Act is an investment in our families, our
dignity, and the community.
Its programs provide families like ours with structure,
valuable resources, support, and hope. I Hope that my siblings
and I can give dad the best care possible, and hope that as our
country ages, no family will have to walk this journey alone.
Thank you again for the opportunity to testify, and I look
forward to your questions.
The Chairman. I think we all hope our kids are going to
take care of us. I hope so. All right, now we are going to
recognize Senator Alsobrooks to introduce our next witness.
Senator Alsobrooks. All right. Thank you so much to
Chairman Scott and Ranking Member Gillibrand. I am really
pleased to introduce our next witness, Steve Sappington, who is
a constituent of mine from Harford County, Maryland.
Mr. Sappington is a patient advocate who was diagnosed with
Parkinson's disease in 2015. Shortly after his diagnosis, Mr.
Sappington became involved with Rock Steady Boxing, which
provides boxing classes for Parkinson's patients that are
specifically designed to help mitigate symptoms.
When funding provided through the Older Americans Act for
Rock Steady Boxing was in jeopardy, Mr. Sappington became a
driving force behind the creation of Rally Against Parkinson's,
a non-profit organization dedicated to protecting this vital
exercise, education, and wellness resources for people living
with Parkinson's.
Mr. Sappington continues to advocate for the
reauthorization of the Older Americans Act and the
implementation of the National Plan To End Parkinson's Act to
better support Marylanders living with Parkinson's disease.
Mr. Sappington, thank you so much for joining us today to
share your story. You may begin your testimony--actually we are
going to go to introduce one more witness--okay, and you can
actually begin your testimony now.
STATEMENT OF STEPHEN SAPPINGTON, PATIENT
ADVOCATE, HARFORD COUNTY, MARYLAND
Mr. Sappington. Thank you so much. Hello, Chairman Scott,
Ranking Member Gillibrand, and members of the Committee. Thank
you for the invitation to join you today. My name is Steve
Sappington, and I am 73 years old. I am married to my wife Dee
for 51 years, and I was diagnosed with Parkinson's disease in
2015.
We have five sons and nine grandchildren who keep us busy
and motivated. For over three years before my diagnosis, my
wife and I noticed a number of changes in my behavior. I was
taking tiny steps instead of long strides. My once clear
handwriting became illegible. We went to Longwood Gardens, and
I suddenly couldn't smell the thousands of blooming flowers. My
hands began to shake.
My balance was deteriorating. I had no idea what
Parkinson's disease was. Dee urged me to see her family
physician who referred me to a neurologist. That is when I was
diagnosed in 2015. I was upset and frankly in denial. No one in
my family had ever had Parkinson's disease.
At that time, Dee and a close friend who also had
Parkinson's--and she and a friend were attending a class called
Rock Steady Boxing, and these classes, they kept telling me for
weeks how great they were. I wanted nothing to do with it at
the time, why would I want to go to a boxing class? I was still
angry and ignoring the obvious, and I guess going to a class
would mean I had to recognize I did indeed have PD. Eventually,
I gave in, mostly to get them off my back.
I went to observe a class secretly determined to hate it.
Instead, I found it interesting and even fun. Everyone was
friendly and welcoming. All had Parkinson's, had different
progressions, and they were doing exercise specifically
designed to counter the symptoms of the disease.
I started going to three-hour long classes, four to six
times a week--I am sorry, three-hour long classes, four to six
time a week and noticed small but immediate results. I
faithfully went for 18 months, and then I heard that the
funding for these classes was in jeopardy. After talking with
the gym owner and certified trainers, I realized I couldn't let
the classes stop due to lack of funding.
More than over 200 older adults with Parkinson's, people
like me, were benefiting from these free classes. I decided to
start a nonprofit to raise money to keep them going. In 2018, I
launched a nonprofit called Rally Against Parkinson's, or RAP,
to make that happen. We were all volunteers, mostly seniors
living with Parkinson's and some friends, learning as we went.
With help from community grants as in the Older Americans
Act and our own fundraising, we were able to secure enough
funds to cover costs and keep every class free. That support
made it possible for hundreds of people with Parkinson's to
keep exercising, connecting and improving their health.
Today, our program offers 10 free hour long classes each
week. It has been life-changing for so many. Programs like this
need secure, long-term funding. My neurologist tells me that my
Parkinson's symptoms have remained unusually steady, saying it
has never happened before in decades of her practice and
dubbing it a miracle.
I went eight years without needing to increase my
medication, something very rare in a progressive
neurodegenerative disease like Parkinson's. I believe the
exercise and community programs like Rock Steady Boxing are a
big reason why. When I first heard my diagnosis, it rocked my
world. I didn't know what my future would hold. My balance and
energy were fading.
I was skeptical of the boxing class originally, but I went.
That single decision changed my life. That is why the Old
Americans Act matters. Programs that provide transportation,
home delivered meals, caregiver support, and community services
make it possible for people like me to get to classes that
improve mobility, reduce isolation, and help caregivers
continue their vital work.
I and many from Rock Steady Boxing class attend monthly
Parkinson's support group meetings, and caregivers attend the
caregiver support group monthly meetings, all funded by the
OAA. Thank you. These services don't cure Parkinson's. There
still is no cure, but they keep us moving, participating, and
connected while these researchers work toward better
treatments.
My ask is simple, please reauthorize and fund the Older
Americans Act this year with strong support for Title III
services, nutrition programs, transportation, and caregiver
support. These investments help people with Parkinson's and
millions of other older adults stay in their homes, and
communities keep moving and stay connected.
I also ask on behalf of the Parkinson's community that you
support robust federal funding for PD research and ensure the
implementation of the National Parkinson's Project Act and a
seated advisory council. These efforts are important pathways
to a cure. Thank you for the opportunity to share my story.
I will be submitting a full written statement and look
forward to any questions that you may have. Thank you so much.
The Chairman. Thanks for being here. I look forward to
hearing about the boxing. Okay, Senator Husted, if you will do
our next witness.
Senator Husted. Thank you, Mr. Chairman. I would like to
introduce in Ohioan, Duana Patton. Welcome to the Committee.
Ms. Patton serves as the President of USAging, a national
organization representing the Nation's 600 plus Area Agencies
on Aging.
In this role, she leads efforts to strengthen and modernize
the Older Americans Act and ensure that community-based
programs like home delivered meals, transportation, caregiver
support, and in-home assistance remain accessible to older
adults and their families.
Additionally, Ms. Patton serves as the CEO of Ohio District
5 Area Agency on Aging, where she has worked to expand access
to dementia friendly services, improving workforce training,
and promoting partnerships across health and aging sectors. Ms.
Patton, thank you for joining us today, and please begin your
testimony.
STATEMENT OF DUANA PATTON, USAGING PRESIDENT,
CEO, OHIO DISTRICT 5 AAA, ONTARIO, OHIO
Ms. Patton. [Technical problems]--sorry. Chairman Scott,
Ranking Member Gillibrand, and members of the Committee, thank
you for the opportunity to speak before you today. My name is
Duana Patton, and I am honored to serve as the CEO of Ohio
District 5 Area Agency on Aging, where I have worked for nearly
31 years.
Our agency located in Ontario, Richland County, Ohio, is
one of 613 Area Agencies on Aging, or AAAs, located across the
Nation that helps older adults remain independent and supported
in their communities. I am also the board President of USAging,
the National Association of AAAs.
On behalf of these agencies, and the millions of older
adults and family caregivers we serve, I want to express my
gratitude for your continued commitment to improving and
prioritizing the Older Americans Act. As the older adult
population in the United States continues to rise rapidly, AAAs
have seen increased demand for OAA programs and services across
the country.
Strengthening the OAA, which is administered by the
Administration for Community Living, over the next decade will
be critical as it is the cornerstone of the Nation's non-
Medicaid home and community-based services, serving nearly 11
million older Americans per year. The Aging Network carries out
these services and includes state units on aging, Title VI
Native American aging programs, and tens of thousands of local
service providers.
The OAA enables the local delivery of home and community-
based services, which are almost always less expensive than
institutional care provided in nursing homes or assisted living
facilities. The longer older adults can successfully age at
home, the better it is financially for families and the Federal
Government.
For over 50 years, AAAs have served as the local leaders on
aging. We are social care experts and often the front door to
aging services, receiving referrals from caregivers,
physicians, and community partners, usually at a time when a
person is facing a new or increasing risk related to aging.
The core services we provide include nutrition, supportive
services, caregiver support, health and wellness, and elder
rights. Our person centered approach recognizes the health of
the person and focuses on interventions that will foster better
outcomes. A good example of that is Ms. Gray.
Ms. Gray was referred to our AAA following a hospital stay
for a chronic health condition. She was not complying with her
medication regimen and had poor eating habits. By providing
personal care in her home weekly and home delivered meals, Ms.
Gray has improved health both physically and mentally and has
not been admitted to the hospital since she started receiving
these services.
This is a powerful impact of the Older Americans Act. There
are several OAA programs that provide critical support to older
adults with age-relating diseases. First is the Older Americans
Act Title III-B, Supportive Services, the bedrock of the Act,
and a lifeline for older adults needing in-home support.
Then we have OAA Title III Nutrition Services Program, the
largest program in the country that provides nutrition services
to older adults in need. Additionally, OAA Title III-D,
Evidence Based Health Promotion and Disease Prevention Programs
support falls prevention and health management for older
adults.
Title III-E, the National Family Caregiver Support Program,
supports the family caregivers of older adults. Last,
authorization of the OAA expired last year, and since the last
reauthorization in 2020, AAAs have identified new opportunities
to be even more responsive to the evolving needs of older
adults.
In closing, the lessons we learned during the pandemic
underscore the importance of allowing AAAs to continue using
innovative practices that have proven effective. The timing of
this reauthorization is ideal. It gives us the opportunity to
strengthen what works, modernize where needed, and ensure the
Act continues to meet the needs of older adults, caregivers,
and communities across the Nation.
Chairman Scott, Ranking Member Gillibrand, and members of
the Committee, thank you for the privilege to share my passion
and stories from the field. This day for me is particularly
meaningful, not only because it marks my mother's 82nd
birthday, but also because this opportunity stands as a
cornerstone moment in my career dedicated to serving older
adults like my mom.
The Chairman. I thank each of you. You have great stories
about the importance of the OAA. Now we are going to go to
questions. Senator McCormick, would you like to go first?
Senator McCormick. Thank you. Thank you all--thank you, Mr.
Chairman. Thank you, Ranking Member. Thank you all for taking
time to speak with us today. You bring such important
perspectives, and this is something that we are very focused on
in Pennsylvania with our aging population.
Mr. Sappington, you have a unique perspective as both a
patient and an advocate for Parkinson's disease patients and
caregivers. How does the support you get from your community
volunteers compliment federally supported programs like those
covered under the Older Americans Act?
Mr. Sappington. Volunteerism is the center of everything.
We wouldn't have anything if it weren't for volunteers and
people that we are working on. I hope I am answering your
question properly, but I think it works in concert with those
benefits provided by the OAA because the OAA provides many
services such as transportation, nutrition, and well, many
other services.
I think without the people, the caregivers, and the
volunteers who support them, you wouldn't be able to have all
that. In other words, it wouldn't happen without--they are
synergistic, I guess.
From my vantage point, all of these have been very
beneficial for all of us. We would not be able to sustain the
program that we have at all without that being the case,
without the OAA providing transportation, without providing
some of the programs that they have.
I know that the support group meetings that I go to were
funded by the OAA. That is something that has been vital for us
to get information and get the word out to other people that--
through our volunteers, we are able to get large people
gathered for these meetings and get the word out about our
programs that we offer, so again, they kind of go hand in hand.
I hope that helps.
Senator McCormick. Yes, it does. Thank you. You know, we
have more than 300,000 Pennsylvanians that suffer from
Alzheimer's, and nearly 50,000 Parkinson's patients live in our
Commonwealth. These numbers don't capture the hundreds of
thousands of caregivers who volunteer their time and resources
to support their loved ones.
Mr. Montealegre--I hope I got that right--you know, your
firsthand experience, you know, with your father and so many
others in your community is extremely valuable. You have
touched on several services supported by the Older Americans
Act.
What do you think is missing in the programs covered under
the OAA that would go a long way toward supporting Americans
with these neurodegenerative diseases?
Mr. Montealegre. Thank you for the question. I think one of
the most important things is time. The sooner that the family
caregivers can learn what services there are at the diagnosis
point--a lot of families get diagnosed, they get told, and then
they get appointments with social workers who can give them a
multitude of options.
The family needs to understand that the sooner they can get
their loved ones into treatment and therapy, the sooner they
can start pushing back on these diseases that do not have
cures.
I think a lot of times there is a slight delay between
diagnosis and the start of community resource interventions. If
there is anything we could do to shorten that time or limit
that time, it would make an impact in everybody's lives.
Senator McCormick. Thank you very much. Thank you, Mr.
Chairman.
The Chairman. Thank you. Senator Alsobrooks.
Senator Alsobrooks. Thank you so much to Mr. Chair and
Ranking Member Gillibrand. You know, like so many of my
colleagues, I am a part of what they call the sandwich
generation, which means that I am caring for a 20-year-old
daughter, and also I am really privileged to balance that with
the caregiving of my parents.
I also hear daily from Marylanders who are caring for their
own family members, and I know how important the responsibility
can be. I share it with each of you in having a mother who is
suffering from dementia. My father was her caregiver, and he
has most recently turned ill himself.
It is the case that so many adult children who are
balancing work, childcare, and caregiving, it can be a really
awesome responsibility. We know that a shutdown causes so much
fear and turmoil for so many people who are just wondering what
tomorrow will look like.
Now, the Older Americans Act exists to bridge the gap for
caregivers, to ensure that older adults can live independently
and with dignity, and to support the families who care for
them. Last year, Congress got to the five-yard line on a
bipartisan reauthorization of this critical law before a tweet
by Elon Musk undermined the progress.
At the very same time, the families are being requested to
do more with less, we know that this Administration has moved
to dissolve the Administration for Community Living, weakening
the agency responsible for coordinating the support nationwide.
Our responsibility is clear.
We must reauthorize and strengthen the Older Americans Act
and ensure the programs and agencies that carry it out have the
staffing and stability needed to meet rising need, especially
during a shutdown that, in my opinion, has gone on too long. I
look forward to hearing from each of you today in discussing
how we can protect and strengthen the systems that our seniors
depend on so that they and their caregivers are supported and
not left behind.
The first question for Ms. Patton or Mr. Montealegre, is
about the ACL cuts and shutdown. The Administration for
Community Living is the backbone of the Older Americans Act. It
keeps the Nation Aging Network coordinated and functioning, but
over the past year we have sweeping staffing reductions along
with a proposal to dissolve the agency altogether and fold its
functions into a larger, less specialized division at the
Department of Health and Human Services.
Now, layered on top of these cuts, we are 36 days into a
shutdown that has frozen or delayed essential work across the
agency. Ms. Patton, what does it mean for families and
caregivers when the ACL loses staff, loses structure, and is
unable to operate its Older Americans Act programs?
Ms. Patton. Thank you for the question. You know, I think
that is where the Older Americans Act, where we see its
greatest strength, is because it does start at the federal
level through state units on aging, all the way down to the
local level.
You know, during the pandemic, the AAAs, we were required
to be very nimble and to come up with ways in which, during
trying times or challenging times, whatever the reason, to make
sure that individuals and families have the services and
supports that they need.
When we think about the Older Americans Act and the way it
is designed, and the importance of the reauthorization, it is
making sure that no matter what is happening around us, that we
have the ability to serve the people in our communities, to
take care of the individuals in a timely way, and to think
about caregivers.
You know, that is the value of the Older Americans Act is
because there is this federal perspective and the authority to
administer the Old Americans Act, but then it works its way all
the way down to the local level where we can be innovative and
responsive to the needs of individuals.
Senator Alsobrooks. Thank you. Now, Mr. Sappington, first
of all, I want to thank you for being here today and for the
work that you have done in Maryland in keeping our community
exercised and moving in programs like the one that you have
been involved in.
Your testimony, I think, underscores something really
important about the Older Americans Act, and it is how it helps
people to live well today and also helps people to have hope
for tomorrow. As someone who is living with Parkinson's, you
know personally what it means to rely on the day-to-day support
for long-term search for better treatments.
I want to ask you, how do the services that the Older
Americans Act supports, like transportation, caregiver
resources, and community exercise programs, help people with
Parkinson's maintain functions, stay connected, and live well
day to day?
Mr. Sappington. Thank you for the question. I will try to
do my best to answer that. The OAA provides vital support in
terms of the transportation and the caregiver support that
people with Parkinson's desperately need.
The fact that it is a federal program and obviously needs
to be supported and reauthorized to prevent any disruptions and
access to critical support like home care, transportation, or
caregiver assistance.
I am also going to say that the National Plan To End
Parkinson's Act would be something that would go hand in hand
with the OAA, because the OAA provides what people need now,
the services they need to get from point A to point B to be
connected and to continue to stay active, and as well as the
nutrition and the caregiver supports.
The OAA is vital to people with Parkinson's and those that
have neurodegenerative diseases in the older population. They
both go hand in hand with the National Plan To End Parkinson's
Act.
One is basically providing people what they need now to
live with their--older Americans to live their
neurodegenerative diseases, and the other looks for a permanent
end to those diseases, so they kind of work hand in. One is the
now cause. One is the future cure for it. I can't say enough
about the need for both, so thank you very much for that
question.
Senator Alsobrooks. Thank you so much.
The Chairman. Ranking Member Gillibrand and I would love it
if everybody on the Committee would co-sponsor the re-
authorization of the OAA. Let me turn it over to Senator Moody.
Senator Moody. Thank you so much, Chairman Scott and
Ranking Member Gillibrand. Thank you for holding this important
hearing on a very important topic. Let me welcome my fellow
Floridian from Broward County, Eric Montealegre. I Appreciate
you being here.
Thank you so much, and to all of our witnesses today. This
is so important, and these hearings help us not only highlight
how certain policies help Americans--the challenges that we
might face in getting policies pushed through Congress. This is
all part of that process and such an important part, and we
appreciate you taking part in today's hearing.
I was raised by a mom who dedicated her entire career to
helping seniors, aging Americans, working with the groups that
are supported through the Older Americans Act. It is probably
no surprise when I became Florida's Attorney General, one of
the first things I did was set up a senior protection team,
which was an interagency team to focus on how we can better
serve aging Americans.
As you know, we are the Sunshine State in Florida, but we
are also the Silver State, I like to say. It was so important.
I want to thank the attorneys that worked with me and the
investigators that worked with me.
They did so much to protect seniors in our state, but I
think one of the things that gets lost in this piece of
legislation is that it authorizes grants for long-term care
ombudsman program, and specifically the Elder Abuse Neglect and
Exploitation Prevention Programs.
I know that we have people here, a volunteer now with
Alzheimer's Association, but previously, I believe, sir, you
served as a long-term care ombudsman. I know, Ms. Patton, you
as well.
I would just like to talk to you because so many of these
programs, and not just those that are specifically designed to
prevent or hold people accountable for abuse and exploitation,
but also the programs like Meals on Wheels and other programs
where we have interaction with our aging population so that we
can better identify those seniors that may be in need--I would
just like to hear from you how important those programs are to
our aging population based on your own personal experience.
We will start with you, Mr. Montealegre.
Mr. Montealegre. Thank you, Senator Moody. I like to think
of the ombudsman program less of a compliance program and more
of like a cooperation program. Residents oftentimes have needs
that they can have trouble expressing or maybe don't know who
to express those needs to.
The ombudsman would uncover those needs through asking,
through developing relationships, and then bring those needs to
the management of a facility to try to resolve or to maybe just
bring that to awareness.
Most of the time, when I was in the program, that was
exactly the case. It was a need that was not being addressed
because there was no awareness, and that was some of the best
work that I could do.
Senator Moody. Are there any tweaks that you think need to
be made to the legislation--probably in many instances, once
you made them aware, that was remedied, and we were providing
better care, but do you think there need to be any tweaks in
the legislation to provide better coordination with law
enforcement when these instances might be identified?
Mr. Montealegre. Well, the ombudsman are required
reporters, and there is a process in place--at least in
Florida, there is a process in place to report that to the
correct authorities when needed--immediately if needed so.
I am not sure about legislation, but I would say that I
think there's an education piece that needs to be done at the
community level so that the residents are aware of their rights
and aware of what we can do to benefit them.
Many times, I would tell somebody, hi, I am your ombudsman,
and they are like, what? Once they understand what my
responsibility was and my role was in supporting them, they
would open up. I think that is just a lack of clarity to the
population.
Senator Moody. I will ask you, Ms. Patton, the same
questions.
Ms. Patton. Thank you. Great question, and from our
perspective, in Ohio, at our AAA, we actually administer and
sponsor the Ombudsman Program, so I am very familiar with that,
and also, in parts of our region, we administer the Adult
Protective Service Program.
I think one of the amazing things is that the Older
Americans Act allows AAAs to be the front door. A lot of times,
people are coming into a AAA at the front door needing
information and assistance, or a referral somewhere, and
through the process of, you know, talking with them and
building this trust, we often learn about things that are going
on in their lives that maybe they might not open up to that are
very appropriate for a referral to an ombudsman program or to
an adult protective services program.
A lot of times people do find themselves in situations and
they don't even realize that they have rights or that they
might be exploited. The fact that the Older Americans Act
exists--and Area Agencies are across the country working with
ombudsman programs, whether they sponsor it, or it is somewhere
else in their community, or adult protective services, or law
enforcement.
The fact the AAAs are boots on the ground in their
communities, we like to think that those collaborations happen,
and, you know, I think when we think about the reauthorization
of the Older Americans Act, and the fact that we want to embark
more flexibilities, that there can be more of that, more
collaboration at the local level to protect individuals.
Senator Moody. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Moody. Senator Kim.
Senator Kim. Thank you, Chairman. Ms. Patton, I actually
just wanted to build off of what you were just talking about
there. You noted that Area Agencies on Aging are often front
doors for families navigating aging related challenges. I guess
I wanted to ask you, how can we strengthen coordination across
the local, the state, and the federal levels to make it easier
for older adults and caregivers to access the full range of
support that they need?
Ms. Patton. I think that part of that comes with, you know,
awareness of what AAAs can do and do in their communities--
talking about it. I love the stories that the gentlemen have
shared here with me today, is that when there is this awareness
and there is conversations about things that are sometimes a
little difficult to talk about, it builds that collaboration.
When the Aging Network, AAAs, other partner agencies can be
at the table and talk about policies, talk about funding, talk
about challenges that exist, then great programs and innovative
ideas come to be.
Senator Kim. Because you are saying that they are where the
rubber hits the road, and as a result, you know, the insights
so they can be able to provide--can just really encourage that
kind of creative, innovative thinking?
Ms. Patton. Absolutely. I think AAAs, you know, throughout
many, many years have been innovators. The Act has allowed us
to do that.
Senator Kim. Yes. When we kind of zoom out a little bit, I
guess I just wanted to get a sense of your kind of overarching
priorities. You know, do you have ideas of what are some of the
most critical priorities that Congress should consider as we
are working to reauthorize the OAA, you know, to be able to
ensure that the programs are meeting the needs of today?
Ms. Patton. I think it would be real easy for folks to talk
about funding. When we talk about the Older Americans Act, and
the way that it exists--and its purpose is to make sure that
there is this local perspective.
That local organizations can work together to determine
what the needs are in their local communities, and that there
is flexibility to ensure that maybe the way that somebody needs
a home delivered meal in one part of the region or country is
not necessarily the same way somebody needs it in another part
of the country.
Senator Kim. Yes. I appreciate that. Mr. Montealegre, I
guess there is something there that I felt like kind of
connected with things that you have talked about when you have
highlighted the importance of you know, culturally and
linguistically appropriate care. How can the OAA programs
better ensure that caregivers and older adults from diverse
communities have equitable access to this kind of support?
Mr. Montealegre. Well, I think it is important to
understand that as people progress through the disease, very
often they start losing languages but then revert to original
native languages.
It is important to us to understand, you know, where our
community came from so that we can train and bring in the right
people with the right skill set to support those people who
have for one reason, or another lost the ability to speak
English.
That would keep them engaged with therapies and with
community resources that will help them stave off the
progression of disease.
Senator Kim. Yes. I appreciate that. It is something that I
have been grappling with myself. My father is somebody who has
been declining quite rapidly over the last year, and actually
just a couple weeks ago we got the formal diagnosis of
Alzheimer's for him.
He is somebody that has lost the faculty to speak English,
has reverted back to Korean. He doesn't actually realize he is
not speaking English. He thinks he is, but it has been very
difficult. There are very few places where we can get care--
caregivers and get that kind of support in Korean.
It has been just very challenging to be able to do so in a
way that I feel like he is taken care of while I am here at the
Capitol, so, you know, I agree with you wholeheartedly on that
front, that we need to be pushing on that. I mean, look, just
as we are talking through this, you know, Chairman, I am
grateful that you brought this up because again, I really do
think and we have talked about this before, you know, this is a
unifying issue.
You know, this is something that all of us understand as
part of the human condition in terms of what our families are
going through, and at a time when we are certainly having
deadlocks and challenges and other types of policy debates, I
do hope that our ability to draw upon just the struggles that
so many families are facing when it comes to aging related
challenges--I know, as I said, you know, we have kind of
plunged into the deep end as a family and it has been
overwhelming for us. It has been a very difficult last year.
Things that I never realized that we would have to
confront, and to do so while I am also raising an eight year
old and a 10 year old has been a lot, and so, you know, this
isn't just academic to me or theoretical to me, and I am
grateful for you all coming on out here, talking to us about
this.
You have my word that we will do everything we can here to
try to push forward on the reauthorization and do it in a way
that can provide help to so many Americans, so with that, I
will yield back, Chairman.
The Chairman. Thank you, Senator Kim. Senator Husted.
Senator Husted. Thank you, Mr. Chairman. Thanks to the
Ranking Member and you for hosting this hearing today. In
preparation for this hearing, I was doing a little research,
and I saw that this problem of isolation and loneliness is
getting worse. It did hit a--perhaps a peak during the COVID
pandemic, but as a trend, it is getting worse.
I saw the report that said people between the ages of 15
and 80 reported feeling lonely and isolated--one in three
people found themselves in that situation, and that loneliness
and isolation is associated with an additional $6.7 billion in
Medicare spending.
If we can do better at eliminating the loneliness and the
isolation, we get better health outcomes, people's cognitive
decline is maintained for a longer period in their life, and
better--higher quality of life, which is also important.
Longevity, but also quality of life is a big deal, and I know
that in doing some of the research, you see that, look, it is--
I know my parents are 86 and 87.
They have each other and they have my brother and sister
who live very near them, so they have that family structure
that helps a lot. It helps a lot, but I know a lot of people
don't have that. Our society, for a variety of reasons, in
terms of family formation, the number of children, people
having the mobility, and people living all around the country
or all around the world--children, meaning their adult
children--makes it harder on them.
I will start with my Ohioan, Ms. Patton. What have you seen
over the years in these trends? Not just as a matter of policy,
but as a society, how can we do better?
Ms. Patton. Well, I think certainly through the pandemic,
social isolation really came, you know, to be. We started
talking about it.
A lot of those statistics, we are very aware of those. I
think that what we need to make sure that we are doing is not
just saying that someone is socially isolated but meeting them
where they are, and I think the gentleman over here talked
about the fact that he was able to go to a senior center and
didn't realize the value that that would bring. I like to tell
the story real quickly, if I could.
We had a gentleman during the pandemic that could not go to
the grocery store, was afraid to go out in public, but we had
grab and go meals, and so, he came to the agency, picked up a
grab and go meal, and you know, had nutrition--you know, better
nutrition. He was diabetic. He was living on pop tarts and hot
dogs. That is what he was eating because that is what he could
fix.
After he began getting the grab and go meals, he lost
weight, and his diabetic medication was reduced. In addition,
he made friends because we made the grab and go meal experience
something in which the individuals engaged with our staff and
engaged with each other.
Today, that very same gentleman is coming to the congregate
meal site and is healthier, happier, and certainly more engaged
with the community. I think what we have to do is we have to be
creative, and we have to think about what makes someone
socially isolated and what would help them become more engaged
in their community. It might not be going to a senior center or
a meal program.
It might be that they become one of those volunteers in an
innovative program that AAA has created where they pick up the
phone and they are calling somebody else. It can be that
simple.
Senator Husted. Yes. How is it? I mean, I know that every
Agency on Aging is different. They are run by different--you
know, this isn't administration. It is innovation. What are
some of the examples or best practices that you have seen used
to create that engagement?
Ms. Patton. One of the great examples is the phone a friend
where seniors are engaged in telephone calls back and forth
with each other. We have leveraged schools in our communities
where we invite them to participate with us to have
intergenerational programs where we can provide the
transportation for a senior to get to the school and maybe read
to a student.
In addition, you know, a lot of the Older Americans Act
programs bring people into the home because people are
remaining in the community versus in an institutional setting,
and so, by working with meal providers, personal care
providers, and people that are in the home, making sure that
they are building a relationship with the individual.
Maybe sometimes they are bringing puzzles, or books, or
things for people to do so that they can be more engaged,
whether they are at home or in the community.
Senator Husted. Great. Thank you. Thank you, Mr. Chairman.
The Chairman. Ranking Member Gillibrand.
Senator Gillibrand. Thank you, Mr. Chairman. I wanted to
ask a little bit about how the OAA connects older adults to
multiple social services. Sort of a general experience from
you, Eric, and Stephen, and maybe from you, Ms. Patton, you
could tell me how it actually fits together.
Things like Medicaid, SNAP, LIHEAP, that our older
Americans rely on, and how does this serve as an umbrella for
organizational structure for delivery of critical services? In
particular, how does it affect rural Americans, because one in
five of our older adults are in rural America? Ms. Patton?
Ms. Patton. Thank you for the question. The Older Americans
Act as the umbrella of many services allows us to connect
people to the services that you had mentioned, Medicaid and
SNAP.
A lot of times, we will work with individuals in our
agencies that come to the front door or that are participating
in a program, and we want to make sure that they are connected
to the resources that are available to them, whether it is SNAP
or Medicaid, but one of the things that we also do is we are,
in many cases, a Medicaid diversion.
Trying to use the lowest cost intervention that is
possible, the funding sources or programs that exist, and then
connecting them to these services at the right time when they
need them.
A really good example of SNAP is an individual that gets
SNAP but doesn't have transportation is not going to be able to
leverage those, so we have actually, in our network, been able
to leverage the Older Americans Act services, and help people
connect and use the services that they may be eligible for.
Senator Gillibrand. Understood. Stephen or Eric, do you
have any anecdotes about how it has worked for you?
Mr. Montealegre. I will go next, so here in Broward, the
agency serves as, like she mentioned, an umbrella organization,
but they also are an experimental organization as well, where
they are reaching out to technology companies, for example,
like robot puppies or robot cats, to help people deal with
isolation and feelings of loneliness, and as well as like radar
for alert monitoring devices, things like that.
These are things that I wasn't even aware of that existed
or were even needed, and I think the agency is constantly
looking for other things that could help, and while--and then
they vet those programs or products or resources.
Going to the agency gives us a sense of confidence that
there is all these different things, and maybe these things
work for us or not, but what we feel is they are safe to try,
and they are safe to go talk to without possibly having our
family members fall into some kind of bad situation or some
kind of trap, and that certainty makes it easy for us to reach
out to them and say, hey, you are a safe source, so the other
organizations also funnel themselves automatically to the Area
Agencies on Aging because they know that if they can get the
agencies buy in and support, that the population, the community
will reach out to them for help as well.
Senator Gillibrand. Understood. Stephen.
Mr. Sappington. Yes, I would like to say that grassroots
programs are often the closest to the need and they see
firsthand what helps older adults and people living with these
cognitive diseases stay healthy and engaged. Increasing the
funding for the Area Agencies on Aging so that they can partner
with and support innovative community-based nonprofits.
Area Agencies on Aging can also offer technical support and
guidance to older adults who want to start local programs but
may lack the experience or resources, and transportation is
also--on the OAA, transportation is often the biggest barrier
for keeping older adults and people with Parkinson's and other
neurodegenerative diseases----
Senator Gillibrand. Have you used any of those
transportation services?
Mr. Sappington. Yes, I have.
Senator Gillibrand. Give us an example of where it made a
difference for you.
Mr. Sappington. We have had--well, personally speaking, we
have--I got a call from a gentleman that had just been
diagnosed with Parkinson's.
He thought it was the end of the world. His parents had
died. His girlfriend had just broken up with him. He went to
the doctor and was diagnosed, and he came back in--ironically
enough an infomercial was on, and I had reached out to some
people in the media and was doing a thing on Parkinson's and
how to fight back against that, and he thought his world was
coming to an end and saw me giving my phone number, and I got a
call from him. I spent the next two and a half hours walking
him off the edge.
I ended up meeting with him halfway. He was 20--he was in
Baltimore City. I was up around the Pennsylvania line, and
anyway, we ended up meeting halfway and I hooked him up with a
way to get from down 20 miles away from where he was to a Rock
Steady Boxing class that he would be able to----
Senator Gillibrand. Oh, that is great.
Mr. Sappington [continuing]. be able to take advantage of
that. That worked out very well. Thank you for that.
Senator Gillibrand. Thank you--thank you.
The Chairman. Mr. Sappington, tell me about your boxing.
What do you do?
Mr. Sappington. It is fun. Well, first of all, I want to go
back and say I did tell all the gals that were trying to get me
to go that they were right.
The Chairman. It is always better.
Mr. Sappington. Yes, yes it is. You recognize that sooner
is always better later, but they play music, and everything
they do is designed to combat the symptom of Parkinson's, and
Parkinson's is one of those things where you have--you know,
your brain and interferes with your muscles' ability to respond
and your body. That is why they get the dyskinesia and the
shakes, and your body not behaving the way that it should.
First of all, they play rock music of our generation, which
gets you involved with it. You know, so you are there from a
musical standpoint. That is wonderful, and then they give you
short commands where you have to use your brain and your mind
to stay active. Like, you are going to throw x amount of
combinations of punches into heavy bags, or you are going to--
they have ladders painted on the floor, and you have to step in
and step out of them in much the way you see football players
do between tires.
Ours are not between tires because we would be falling all
over the place, so these are just painted on a floor, and you
would have to use your footwork, and you have to have strength
in your brain to tell your muscles what to do, and if you keep
doing that, the muscle memory becomes very strong, and it can
override some of the symptoms, and that is wonderful.
Parkinson's even takes away your voice, and my voice used to
not very often be this soft, but even with the commands that
they give you, you have to use your voice to holler back, so
you get you to--the more you exercise it, the more can
strengthen your voice, so it works out very well.
The Chairman. You don't have to box a person.
Mr. Sappington. No. That was one of the things that I
harbored under when I first heard it. Why would I want to go
boxing, you know, but----
The Chairman. I already have a problem. I don't need
another one.
Mr. Sappington. Right. No, but I appreciate the question.
That is exactly where I was, at least from my standpoint, so,
thank you.
The Chairman. Mr. Montealegre, how would you find these
services? How did you even find out about them?
Mr. Montealegre. Not fast enough, to be perfectly honest.
We started, you know, using internet searches to try to find
and see what options there were. I think that is where we
started getting confused. I think if you put in, you know,
dementia, any of those kind of searches, tons of things come
up.
After having gone through several rounds of talking to the
wrong people, I found the right people, and they were able to
get us in to take classes for us so that we could understand
what was going on, so we could learn about what dementia
progression looks like. What some symptoms are that might
happen.
What adaptations we can make to help our family members. It
is that kind of education that really gave us the confidence to
keep looking. At that point, we don't even know what we don't
know, so when you don't know what you don't know, you don't
know what to look for.
Being in those classes, it tells you this is what you need
to look for, this is what you need to look for, and it is
really developing like a new vocabulary for things that we had
never heard of before.
The Chairman. Ms. Patton, can you tell me--do you have any
other stories you want to tell us about how you have changed
people's lives?
Ms. Patton. Thank you for asking, so, I have been very
inspired by both of the other witnesses here today and the
questions that have come from the Committee. I think that, you
know, what I would really like to just share is the things that
we have just talked about here, this discussion has inspired me
to think about, you know, the value of the Older Americans Act,
the value of conversations like this with people that can tell
stories and that can make a difference in policy and in
practices.
It saddens me when Eric says that he didn't get the
information fast enough, and, you know, I think that, you know,
through the Older Americans Act and the innovative approaches
for AAAs, and when we think about the programs that we have--
you know, I am thinking about 3(d) and the evidence-based
programs--is where we are touching individuals and how
invaluable it is that we are meeting people before they are in
crisis. That we are leveraging the funds and the programs under
the Older Americans Act to get to families, caregivers, and
individuals before the crisis.
The Chairman. Do you think you both help people and you
save money?
Ms. Patton. Absolutely. We help people and we save money,
and the sooner that we do that, and the more innovative we can
be, yes.
The Chairman. Have you helped people either stay active in
their job or stay active in their volunteering?
Ms. Patton. Yes, through the Area Agency and through the
Older Americans Act transportation services, through the
ability to work collaboratively with other organizations. We
have many individuals that come and volunteer in our meal sites
that might not otherwise get out.
The Chairman. For any of you, is there any reason at all
you think we shouldn't reauthorize the OAA? Is there any--in
your wildest imaginations, can you imagine why we wouldn't do
that?
Ms. Patton. [No response.]
The Chairman. No, it is pretty simple isn't it. Well, on
behalf of the Ranking Member, I just want to thank you guys for
coming here. I want to thank you for your testimony. I think
that having a hearing like this gives us an opportunity to
give--you know, hopefully inspire all of our colleagues to
focus on this and get this done as quickly as possible.
I would like to thank everyone for being here today and
participating. I look forward to working with members across
the aisle and down the dais. If any Senator has additional
questions for the witnesses or statements to be added, the
hearing record will be open until next Wednesday at 5:00 p.m.
Thank you guys for coming.
[Whereupon, at 4:36 p.m., the hearing was adjourned.]
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APPENDIX
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Prepared Witness Statements
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U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Prepared Witness Statement
Erick Montealegre
Chairman Scott, Ranking Member Gillibrand, and members of
the Committee - thank you for the opportunity to testify today.
My name is Erick Montealegre, and I live in Broward County,
Florida. I'm a family caregiver, a volunteer with the
Alzheimer's Association, and a small business owner in the
senior care field. I've only been in this field for a short
time - about a year and a half - but every day reminds me just
how vital programs supporting older adults are, not just for
families like mine in Florida, but for the nearly 12 million
family caregivers nationwide who are caring for someone living
with Alzheimer's.
Today, I speak to you first and foremost as a son - one of
four adult children doing our best to care for our father,
Alberto, who is living with stage three mild cognitive
impairment. I am proud to have him here with me today. As
November is National Family Caregivers Month, it makes today's
hearing especially meaningful.
Dad was diagnosed with mild cognitive impairment five years
ago, after we first began noticing changes in 2019. Initially,
he lived on his own, proud of his independence, but over time,
it became clear he needed more support and moved in with my
sister. We soon found ourselves learning, often by trial and
error, how to balance his independence with safety - and how to
find resources that would help him stay connected to his family
and his community.
Caregiving, as many of us here know, is emotionally taxing,
physically demanding, financially challenging and a full-time
responsibility. With the help of our local Area Agency on
Aging, we accessed services under the Older Americans Act,
which have made a world of difference to his quality of life.
At first, Dad received home-delivered meals, which ensured he
had healthy food and provided the reassurance of a daily check-
in. He then began attending a local adult day center, which has
become the heart of his day-to-day life - and, in many ways,
the heart of my story. Dad now participates in many activities
that keep him engaged and happy, like piano and art. He is able
to exercise regularly and safely at the gym they have on-site.
He also gets to play chess daily, which is something he has
enjoyed throughout his life and allows him to remain socially
and mentally engaged. He's 84 years old and, since attending
the center, he has taken up dancing - which has been a surprise
to all of us. It's encouraging to see him enjoying something
new at this stage of life and it gives us hope in his ability
to hold back the progression of the disease.
The center provides much more than just recreation. It
gives him cognitive stimulation, physical activity, social
connection, and dignity, and for my siblings and me, it gives
us respite and peace of mind. Knowing he's in a safe, engaging
environment allows us to focus on our own families and careers
without constant worry. I truly believe that the structure,
consistency, and connection that the center provides are key
reasons why my father is still doing as well as he is today. It
has allowed me to step back from being a "care manager" and
freed me to spend time with him as his son.
Dad immigrated to the United States from Colombia back in
the 1970s. Over the course of his disease, he's lost some of
his English and now speaks primarily Spanish. This can make it
difficult for us to communicate with him on complicated topics,
such as retirement benefits and planning. The center employs
bilingual staff who can speak with him in his native language,
helping him and us understand complicated issues around
decisions that need to be made. It's hard to overstate what a
relief it is to have caregivers who truly understand him and
speak his language. They can pick up on nuances in his speech
that even I sometimes miss.
Hispanics are one and a half times more likely to develop
Alzheimer's disease, making it all the more important to
prioritize high-quality, culturally and linguistically
appropriate programs. Programs funded through the Older
Americans Act are doing exactly that - meeting people where
they are and honoring their story. In my culture, caring for
our elders is part of who we are, and I hope my children see
that example and carry it forward.
Reauthorizing and strengthening the Older Americans Act is
an investment in families, dignity, and community. Its programs
provide families like ours with structure, valuable resources,
support, and hope. Hope that my siblings and I can give Dad the
best care possible while balancing our own lives, and hope
that, as our country ages, no family will have to walk this
journey alone.
Thank you again for the opportunity to testify, and I look
forward to your questions.
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Prepared Witness Statement
Stephen Sappington
Hello Chairman Scott, Ranking Member Gillibrand, and
members of the Committee. My name is Steve Sappington. I'm 73
years old, married to my wife Dee for 51 years, and I was
diagnosed with Parkinson's disease in 2015. We have five sons
and nine grandchildren who keep us busy and motivated.
For about three years before my diagnosis, Dee and I
noticed strange changes in my health. I was taking tiny steps
instead of my usual long strides. My once-clear handwriting
became illegible. We went to Longwood Gardens and I suddenly
couldn't smell the thousands of blooming flowers. My hands
began to shake, and my balance started to deteriorate. We had
no idea what Parkinson's disease was. Dee urged me to see our
family doctor, who referred me to a neurologist. When I was
diagnosed, I was upset - and frankly, in denial.
A friend of Dee's who also had Parkinson's kept telling me
about a local boxing program called Rock Steady Boxing. She
said it was life-changing. I wanted nothing to do with it. Why
would I want to go to a boxing class? I was angry and ignoring
the obvious.ut eventually, I gave in and went to observe a
class, finding it interesting and fun. Everyone there had
Parkinson's, each at different stages, and the exercises were
designed specifically to combat symptoms of the disease.
Everyone was friendly and welcoming. I started going to the
free, hour-long classes four to six times a week. The results
came slowly but surely: better balance, improved strength, and
a huge boost in mood. I went religiously for 18 months. Then I
learned the funding for the classes was in jeopardy.
After talking with the gym owner and certified trainers, I
realized I couldn't let the classes stop. More than 200 older
adults with Parkinson's were benefiting from these free
classes. I decided to start a nonprofit in late 2017 to raise
money to keep them going.n April 2018, I helped create Rally
Against Parkinson's (RAP) to keep the classes going. Getting it
started took a lot of work. We were a group of unpaid
volunteers - all seniors, most living with Parkinson's - who
had no experience running fundraisers. We learned on the job
because we knew what these classes meant to us.
We applied for a Community Grant-in-Aid through the
Community Outreach Office. We were denied the first year, but
the next year we received half of what we requested - about
$10,000. The full cost to run the program was more than $30,000
a year, so we organized several fundraisers annually to make up
the difference. RAP has always been a no-cost program, using
100 percent of every dollar raised to pay for the classes.
When COVID hit and gyms closed, we didn't stop. We quickly
adapted by holding socially distanced classes in the gym's
parking lot and launching Zoom sessions for those who couldn't
or preferred not to leave home. As the program grew, we
expanded to our local YMCA and secured a county grant to
purchase equipment. Today, our program includes four in-person
classes each week, two livestream classes added during the
pandemic, and two additional sessions hosted at the YMCA.
At 71, I decided it was time to step back and was fortunate
to find another volunteer - a young 65-year-old - to take over
as president. My neurologist calls me "a miracle." He says it's
rare to see someone with Parkinson's remain at the same
medication level for eight years. I credit that to consistent
exercise and the community built through programs like RAP.
Programs like ours are possible because of the foundation
created by the Older Americans Act (OAA). Local OAA-funded
services, including transportation, congregate and home-
delivered meals, caregiver support, adult day services, and
other supportive programs, make it possible for older adults
like me to stay active and connected.
These services work together:
Transportation helps participants get to classes and
support groups.
Nutrition programs provide meals that support health and
energy.
Caregiver support allows family members to continue
their vital role.
Title III supportive services give local agencies the
flexibility to meet community needs.
Without this infrastructure, many older adults wouldn't be able
to participate in programs that improve their health and well-
being.
Despite progress, several challenges remain. Many older
adults are unaware of available services, underscoring the need
for culturally competent outreach - particularly to low-income,
rural, and minority communities. Even when programs are
accessible, transportation barriers often prevent
participation; funding through the OAA helps address these
gaps. Additionally, sustaining free or low-cost programs is
difficult due to limited unrestricted funding. These
initiatives rely heavily on consistent public investment and
strong local partnerships to remain viable.
To ensure that older adults with Parkinson's and other age-
related diseases can thrive, I respectfully recommend that
Congress:
1. Reauthorize the Older Americans Act this year and
maintain or increase funding for:
Title III nutrition programs
Title III B supportive services (including
transportation and in-home supports)Caregiver support programs
2. Provide dedicated outreach and capacity-building
funding so local agencies can reach underserved seniors,
including those in rural and minority communities.
3. Support flexibility for virtual and hybrid
programming, such as livestreamed exercise classes, so
homebound seniors can stay active and connected.
4. Sustain funding for transportation and meal programs,
which are foundational to participation in community exercise
and wellness programs.
As a patient advocate, I'm encouraged by Congress's
bipartisan passage of the National Plan to End Parkinson's Act,
now being implemented by the federal government. This law
creates the first-ever whole-of-government strategy to prevent,
diagnose, treat, and ultimately cure Parkinson's disease. It
also establishes a federal advisory council to coordinate
research and services across agencies and address the needs of
caregivers and families.
From my perspective, this effort complements the Older
Americans Act. The OAA ensures that people like me can live
well today, while the National Plan builds the roadmap for
tomorrow. Together, they represent hope: hope for better
quality of life now, and hope for a future without Parkinson's
disease.
We don't yet have a cure for Parkinson's and we need strong
federal investment in research to get there. While researchers
work every day toward that goal, I'm proud to do my part
through studies like the Parkinson's Progression Markers
Initiative (PPMI) to help advance our understanding of
Parkinson's Disease. Programs funded and authorized under the
Older Americans Act keep people like me moving, connected, and
cared for. They make the difference between being isolated at
home and living a full life with community, purpose, and
dignity.
Thank you for considering these requests. I welcome follow-
up questions and will gladly help the Committee understand how
OAA services directly improve outcomes for people living with
Parkinson's and their caregivers.
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Prepared Witness Statement
Duana Patton
Chairman Scott, Ranking Member Gillibrand and members of
the Committee, thank you for the opportunity to speak before
you today. My name is Duana Patton, and I am honored to serve
as the Chief Executive Officer of the Ohio District 5 Area
Agency on Aging, Inc., where I have worked for nearly 31 years.
Our Agency, located in Ontario, Richland County, Ohio, is one
of 613 Area Agencies on Aging (AAAs) across the nation that
helps older adults remain independent and supported in their
communities. I am also the current Board President of USAging,
the national association of AAAs. On behalf of these agencies-
and the millions of older adults and family caregivers we
serve-I want to express my gratitude for your continued
commitment to meeting the needs of individuals, families, and
caregivers through the Older Americans Act (OAA). As the older
adult population in the United States continues to rise
rapidly, AAAs have seen increased demand for OAA programs and
services across the country. In 2022, older adults numbered
57.8 million, representing 17.3 percent of the population and
the number of older adults has increased by 34 percent since
2012 compared to an increase of two percent in the population
under age 65. The older adult population is expected to
continue to grow significantly in the future and is projected
to reach 88.8 million in 2060.i
Strengthening the OAA, which is administered by the
Administration for Community Living (ACL), over the next decade
will be critical as it is the cornerstone of the nation's non-
Medicaid home and community-based services (HCBS) system
serving nearly 11 million older Americans per year across the
country. The Aging Network carries out these services and
includes State Units on Aging (SUAs), AAAs, Title VI Native
American Aging Programs (Title VI programs) and tens of
thousands of local service providers.
Older Americans Act Overview and Background on Area Agencies on
Aging
Signed into law in 1965, the OAA has connected older adults
and their caregivers to services that help older adults age
with health, dignity and independence in their homes and
communities-where they want to be. The OAA enables the local
delivery of home and community-based services, which are almost
always less expensive than institutional care provided in
nursing homes or assisted living facilities. The longer older
adults can successfully age at home, the better it is
financially for families and the federal government. OAA
programs and services also support healthy aging and address
upstream drivers of health.ii
AAAs were formally established in the 1973 OAA as the "on-
the-ground" organizations charged with helping vulnerable older
adults live with independence and dignity in their homes and
communities. For 50 years, AAAs have served as the local
leaders on aging and the OAA was intentionally designed to give
AAAs the flexibility to ensure that the local needs and
preferences of older adults are considered and reflected in the
design and implementation of local service delivery systems.iii
Across the country, AAAs play a vital role in supporting both
individuals living with aging-related diseases and their
caregivers, thanks to the foundation provided by the OAA. As an
AAA, our mission is to plan, fund and deliver a broad range of
programs and services rooted in the demonstrated needs of the
communities we serve. We are often the "front door" to aging
services, receiving referrals from individuals, caregivers,
physicians and community partners-often at a time when a person
is facing a new or increasing risk related to aging. Once AAAs
receive input from consumers, service providers and other
stakeholders, we develop Area Plans, which outline local needs
and propose recommendations for programs and services for older
adults and caregivers. Through comprehensive assessments, we
determine what supports and interventions will best promote
their health, safety and independence. When an individual comes
to the AAA, they are not coming for health care, they are
coming to seek support in navigating challenges and risks
associated with their health condition.
AAAs are social care experts and we know that social needs
often drive health outcomes. The core services we provide
include nutrition, supportive services, caregiver support,
health and wellness and elder rights. Our person-centered
approach and assessment expertise recognizes the health of the
person and focuses on interventions that will foster better
outcomes. A good example is that of Ms. Gray. Ms. Gray was
referred to our AAA following a hospital stay for a chronic
health condition. She was not complying with her medication
regimen and had poor eating habits. By providing two hours a
week of personal care in her home as well as home-delivered
meals, Ms. Gray has improved health, both physically and
mentally, and has not been admitted to the hospital since
receiving these services. This is the powerful impact of the
OAA.
Key OAA Programs Supporting Older Adults with Aging-Related
Diseases
OAA Title III B Supportive Services
OAA Title III B Supportive Services is the bedrock of the
Act and provides states and local agencies with flexible
funding to provide a wide range of supportive services to older
Americans like Ms. Mary. These services include in-home
services for frail older adults, senior transportation
programs, Information and Referral/Assistance Services (e.g.,
hotlines to help people find local services, resources), case
management, home modification and repair, chore services, legal
services, social engagement activities, emergency/disaster
response efforts and other person-centered approaches to
helping older adults age well at home. Services provided
through Title III B are a lifeline for older adults and are
heavily based on assessed local needs and the desires of older
adults in that community.iv These services are especially
critical for older adults with aging-related diseases such as
Alzheimer's and Parkinson's disease. As their diseases progress
and their needs change, the AAA can adjust the type or
intensity of services provided to meet the client where they
are.
OAA Title III C Nutrition Services Program
To meet the nutrition needs of older adults, all AAAs
provide nutrition services through the OAA Title III C
Nutrition Services Program. OAA Title III C is the largest
program in the United States that provides nutrition services
to older adults in need and provides older adults with
opportunities for optimal health and well-being, reduced food
insecurity and chances for social interaction with peers. AAAs,
working with contracted community-based partners, provide both
congregate and home-delivered meals to older adults in their
service areas. Congregate meals sites can include senior/
community centers, senior cafes, schools, churches, farmers
markets and other places where older adults gather. Home-
delivered meals are available to older adults who are homebound
or otherwise have difficulty getting to congregate sites. The
OAA also allows AAAs to provide nutrition education, risk
screening and counseling to older adults. Like under Title III
B, AAAs have some flexibility under Title III C and can adjust
services as a client's needs change. For example, an older
adult newly living with Parkinson's or dementia may at first
benefit from attending a congregate meal program in their
community. However, should their disease progress, and they
experience increased difficulty leaving their home, the AAA may
offer transportation to the congregate site or, if needed,
switch to providing home-delivered meals.
OAA Title III D Evidence-Based Health Promotion and Disease
Prevention Programs
In addition to nutritional needs, the OAA also supports
healthy aging for older adults through Title III D Evidence-
Based Health Promotion and Disease Prevention. OAA Title III D
was established in 1987 to provide formula grants to State
Units on Aging to support healthy lifestyles and behaviors
among adults age 60 and older with priority given to those in
greatest economic need and living in medically underserved
areas of the state.v Decades later, Congress required the
programs to be evidence-based. Of the formally recognized by
ACL evidence-based programs, AAAs are most likely to deliver
the following: A Matter of Balance, Chronic Disease Self-
Management Program, Diabetes Self-Management Program, Tai Chi
for Arthritis and Powerful Tools for Caregivers. The impact of
the OAA-and the Aging Network that brings it to life-is deeply
personal and person-centered. For example, one older gentleman
in our region who was living with Parkinson's disease enrolled
in a Title III D falls prevention class at the recommendation
of his physician after experiencing a fall. The program
provided him with exercises and education to reduce his fall
risk, improving both his confidence and his quality of life.
OAA Title III E National Family Caregiver Support Program
Lastly, the OAA provides critical support to the family
caregivers of older adults living with aging-related diseases
through the Title III E National Family Caregiver Support
Program (NFCSP). The NFCSP funds local AAAs to assist older
caregivers and family members caring for older loved ones by
offering a range of in-demand supports to family caregivers in
every community. An estimated 63 million Americans provide care
for an older adult, or someone living with illness or
disability, nearly a 50 percent increase since 2015. Nearly
half of care recipients are age 75 or older and face multiple
chronic health conditions with the most common primary
conditions including age-related decline, Alzheimer's or other
dementias, mobility limitations, cancer and postsurgical
recovery.vi Family caregivers provide a wide range of services,
such as transportation, food preparation, housekeeping and
personal care, enabling care recipients to live at home or in
the setting of their choice with dignity and independence. OAA
Title III E services include respite care; individual
counseling and support groups; caregiver education classes/
training; and emergency assistance. AAAs also play a crucial
role in information and referral and caregiver navigation,
ensuring families are connected with local providers who can
help them create a caregiving plan, address specific challenges
and ensure they receive the right services at the right time.
Caregivers supporting older adults are not only family
members but can also be paid professional caregivers. However,
the nation is experiencing grave direct care workforce
shortages which have contributed to greater strain on already
stressed family caregivers and puts the health and safety of
millions of older adults without other caregivers at risk. The
direct care workforce includes professionals such as personal
care attendants, home health aides, residential workers and
more. The United States does not currently have the caregiving
workforce it needs to support the rising number of older adults
who need personal, in-home care or institutional support. The
pay is low (median earnings of $23,688 annually) and the work
is physically and mentally demanding with very limited
opportunities for career advancement.vi While not directly
supported by OAA Title III E, the direct care workforce
provides critical support to family caregivers and should not
be ignored. Without professional caregivers, older adults have
an increased chance of receiving low quality care, which
threatens their lives and health.
OAA Reauthorization
Authorization of the OAA expired last year and since the
last reauthorization of the OAA in 2020, AAAs have identified
new opportunities to be even more responsive to the evolving
needs of older adults. During the pandemic, we were challenged
to adapt-and that adaptation sparked innovation. When
congregate meal sites had to close, AAAs were permitted to
provide "grab-and-go" meals, allowing older adults to maintain
access to nutritious food and social connection in a safe way.
One participant, a man with diabetes, began using the program
because he wanted to avoid grocery stores during the pandemic.
He later shared that the meals helped him lose weight and
reduce his medications. Today, he continues to attend
congregate meal sites and actively manages his condition. To
reflect the needs of today's older adults and preserve OAA's
inherent flexibility and locally driven structure, it is
critical for the OAA to be reauthorized, and I urge Congress to
swiftly pass the bipartisan, bicameral reauthorization bill
that fell out of last December's final spending package.
Conclusion
The lessons we learned during the pandemic underscore the
importance of allowing AAAs to continue using innovative
practices that have proven effective. The timing of this
reauthorization is ideal-it gives us the opportunity to
strengthen what works, modernize where needed and ensure the
Act continues to meet the needs of older adults, caregivers and
communities across the nation. Chairman Scott, Ranking Member
Gillibrand and members of the Committee, thank you for the
privilege to share my passion and stories from the field. This
day is particularly meaningful; not only because it marks my
Mother's 82nd birthday, but also because this opportunity
stands as a cornerstone moment in my career dedicated to
serving older adults like my Mom.
------------------------------------
(i) Administration for Community Living, 2023 Profile of Older
Americans (2024)
(ii) USAging, Older Americans Act: Get the Facts (2025)
(iii) USAging, Area Agencies on Aging: Local Leaders in Aging
Well at Home (2023)
(iv) USAging, Policy Priorities 2025: Promote the Health,
Security and Well-Being of Older Adults (2025)
(v) Administration for Community Living, Health Promotion
(2025)
(vi) AARP and the National Alliance for Caregiving, Caregiving
in the US Research Report (2025)
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Questions for the Record
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U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Questions for the Record
Erick Montealegre
Senator Raphael Warnock
Question:
There are nearly 188,300 individuals in Georgia living with
Alzheimer's disease and over 384,000 caregivers.
What advice would you give families who are just starting
this journey after a dementia or mild cognitive impairment
diagnosis on how to advocate for needed services and how to
engage community resources to supplement formal programs?
Response:
The first thing I would want families to know is that they
are not alone. A new diagnosis of dementia can feel
overwhelming, but there are clear steps they can take to
advocate for their loved ones and start building a strong
support network.
I would tell them to start with educating themselves by
taking advantage of the educational programs provided through
the Older American's Act and the Area Agencies on Aging.
Understanding the diagnosis empowers families to make informed
decisions. They should ask specific questions such as:
What changes should we expect?
What services should we put in place early?
When should we request a referral to a neurologist,
geriatrician, or memory-care specialist?
Then, document everything. Keep a binder or digital folder
with medical notes, test results, medication lists, and any
observed changes in memory or behavior. Having clear
documentation also helps families advocate for the level of
care their loved ones truly need.
Third, they should build their teams earlier than they
think they will `need' them. Dementia care is strongest when it
combines formal services with community support. Families
should explore:
Local Aging & Disability Resource Centers (ADRCs) for
benefits screening and case management
Area Agency on Aging for low-cost or free programs
Senior centers and adult day programs to reduce isolation
Faith-based and community organizations for social
engagement and respite
In-home care providers who offer companionship, personal
care, and safety oversight
Support groups for both caregivers and those living with
early-stage dementia
The biggest advice I can give is to start early, any delays
in receiving treatment or therapy can be devastating. Unlike
many diseases which can be recovered from, once function is
lost to dementia it's gone for good. There simply is no time to
delay treatments and therapies.
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Questions for the Record
Duana Patton
Senator Raphael Warnock
Question:
Area Agencies on Aging (AAAs) offer critical services for
seniors across the country. Georgia's 12 AAAs do exceptional
work providing resources and care to older Georgians. However,
the aging population is growing rapidly, and AAAs across the
country need increased funding to meet the real and urgent
needs of their community.
How would the reauthorization of the Older Americans Act
(OAA) help AAAs connect older adults with aging-related
diseases to the services they need?
Response:
The number of older adults living with one or more chronic
conditions is rapidly increasing and many require long-term
supports that go far beyond traditional medical care. Without
adequate community services, caregiver resources, and
coordinated care, older adults face greater risk of
malnutrition, falls, hospital readmissions, caregiver burnout,
and premature institutionalization.
Reauthorizing the Older Americans Act (OAA) will modernize
and strengthen funding for community-based services that
support chronic disease prevention and self-management, care
coordination, in-home services, and caregiver assistance. It
provides Area Agencies on Aging (AAAs) with greater flexibility
to continue their pandemic-era nutrition services innovations
and to build stronger partnerships with health care systems in
order to reach more adults with these life-changing
interventions. Importantly, OAA reauthorization increases the
ability of AAAs to reach older adults at the right time, in the
right place-often before a crisis occurs.
Question:
According to the American Association of Retired Persons
(AARP), nearly one in three adults in Georgia is an unpaid
caregiver for family members or friends with health conditions
or disabilities. The number of caregivers is expected to
increase over the next few years, as Georgia's older adult
population grows.
How do services authorized by the Older Americans Act (OAA)
support unpaid caregivers, and what steps can Congress take to
further alleviate the financial and social burden of caregivers
in states like Georgia?
Response:
The Older Americans Act (OAA) plays a vital role in
supporting the millions of unpaid family caregivers who form
the backbone of our long-term care system. Through services
such as respite care, caregiver training, counseling, and care
coordination, OAA-funded programs help caregivers manage the
physical, emotional, and financial strain that comes with
caring for an older adult with complex health needs. These
supports allow caregivers to remain in the workforce, protect
their own health, and continue providing care safely at home-
delaying costly hospitalizations and institutional placements.
Yet, the demand for caregiver support far exceeds current
capacity. Reauthorizing the OAA presents a critical opportunity
for Congress to support funding for the OAA Title III E
National Family Caregiver Support Program, increase access to
respite services, and provide Area Agencies on Aging with
greater flexibility to use funds for evidence-based programs,
supportive services, and partnerships with health care systems.
These steps would allow AAAs to reach caregivers earlier-often
before they are in crisis-and deliver the assistance they need
to sustain care over time.
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Statements for the Record
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U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
AARP Statement
AARP, which advocates for the more than 100 million
Americans age 50 and older, thanks the Committee for holding
this hearing, "Renewing Our Commitment: How the Older Americans
Act Uplifts Families Living with Aging-Related Diseases." We
appreciate the opportunity to offer our support for older
adults and their family caregivers through the Older Americans
Act (OAA) Reauthorization Act of 2025 (S. 2120). AARP commends
you for your bipartisan work on this legislation and joins you
in calling for its prompt passage.
For 60 years, the OAA has helped older Americans live at
home with independence and dignity, deferring or eliminating
more costly institutional services and hospitalizations. It
delivers essential services to approximately 11 million older
adults in a typical year, including home care, job training and
employment opportunities, family caregiver support, congregate
and home-delivered meals, case management, transportation,
adult day care, legal services, elder abuse prevention, and
long-term care ombudsman programs to help keep people safe. OAA
programs are cost-effective investments that serve the needs of
older Americans while helping them to remain in their homes and
communities as they age, where the vast majority prefer to be.
America's older population is growing and so too must the
resources to help them remain independent and live at home.
Family caregivers are filling in the gaps, providing care to
their loved ones at significant expense to themselves in terms
of both time and money, but the number of family caregivers is
not likely to keep up with the demand. Now more than ever, OAA
programs are essential for America's older adults and their
families.
Within the OAA Reauthorization Act of 2025, we appreciate
and support the effort to strengthen OAA's many successful
programs, including the National Family Caregiver Support
Program (NFCSP) and Title VI Native American Caregiver Support
Services, the Senior Community Service Employment Program
(SCSEP), nutrition services, the Long-term Care Ombudsman
Program (LTCOP), the direct care workforce national resource
center, and housing services, all of which are outlined below.
National Family Caregiver Support Program (NFCSP) and Title VI
Native American Caregiver Support Services
As we mark National Family Caregivers Month, we recognize
the 63 million family caregivers who are the backbone of the US
long-term care system. Family caregivers provide about $600
billion annually in unpaid labor to their adult loved ones. The
care they provide ranges from bathing and dressing to paying
bills and transportation, and their assistance helps save
taxpayers billions of dollars by helping to delay or prevent
more expensive care. However, despite the many benefits family
caregivers contribute to the economy and the important role
they play in preserving the health and well-being of their
loved ones, family caregivers often face significant financial,
physical, and emotional challenges. According to Caregiving in
the US 2025, 55 percent of family caregivers perform medical
and nursing tasks for their loved ones; too often, they have
little preparation or training.
NFCSP was created in 2000 to support a range of services
that assist family and other unpaid caregivers. Similarly,
OAA's Title VI Native American Caregiver Support Services
provide support for American Indian, Alaskan Native, and Native
Hawaiian families, including through information and outreach,
access assistance, individual counseling, support groups and
training, respite care, and other supplemental services. As our
nation ages, this support is needed more than ever.
Importantly, the OAA Reauthorization Act of 2025 builds on
progress to support family caregivers that began in the 2020
OAA reauthorization through improvements to caregiver needs
assessments and support services provided to caregivers, the
accessibility of information about available supports for
caregivers, and more. We also support the extension of the
RAISE Family Caregivers Act and Supporting Grandparents Raising
Grandchildren Act.
Senior Community Service Employment Program (SCSEP)
SCSEP provides part-time community service assignments for
low-income adults age 55 or older who face limited employment
opportunities, often due to persistent barriers such as age
discrimination. SCSEP-funded services are available in nearly
all 3,000 U.S. counties and territories and have helped
thousands of older jobseekers into jobs providing them work-
based training and the opportunity to use their skills.
According to the most recent Department of Labor Workforce GPS
survey, participants strongly believe that the program helped
prepare them for success in the workforce (8.4 on a 10-point
scale). Through the program, many older Americans are able to
contribute positively to their communities while seeking new
employment opportunities, making this a true win-win program.
We appreciate the continued support for SCSEP, the only federal
program specifically created to assist workers 55 and older to
gain the skills and experience necessary to be productive
members of the workforce.
Nutrition Services
In 2023, nearly 12.6 million (more than one in ten)
Americans age 50 and older faced food insecurity and the threat
of hunger, the highest share in nearly a decade. While only
part of the solution, OAA nutrition programs are a critical
component of addressing senior hunger. OAA-funded senior
nutrition programs also provide more than a meal; they provide
opportunities for social engagement, offer nutrition screening
and counseling, and link participants to other home and
community-based supports. Congregate and home-delivered
nutrition services provided by OAA reduce hunger, improve
health, and combat social isolation, which costs Medicare an
estimated $6.7 billion annually. Research shows that without
these programs, many older adults would skip meals or eat less.
We appreciate the efforts to innovate nutrition services within
OAA, specifically, the codification of added flexibility around
grab-and-go service delivery methods. This provision will allow
service providers to better meet the needs of their
communities. Access to these services is more critical than
ever, as food insecurity among older adults continues to rise
and demand for nutrition programs intensifies. With
fluctuations in Supplemental Nutrition Assistance Program
(SNAP) benefits and rising food costs, OAA-funded nutrition
programs are increasingly relied upon to fill the gap, making
sustained investment essential.
Long-Term Care Ombudsman Program (LTCOP)
The LTCOP is the most effective program to advocate and act
as a resource for the older adults who live in nursing homes,
assisted living, and other licensed adult care homes. Every
state - along with Puerto Rico, Guam, and the District of
Columbia - has a long-term care ombudsman office. These offices
work to resolve issues related to residents' health, safety,
welfare, and rights, while helping individuals and their
families understand and exercise those rights. In 2024, the
LTCOP processed over 200,000 complaints. By promoting dignity
and quality of life, the LTCOP plays a critical role in
ensuring that long-term care environments are safe, respectful,
and responsive to the needs of those they serve.
We support the provisions within S. 2120 to strengthen the
LTCOP, which effectively advocates and acts as a critical
resource for the older adults who live in nursing homes,
assisted living, and other licensed adult care homes.
Direct Care Workforce National Resource Center
The direct care workforce is an integral part of the
nation's healthcare system. Around 12.6 million adults in the
US need long-term services and supports (LTSS). Despite the
increased demand for direct care workers, job quality for all
members of the direct care workforce remains low, contributing
to high turnover and workforce shortages. The shortage of well-
trained direct care workers, combined with an expected doubling
of the older adult population between 2023 and 2040, points to
an emerging crisis that requires immediate attention.
AARP strongly supports efforts to bolster the direct care
workforce through additional support and investments in the OAA
and appreciates the inclusion of the national resource center
on direct care workforce.
Housing Services and Supports
OAA provides vital resources for millions of older adults
who want to age in their homes through assistance for home
repairs and modifications to ensure the home is safe and
updated with accessibility features. We support the provision
within the OAA Reauthorization Act that extends the eligible
housing services to include weatherization.
Conclusion
OAA programs are cost-effective investments that serve the
needs of older Americans while reducing the need for costly
institutionalization. As America's older population grows, so
too must the resources to help them remain independent and live
at home. Older Americans have earned the right to age with
dignity, and the OAA helps make that possible - now is the time
to renew our national commitment. We urge prompt OAA
reauthorization so that our loved ones can continue to turn to
these services for their health and economic security as they
age.
Again, thank you for your bipartisan leadership on this
important legislation, and we look forward to continuing to
work with the Committee on a bipartisan basis.
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
American Foundation for the Blind (AFB) Statement
The American Foundation for the Blind (AFB) is a national
nonprofit that creates equal opportunities and expands
possibilities for people who are blind, have low vision, and
are deafblind through advocacy, thought leadership, and
strategic partnerships. We appreciate this opportunity to
submit a statement about how the Older Americans Act (OAA) can
maximize opportunities for older Americans who are blind
through improved coordination between the aging network and
blindness service providers.
Many Older Adults Experience Blindness or Low Vision
Blindness and vision loss is often an age related
disability. Certain causes of blindness that tend to be age-
related include Age-Related Macular Degeneration, Cataracts,
Diabetic Retinopathy, and Glaucoma. According to the 2023
National Health Interview Survey, about 23% of people 65 and
older are blind or have trouble seeing, even when wearing
glasses. In addition, there are significant comorbidities
between blindness and other age-related conditions, including
hearing loss, mobility disabilities, Alzheimer s and dementia,
and Parkinsons disease. In fact, research shows a relationship
between dementia and vision loss.
Agencies that serve people who are blind
People who are blind or have low vision benefit
significantly from access to peer support groups and blindness
skills training services that empower them to live
independently and in a way they choose. However, many people
who experience age-related vision loss continue to go without
any services, due to a lack of awareness or funding, and they
frequently end up relying on family members or having to move
into nursing homes.
Private and public agencies across the country serve people
who are blind or have low vision to equip them with skills and
mentorship to adjust to living with blindness. Some of these
blindness skills may include cooking, using assistive
technology, and Orientation and Mobility skills that help
people move confidently through their environment with the use
of a white cane or guide dog. Talking with peers who are blind
can help with confidence living at home and provide resources
such as how to use audio description to watch television and
access the National Library Service to borrow audiobooks or
braille books.
Coordination is an important opportunity in the OAA
Likewise, the aging network helps people to continue living
in their homes. Area agencies on aging carry out programs and
services for people who need transportation, who experience
isolation, and need meal services. In fact, AAAs and meal
delivery programs may be the only point of regular contact for
isolated adults.
We appreciate that the current versions of the OAA
reauthorization bill include provisions for supporting older
individuals with disabilities through improved coordination.
There is ample opportunity for conscientiously increasing
coordination between the aging network and blindness services.
Through improved coordination, we could shorten the time
that people experiencing vision loss take to learn about and
receive vision related services and ensure they receive other
services they may need that are provided through the aging
services network. Coordination would also expand awareness for
caregivers about how their family member can continue to live
independently as a blind or low vision person. Aging service
providers could request consultation to ensure their programs
are fully accessible (e.g. by providing information in
alternative formats and ensuring blind participants have
transportation access). Many AAAs hold falls prevention
training, but even though vision loss is a risk factor for
falling, many falls prevention trainings are either not
accessible to a blind person, or they do not provide blindness
specific resources.
Blindness service providers can offer resources about their
programs to AAAs and to the people they serve to increase the
rate of referrals. Increasing awareness and referrals would
ensure that all older adults with vision loss have access to
peer support and blindness skills training that they need to
retain their quality of life. Improved coordination is
necessarily bidirectional as vision service providers need to
be familiar with the AAA system while blind older adults would
benefit from receiving more information about blindness
services and more accessible programming within the aging
network. Currently this coordination does not exist.
The OAA is vitally important for Older Americans, including
the many who are blind or have low vision. Yet, there are
opportunities to improve coordination, so that older adults who
are blind can benefit even more from OAA programs. We hope the
Committee will prioritize passing legislation that truly
improves coordination between organizations that specifically
serve blind adults and those that serve older adults.
Thank you for the opportunity to submit this statement for
the record. Should you have any questions about the information
raised in this statement, please reach out to Sarah Malaier.
Sincerely,
Stephanie Enyart
Chief Public Policy and Research Officer
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
Alzheimer's Association and Alzheimer's Impact Movement Statement
The Alzheimer's Association and Alzheimer's Impact Movement
(AIM) appreciate the opportunity to submit this statement for
the record to the Senate Special Committee on Aging hearing
entitled "Renewing Our Commitment: How the Older Americans Act
Uplifts Families Living with Aging-Related Diseases". The
Association and AIM thank the Committee for its continued
leadership on issues important to the millions of individuals
living with Alzheimer's and other dementias and their
caregivers. This statement highlights the importance of
policies and programs within the Older Americans Act (OAA) that
can help meet the unique needs of our nation's growing number
of Americans living with Alzheimer's and other dementias.
Founded in 1980, the Alzheimer's Association is the world's
leading voluntary health organization in Alzheimer's care,
support, and research. Our mission is to eliminate Alzheimer's
and other dementias through the advancement of research, to
provide and enhance care and support for all affected, and to
reduce the risk of dementia through the promotion of brain
health. AIM is the Association's advocacy affiliate, working in
a strategic partnership to make Alzheimer's a national
priority. Together, the Alzheimer's Association and AIM
advocate for policies to fight Alzheimer's disease, including
increased investment in research, improved care and support,
and the development of approaches to reduce the risk of
developing dementia.
Over seven million Americans are living with Alzheimer's,
and by 2050, this number is expected to rise to nearly 13
million. Alzheimer's is one of the costliest conditions in the
United States. In 2024, total payments for all individuals with
Alzheimer's or other dementia are estimated at $360 billion
(not including unpaid caregiving). By 2050, these costs are
projected to rise to nearly $1 trillion. These mounting costs
threaten to bankrupt families, businesses, and our health care
system. Unfortunately, our work is only growing more urgent.
As the prevalence of Alzheimer's disease and other
dementias increases, so does the need for care and support
services for those living with these diseases. The OAA provides
federal funding and the necessary infrastructure to deliver
vital support programs and social services to our nation's
seniors, including those with Alzheimer's disease. These
critical programs are utilized by millions of low-income
Americans and provide for such services as home-delivered and
congregate nutrition services; in-home supportive services;
transportation; caregiver support; community service
employment; health and wellness programs; the long-term care
ombudsman program; services to prevent the abuse, neglect, and
exploitation of older adults; and other supportive services.
Twenty-four percent of older individuals with Alzheimer's
disease and other dementias who have Medicare are also eligible
for Medicaid, punctuating the need within the Alzheimer's
community for such programs as the Senior Nutrition Program and
the National Family Caregiver Support Program.
We strongly support the bipartisan Older Americans Act
(OAA) Reauthorization Act of 2025 (S. 2120), led by Chairmen
Cassidy (R-LA) and Scott (R-FL) and Ranking Members Sanders (I-
VT) and Gillibrand (D-NY), which includes expanded efforts to
address social isolation, a pressing issue for the aging
population and especially for individuals with dementia. Social
isolation exacerbates cognitive decline, mental health issues,
and physical health risks. The Alzheimer's Association's
Dementia Care Practice Recommendations emphasize the benefits
of support groups in reducing isolation and improving outcomes,
including quality of life and communication with family
members. The establishment of an Advisory Council on Social
Isolation and Loneliness is an important step toward better
understanding and responding to this growing public health
issue.
We are grateful that the Supporting Older Americans Act of
2020 (P.L. 116-131) included the bipartisan Younger Onset
Alzheimer's Disease Act, championed by Senators Susan Collins
(R-ME) and Bob Casey (D-PA), to codify existing authority to
provide services to individuals living with younger-onset
Alzheimer's disease under the National Family Caregiver Support
Program and the Long-Term Care Ombudsman Program. We appreciate
that this legislation continues to include this important
language, ensuring that individuals with younger-onset
Alzheimer's disease and related dementias can access the
supports they need. These services are particularly helpful for
those who may still be raising young children, in the
workforce, or struggling to secure an accurate diagnosis-facing
stigma and delays that compound the disease's toll.
Supporting Dementia Caregivers
Eighty-three percent of the help provided to older adults
in the United States comes from family members, friends, or
other unpaid caregivers, and the emotional, physical, and
financial costs can be overwhelming. Nearly half of all
caregivers who provide help to older adults do so for someone
living with Alzheimer's or another dementia. In 2024 alone,
more than 12 million Americans provided unpaid care for people
with Alzheimer's and other dementias, contributing an estimated
19 billion hours of care valued at $413 billion. Of the total
lifetime cost of caring for someone with dementia, 70 percent
is borne by families - either through out-of-pocket health and
long-term care expenses or from the value of unpaid care.
Community services provided under the OAA offer invaluable
support for individuals living with dementia, and, due to the
unique challenges they face, it is paramount to continue
prioritizing care coordination efforts within communities
during the reauthorization process. Dementia often requires a
multi-disciplinary approach involving medical professionals,
caregivers, social workers, and community support services.
Effective coordination helps caregivers navigate the complex
healthcare and social service systems and ensures that
caregivers and health care professionals collaborate
seamlessly, providing comprehensive care tailored to their
individual needs. Challenges such as cognitive decline,
communication difficulties, and fluctuating symptoms
necessitate specialized strategies for coordination.
Initiatives promoting dementia-friendly communities and
caregiver education programs play crucial roles in enhancing
coordination and support networks. By prioritizing and refining
care coordination, communities can offer a better quality of
life and support for individuals living with dementia and their
caregivers.
We are also deeply grateful for the reauthorization and
extension of the RAISE Family Caregivers Act. The Alzheimer's
Association and AIM have been strong advocates for the RAISE
Family Caregivers Act since it was introduced in Congress. As
the caregiving crisis intensifies, especially in the
Alzheimer's community, this extension will ensure the
Department of Health and Human Services can fully implement a
national strategy to better support unpaid caregivers. These
dedicated caregivers greatly benefit from increased resources,
training, and support to help them navigate the strain of
caregiving and improve their health and quality of life.
Strengthening the Dementia Care Workforce
We ask that the Committee prioritize policies to reduce
barriers and ensure individuals living with dementia have
adequate access to long-term care and home- and community-based
services. People living with Alzheimer's and other dementias
make up a significant portion of all long-term care residents,
comprising 49 percent of all residents in nursing homes and 34
percent of all residents in assisted living communities and
other residential care facilities. Given our constituents'
intensive use of these services, the quality of this care is of
the utmost importance. As a result, we encourage the Committee
to consider policies to enhance long-term care and support
services for the growing number of Americans with Alzheimer's
and other dementias who are eligible to receive OAA services.
A strong dementia care workforce is needed to ensure
quality care for aging populations. For example, the fourth
most common chronic condition in participants using adult day
services is Alzheimer's disease or other dementias, and 25
percent of individuals using adult day services have
Alzheimer's or other dementias. Access to these services can
help people with dementia live in their homes longer and
improve the quality of life for both themselves and their
caregivers. In-home care services, such as personal care
services, companion services, or skilled care, can allow
individuals living with dementia to stay in familiar
environments and be of considerable assistance to caregivers.
Adult day services can provide social engagement and assistance
with daily activities.
To ensure that care providers are equipped to meet the
specific needs of individuals with dementia, we strongly
support the bipartisan Accelerating Access to Dementia &
Alzheimer's Provider Training (AADAPT) Act (H.R. 3747),
introduced by Representatives Troy Balderson (R-OH-20) and
Nanette Barrag n (D-CA-44), which would provide grants to
expand virtual education and training on Alzheimer's and
dementia so that more primary care providers better understand
detection, diagnosis, care, and treatment - and so that more
providers in rural and underserved communities can receive
dementia training.
By prioritizing a well-trained dementia care workforce,
Congress can ensure that individuals living with Alzheimer's
and other dementias receive timely, accurate diagnoses and
high-quality, coordinated care, no matter where they live. This
investment will not only improve outcomes for patients and ease
burdens on family caregivers but also reduce overall health
care costs by minimizing unnecessary hospitalizations and
specialist referrals. The AADAPT Act is a critical step toward
building a more equitable and effective dementia care system
nationwide.
Advancing Brain Health Through Evidence-Based Interventions
The Alzheimer's Association and AIM encourage the Committee
to recognize the opportunity to promote brain health and risk
reduction through evidence-based lifestyle interventions. The
Alzheimer's Association U.S. Study to Protect Brain Health
Through Lifestyle Intervention to Reduce Risk, known as U.S.
POINTER, found that a structured lifestyle program - focusing
on things like improved nutrition, physical exercise, cognitive
engagement, and health monitoring - improved thinking and
memory over two years, keeping brain function from declining as
it normally would with aging. Participants in the structured
program performed like people who were one to almost two years
younger, suggesting that these habits can help the brain stay
resilient against age-related changes. U.S. POINTER is the
first large-scale, randomized controlled clinical trial to
demonstrate that an accessible and sustainable healthy
lifestyle intervention can protect cognitive function in
diverse populations in communities across the United States.
The results present a compelling case for investments in
preventive brain health programs targeting nutrition, physical
exercise, cognitive stimulation and cardiovascular wellness.
OAA-funded programs, especially those authorized under
Title III-B (Supportive Services), Title III-C (Nutrition
Services), and Title III-D (Health Promotion), offer the
infrastructure to deliver these interventions where older
adults already access services. Implementing POINTER-style
models into community-based programs would empower older
Americans to engage in brain-healthy behaviors in familiar and
trusted settings.
This is not only a brain health issue - it is an economic
imperative. Reducing cognitive decline could help reduce future
care costs and support healthy, productive aging. As you move
forward in the OAA reauthorization process, we urge the
Committee to support funding, legislation, and public health
initiatives that bring these proven brain health interventions
into more communities.
Conclusion
The Alzheimer's Association and AIM appreciate the
Committee's steadfast support and commitment to advancing
issues important to the millions of individuals living with
Alzheimer's and other dementias, as well as their caregivers.
We look forward to working with you and again ask that you keep
individuals living with dementia in mind as the Older Americans
Act reauthorization effort moves through the legislative
process.
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
Defeat Malnutrition Today Statement
Defeat Malnutrition Today is a coalition of over 120
members committed to addressing older adult malnutrition across
the continuum of care. We submit for the record an American
Society on Aging article written by our national coordinator
about how Older Americans Act programs can improve the health
of and reduce malnutrition in older adults.
Leveraging Nutrition to Make Older Americans Healthy Again
September 15, 2025
The Trump Administration's MAHA Strategy provides an
opportunity to address older adults within each of the MAHA
pillars.
By Edwin Walker and Bob Blancato
About one in six Americans is now ages 65 or older, with
11,000 turning age 65 every day. While we can't turn back the
clock on age, we can help older Americans continue to make
vital contributions to the economy and society by helping them
maintain their strength and independence. Disability and
chronic disease decrease older adult's health, functionality
and quality of life, with more than half (63.7%) of the older
U.S. population living with two or more chronic diseases. Good
nutrition can make a difference, helping increase not only
older adult lifespan but healthspan, too.
Health is built across an entire lifetime, and while
childhood intervention is important, chronic disease prevention
and health promotion must continue beyond childhood. If we wait
until individuals are already frail, we've missed too many
opportunities to keep people healthy. The Trump
Administration's plan to Make America Healthy Again (MAHA)
includes "fresh thinking on nutrition." An emphasis on
nutrition is also key to Make Older Americans Healthy Again
(MOAHA)-and here's what needs to be done.
Action starts by recognizing that malnutrition is a common
problem for older adults today. Estimates are that up to one in
two older adults are at risk for malnutrition, particularly a
lack of adequate protein, calories and other nutrients, which
contributes to poor health outcomes, frailty and disability,
and increased healthcare costs. Congress recognized the
importance of this issue when it added reducing malnutrition to
the purpose of the Older Americans Act (OAA) during the 2020
OAA reauthorization. The OAA's disease prevention and health
promotion services were also updated to include screening for
malnutrition. Every September, we celebrate Malnutrition
Awareness Week.
OAA programs are administered locally by more than 600 Area
Agencies on Aging, more than 270 Title VI Native American Aging
Programs, and more than 20,000 community service providers
supported by 70,000 volunteers-all trusted by the 11 million
older adults they serve.
These programs leverage federal funds with state, local,
and participant funding. With its nationwide coverage, well-
established community ties, and mix of public and private
support, the OAA network provides an ideal infrastructure for
MOAHA.
With the release of the Trump Administration's MAHA
Strategy, we see an opportunity to address older adults within
each of the MAHA pillars.
Realigning Incentives and Systems to Drive Health Outcomes
OAA programs provide aging services and nutrition-including
nearly one million healthy meals every day-to older adults
across our nation, many of whom are at risk for malnutrition.
OAA interventions are cost effective. It is estimated that just
one day in the hospital costs about the same as providing an
older adult with one year of OAA nutrition program meals.
Furthermore, OAA programs offer a nationwide infrastructure for
piloting and scaling innovative interventions (e.g., medically
tailored meals, protein-rich menus, culturally appropriate
foods).
Identifying individuals at risk for malnutrition who can
benefit from nutrition interventions often begins in the
hospital, where disease-associated malnutrition in older
Americans costs more than $51.3 billion every year. The
Malnutrition Care Score, or MCS, is the only nutrition-specific
hospital quality measure approved by the Centers for Medicare &
Medicaid Services (CMS) for adults ages 18 and older, yet is
not a mandatory measure. Malnutrition cannot usually be fully
resolved in the hospital, thus it is important for acutecare
nutrition plans to link to community nutrition services post
discharge. Studies document that nutrition-focused quality
improvement programs in outpatient clinics are feasible and can
help reduce use of healthcare resources and cut costs.
Nutrition interventions, such as medical nutrition therapy
(MNT) provided by a registered dietitian nutritionist (RDN) can
lead to more successful disease treatment and health outcomes.
However, currently MNT coverage is limited, for example
Medicare only covers MNT for diabetes, kidney disease, or a
recent kidney transplant. Legislation including the Medical
Nutrition Therapy Act (MNT Act) and Treat and Reduce Obesity
Act (TROA) would expand coverage to other nutrition-related
chronic diseases/conditions where diet and lifestyle changes
can be effective, including obesity, malnutrition, cancer and
cardiovascular disease.
Research to Drive Innovation
Including older adults in MAHA research ensures innovation
reaches populations at the highest risk of hospitalization.
Data is imperative to combat public health crises like older
adult malnutrition. For the first time in 2022, the annual
National Survey of Older Americans Act Participants (NSOAAP)
included malnutrition screening questions. Based on this data,
researchers recently found about a fifth of OAA program
participants were at malnutrition risk across all OAA programs
and that there was evidence malnutrition risk may decline with
continued participation in OAA's home-delivered-meals program.
Continued collection of and open access to such data helps
identify and explain the malnutrition problem as well as
document the impact of successful interventions like OAA
nutrition programs.
Nutrition is fundamental for health and well-being,
particularly for older adults. The Strategic Plan for NIH
Nutrition Research includes among its priorities the need to
"Define the role of nutrition across the life span for healthy
development and aging." Yet funding for nutrition research has
remained stagnant at about 5% of total NIH obligations and
therefore needs to increase . otherwise we're just guessing at
solutions.
Increasing Public Awareness and Knowledge
Public messaging about "healthy aging" is often absent in
chronic disease campaigns, even though 93% of older adults have
at least one chronic disease. Awareness of malnutrition is even
lower: fewer than 1 in 5 older adults who are malnourished are
correctly identified in healthcare settings. We should
recognize malnutrition as a chronic disease and MAHA messaging
must include older adults if we are serious about reducing the
nation's chronic disease burden across the lifespan.
Campaigns should highlight how older adults benefit from
OAA programs, which follow the Dietary Guidelines for Americans
to provide healthy food and support older adult's health,
independence, and dignity. It's estimated that 2.9 million low-
income, food insecure older adults who could benefit from OAA
nutrition programs are not receiving meals.
Fostering Private Sector Collaboration
OAA programs are the gold standard of public-private
partnerships. The aging network already partners with thousands
of local providers, health systems, and insurers to deliver
meals and services, providing a 1:4 return on federal
investment. Private insurance is increasingly exploring
coverage for meals after hospital discharge, with OAA programs
showing how community partnerships can deliver efficiently at
scale. Excluding older adults from MAHA leaves a major blind
spot in cross-sector health collaboration-and ignores a
population driving much of our healthcare spending.
The next step is fully funding the Older Americans Act in
Fiscal Year 26.This is crucial to ensure older adults get the
support and nutrition they need to successfully age in place in
their local communities. Indeed, the right of every American to
age with respect and community was recently underscored by
Health and Human Services Secretary Robert F. Kennedy, Jr.'s
comments on the OAA.
As MAHA initiatives take form, leveraging existing networks
like the OAA nutrition programs and supporting Make Older
Americans Healthy Again (MOAHA) is critical. Aging is not a
niche issue. It's a universal experience that should be at the
center of public health policy, including MAHA. Older adults
are the fastest growing segment of the population and the group
with the greatest incidence of chronic disease. Many chronic
conditions that manifest in older adulthood can be further
aggravated by nutritional deficits or poor diet later in life.
Supporting good nutrition in older adults can benefit their
health and quality of life as well as leading to their improved
well-being.
Edwin Walker is the former deputy assistant secretary for
Aging in the Administration for Community Living. Bob Blancato
is the executive director of the National Association of
Nutrition and Aging Services Programs (NANASP) and the national
coordinator of Defeat Malnutrition Today.
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
National Academy of Elder Law Attorneys Statement
On behalf of our more than 4,000 members who are attorneys
representing older Americans and individuals with disabilities,
the National Academy of Elder Law Attorneys (NAELA) writes to
express our strong support for immediate reauthorization of the
Older Americans Act (OAA). NAELA is the leading professional
association dedicated to improving the quality of legal
services for older Americans and individuals with disabilities.
With 31 active state chapters, NAELA provides elder and special
needs law attorneys with education, advocacy, community, and
the resources they need to better serve their clients.
Signed into law in 1965, the OAA is "one of the most
quietly impactful laws this country has ever passed," as
Chairman Scott noted during the hearing. Ranking Member
Gillibrand called it a "bipartisan workhorse program that flies
below the radar" and one that "is costefficient." The OAA has
been reauthorized by multiple Congresses and signed into law by
Presidents of both parties, most recently by President Trump in
2020. S. 2120, the bill introduced in 2025 to reauthorize the
OAA, is co-sponsored by both Chairman Scott and Ranking Member
Gillibrand, as well as Chairman Cassidy and Ranking Member
Sanders of the Senate Health, Education, Labor & Pensions
Committee.
The OAA's programs - including meal delivery and help with
household tasks, transportation assistance, and caregiver
support - are essential services for our clients. These
programs allow them to remain in their homes and stay active in
their communities for as long as possible. This benefits their
physical and mental health, reduces government spending by
delaying their entry into institutional care or
hospitalization, and eases the burden on family caregivers.
Should an individual need to move into a long-term care
facility, the OAA protects their rights through the Long-Term
Care Ombudsman programs under Title VII. As elder law
attorneys, we know that individuals living in residential care
communities are often worried about bringing their concerns to
management or may have trouble expressing their needs,
particularly if they experience aging-related diseases such as
Alzheimer's or Parkinson's. An ombudsman with whom they have a
trusted relationship can communicate with them and advocate for
them, easing their concerns and making sure their needs are
met. Data from fiscal year 2023 shows that Long-Term Care
Ombudsman representatives worked to resolve more than 200,000
complaints from residents, their families, and other
individuals; resolved or partially resolved 71% of complaints;
and provided more than 500,000 instances of information and
assistance to individuals, according to the Administration for
Community Living (ACL).
Legal aid programs under Title IIIB are another way the OAA
helps older adults remain independent and safe. These programs
allow individuals to access legal counseling for free - which
they may not have the ability to do otherwise - as they explore
long-term care options, plan for future financial needs, and
seek protection from or redress against financial abuse,
neglect, and exploitation. The process to apply for Medicaid
long-term services and supports, for example, is complicated;
individuals who try to do this themselves can easily become
overwhelmed and make mistakes. Having legal counsel to guide
them through it can be a lifeline, especially during a time of
stress. Older adults who are the subject of guardianship or
conservatorship actions can turn to legal assistance programs
to help them preserve their independence as long as possible,
which is particularly important for those individuals with
aging-related diseases. The ACL states that nearly 1 million
hours of legal assistance are provided each year by OAA-funded
legal services providers.
In short, OAA programs allow millions of older adults each
year to age with dignity. NAELA members have seen the
difference the OAA's programs make in our clients' lives and
how much older adults and their families depend on these
services every day. With OAA funding and services, such as
food-delivery programs, already disrupted due to the federal
government shutdown, it's even more important that we
reauthorize the OAA now to ensure the program's critical,
needs-based services continue to serve older adults throughout
our country.
We hope that all Senators, particularly those on the
Special Committee on Aging, will cosponsorS. 2120 as soon as
possible. We appreciate the Committee's continued interest in
this vital program, and we look forward to working with you to
serve America's older adults through reauthorization of the
Older Americans Act.
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
National Association of Nutrition and Aging Services Programs Statement
The National Association of Nutrition and Aging Services
(NANASP) on behalf of our 1000+ aging services members commends
the Chairman Rick Scott, Ranking Member Kirsten Gillibrand, and
the Senate Special Committee on Aging for holding this
important and timely hearing regarding how the Older Americans
Act (OAA) and its programs serve older adults-especially those
with disabilities, including age-related disabilities-and how
efforts can be strengthened in rural America and in
coordination with health care systems.
Important because of what the Older Americans Act and its
programs mean to the daily lives of the 12 million Americans
age 60 and over served by these programs and timely because it
is time without further delay to reauthorize this important act
which S.2120 would do. We especially appreciate ranking member
Senator Gillibrand being a co-sponsor of this measure.
The largest program components of the OAA are its three
nutrition programs: Title III C-1 (congregate nutrition
services), Title III C-2 (home-delivered nutrition services),
and the Nutrition Services Incentive Program (NSIP). These
programs are the focus of today's discussion because they
provide more than just meals, they improve health, reduce risk
of malnutrition, and ensure the continuation of vital services
and supports that allow older adults and people with
disabilities to live independently in their communities.
For older adults and people with disabilities, the value of
the OAA nutrition programs is many-fold.
Participants at congregate meal sites are not only
receiving a nutritionally balanced meal (meals must meet
federal standards, including providing at least one-third of
the Dietary Reference Intakes) but also opportunities for
socialization, wellness checks, referrals to other services,
volunteers who engage them, and a community anchor.
For home-delivered meals, older adults who are frail,
homebound, isolated, or have functional limitations receive a
nutritious meal at home, a wellness / safety check from a
caring volunteer or staff person, social contact, and
connection to other community supports.
These nutrition programs are especially important for
older adults with disabilities or age-related functional
challenges because the statute explicitly prioritizes persons
with "greatest social or economic need," including those with
physical disabilities, limited mobility, and those at risk of
institutionalization.
More than one in five older Americans live in rural areas
where challenges such as limited providers, long travel
distances, and higher rates of disability and isolation make it
harder to access services, maintain good nutrition, and stay
socially connected. OAA programs, especially the nutrition
programs, play a critical role in enabling older adults and
people with disabilities to live in their communities with
dignity, independence and safety.
These communities therefore need strong partnerships
between the OAA network (state units on aging, area agencies on
aging, local providers) and state health agencies, rural
hospitals, and public health systems. For example: As rural
health systems implement the new Malnutrition Care Score and
the Age-Friendly Hospital Measure-which help hospitals identify
malnutrition risk among older patients and tailor discharge
planning-there is an opportunity for hospitals to formally
partner with OAA nutrition programs so that when older adults
with disabilities are discharged home, their nutrition concerns
are addressed immediately in the community. By aligning
nutrition screening in hospitals, referral to OAA nutrition
programs, and follow-up coordination, readmissions may be
reduced, older adults with disabilities can be better supported
in their home communities, and health systems and community
providers can jointly track outcomes.
To be clear: the OAA nutrition programs are more than "just
a meal." To the older adults and people with disabilities they
serve, these programs represent a lifeline. They promote better
health and can help prevent malnutrition, they provide
critically important socialization to combat isolation and
loneliness, and for home-delivered recipients they offer a
daily wellness check. They engage volunteerism, foster
connection, offer nutrition education and support chronic
disease management. The nutrition program under Title VI of the
Act for Native American older adults also plays a vital role in
tribal communities.
Given all of this, it is important that Congress act
without further delay to reauthorize the OAA. The Act
celebrated its 60th anniversary in 2025, marking one of the
most successful federal programs ever enacted. Yet the world
for older Americans has changed dramatically. Earlier this
year, the Administration announced a major reorganization of
Department of Health and Human Services that profoundly impacts
the Administration for Community Living (ACL), which
administers the OAA. While we await those results, NANASP along
with Meals on Wheels America, National Council on Aging,
USAging, and Advancing states urge that all aging programs be
housed within a single agency-the Administration for Children,
Families, and Communities-with strong aging leadership and
adequate resources to maintain the aging network's integrity.
Enable state units on aging and area agencies on aging to
fully participate in new funding streams like the Rural Health
Transformation Grants, telehealth infrastructure and workforce
grants to enhance rural nutrition services.
Today's hearing can be a catalyst to move reauthorization
forward on a bipartisan basis to ensure more older adults and
people with disabilities live with dignity and independence in
their communities, especially those with greatest social and
economic need. Let us all work together to make this happen.
The OAA celebrated its 60th anniversary in 2025. It did so
with the reality that it is one of the most successful federal
programs ever enacted hearing can be a catalyst to get
reauthorization moving. Today's hearing is a catalyst to get
the reauthorization moving on a bipartisan basis to ensure
older adults and people with disabilities live with dignity and
independence in their communities. Let us all work together to
make this happen.
Thank you for your consideration.
Sincerely,
Bob Blancato
Executive Director NANASP
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
National Rural Health Association Statement
The National Rural Health Association (NRHA) is pleased to
submit a statement to the Special Committee on Aging Hearing,
How the Older Americans Act (OAA) Uplifts Families Living with
Aging-Related Diseases. We appreciate the Senate Aging
Committee's continued commitment to the needs of older adults,
including the more than 60 million Americans that reside in
rural areas. NRHA submits this statement to highlight the
unique needs of older adults in rural communities and uplift
the importance of improving age-friendly care, nutrition
access, and caregiver support.
NRHA is a non-profit membership organization with more than
21,000 members nationwide that provides leadership on rural
health issues. Our membership includes nearly every component
of rural America's health care, including rural community
hospitals, critical access hospitals, long-term care providers,
doctors, nurses, and patients. We work to improve rural
America's health needs through government advocacy,
communications, education, and research.
Background
Older adults living in rural areas make up a
disproportionate share of the aging population. In 2020, about
1 in 5 people living in rural areas in the United States were
65 and over, compared to 16 percent in urban areas, and face
compounding challenges including higher poverty rates, greater
social isolation, limited means of transportation, food
insecurity, and reduced access to long term care and home- and
community-based services.i These difficulties are magnified by
ongoing rural hospital closures and workforce shortages.
The OAA has been a reliable source of caregiver relief,
nutrition support, and assistance navigating services for many
rural families. The OAA created the Administration on Aging,
part of the Administration for Community Living (ACL), and
established a national aging services network that includes
state agencies, Tribal aging programs, Area Agencies on Aging
(AAAs) and community-based organizations. Together, this
network provides services that play a critical role in helping
older adults remain in their homes and communities. In rural
America, that mission cannot be met without strengthening OAA
funding and flexibility to reflect the realities of rural
service delivery.
Economic Challenges
Poverty: Rural older adults often struggle financially due
to limited employment opportunities, lower Social Security
benefits due to reduced lifetime earnings, and rising health
care costs. The poverty rate among rural older adults is 13
percent, which is 9.6 percent higher than the national
average.ii With limited fixed incomes, even minor changes in
finances, such as unexpected healthcare costs, can cause
immense strain for rural older adults.
Housing: Housing insecurity is reported to be the leading
cause of stress among rural older adults, with many living in
substandard conditions due to the unavailability of senior
housing programs.iii Rural Americans have a lower median
household income compared to urban households, sitting around
four percent lower.iv Inaccessibility of affordable and
available housing for rural older adults further exacerbates
economic challenges faced by this population and is an obstacle
to positive healthcare outcomes. Healthy homes promote good
physical and mental health. Good health depends on having homes
that are safe and free from physical hazards. Residents who
experience difficulty paying rent, mortgage or utility bills
are less likely to have a usual source of medical care and more
likely to postpone treatment and use the emergency room for
treatment.v
Payment & Health Care Costs: Rural older adults spend an
average of 20 percent more on health care than their urban
counterparts.vi Additionally, Medicare is the primary source of
care coverage for rural older adults; however, Medicare only
covers nursing home care in limited circumstances (up to 100
days of skilled nursing care following a hospitalization).
Outside of this, Medicare generally does not cover long-term
care in nursing homes or any assisted living. Rural older
adults typically rely upon Medicaid to help pay for these
costs.
Additionally, limited transportation infrastructure and
reliance on emergency services in rural areas contribute to the
high costs of healthcare for rural adults, as well as heighten
the challenges older rural adults face in accessing care.
Social Challenges
Caregiver Support: Rural families carry a disproportionate
share of the caregiving responsibility because the formal long-
term care system in rural areas is thinner and continues to
contract. Rural areas have experienced higher rates of nursing
home closures, consolidation of home health agencies, and
reduction in hospice and in-home support teams. These closures
force older adults and their families to travel farther for
care or manage complex health needs at home with limited, if
any, professional support. As a result, family, friends, and
neighbors become the default care system where they support
loved ones with dementia, mobility limitations, or multiple
chronic conditions while also balancing work, transportation
challenges and financial constraints.
Even when services exist, workforce shortages limit
availability of rural caregivers. Rural nursing assistants,
home health workers, and long-term care staff are consistently
underpaid, leading to turnover and service gaps. The result is
caregiver burnout and turnover. Expanding caregiver support,
in-home care capacity, and respite access under the OAA are
needed not only to protect caregiver health but also to enable
older adults to remain safely in their homes and communities.
Transportation: Unlike urban areas, most rural regions lack
public transit systems or rideshare services. Older adults who
no longer drive often have no alternative way to get medical
appointments, grocery stores, pharmacies, senior centers, or
social visits. As a result, losing the ability to drive can
lead to instant isolation and access challenges. These
transportation barriers contribute to missed medical care,
delayed treatment, and worsened chronic disease outcomes. OAA-
funded transportation programs attempt to fill these gaps but
are consistently under-resourced and face higher per-trip costs
due to long travel distances and dispersed populations in rural
areas.
Isolation & Mental Health: Rural older adults are more
likely to live alone farther from neighbors, and in communities
where gathering places have declined due to hospital closures,
shrinking senior centers, and loss of local businesses. Social
isolation is linked to higher risks of depression, cognitive
decline, vulnerability to elder abuse, and earlier mortality by
up to 30 percent.vii OAA supported congregate meal programs and
senior centers have historically served as anchors of
connection, but many rural providers struggle to maintain
programming or transportation to bring people together.
Health Care Access
Workforce: Developing, retaining, and sustaining the rural
healthcare workforce is often challenging in rural areas. As a
result of these workforce shortages, rural older adults often
struggle to access primary care providers, nurses, and other
specialty care providers. Rural areas have 64 percent fewer
health care workers per capita than urban areas.viii This in
turn leads to limited access to preventive care and chronic
disease management for older adults. Community health workers
(CHWs) integration into the healthcare system offers one method
to help bridge gaps in health care delivery and increase access
to care. CHWs play an increasingly vital role in delivering
culturally competent education, care coordination, and social
support, especially in rural settings where clinical workforce
shortages persist.
Infrastructure: Healthcare infrastructure that can help
support the rural older adult population is integral in
providing long-term care (LTC) support and addressing the needs
of the rural aging population. This includes home health or
home and community-based services, or institutional
infrastructure such as skilled nursing facilities (SNFs),
assisted living, or long-term care facilities. Rural counties
have a higher percentage of residents 65 or older and have a
higher percentage of the population that identifies as having a
disability, which indicates a greater need for age-friendly
resources. Access to high-quality nursing home care in rural
communities and investments in long-term services and support
(LTSS) are needed to allow rural residents to access support
and care at home or in their local communities. As mentioned,
Medicare often does not provide coverage for many LTC costs.
Residents of rural communities who are Medicare beneficiaries
tend to use more skilled nursing services and have a higher
rate of covered days as compared to urban communities.ix
Funding for LTC services as well as reimbursement adjustments
for these facilities can help prioritize, sustain, and increase
support for health infrastructure for rural older adults.
Nutrition: Reliable access to nutritious food is
foundational to healthy aging, yet rural older adults face
higher rates of food insecurity and malnutrition due to limited
grocery access, long travel distances, and rising food and fuel
costs. In nearly one in five rural counties, there is no full-
service grocery store at all and more than 20 percent of rural
Census tracts qualify as food deserts.x,xi For older adults who
no longer drive, this means that even basic staples like fresh
produce and medication snacks become difficult or impossible to
obtain. OAA nutrition programs directly counter these
conditions. Congregate meals provide structured social
engagement and routine safety checks, reducing the risk of
cognitive decline and loneliness. Home delivered meals like
Meals on Wheels support older adults who are homebound or have
mobility limitations. These meals in rural communities are not
simply supplemental, they are the primary balanced meal of the
day and a key part of managing diabetes, hypertension, stroke
recovery and heart disease.
Overall, rural communities are home to a large population
of older adults. Many factors contribute to the challenges and
barriers this population faces in terms of healthcare access.
The OAA is a key solution to help improve social drivers of
health, offer support to care-givers and rural adult health
needs, and address key issues in health workforce and
infrastructure in rural communities. Addressing these
challenges can help improve the overall health and disease
management of older adults in rural areas.
NRHA thanks the Committee for the opportunity to weigh in
on supporting the health of the older population living in
rural areas throughout the country. For further information on
this topic, please reference NRHA's policy brief, Older
Americans Act: Greatest economic and social needs of older
rural adults. If you have any questions or would like to
discuss our response further, please contact NRHA's Government
Affairs and Policy Director, Alexa McKinley Abel.
Sincerely,
/s/
Alan Morgan
Chief Executive Officer
National Rural Health Association
---------------------------------------------------------------
(i) US Census Bureau. U.S. older population grew from 2010 to
2020 at fastest rate since 1880 to 1890. Census.gov. Published
May 25, 2023. Accessed November 12, 2025. https://
www.census.gov/library/stories/2023/05/2020-census-
unitedstates-older-population-grew.html
(ii) RUPRI Center for Rural Health Policy Analysis. Nursing
Homes in Rural America: A Chartbook. 2022. Accessed November
12, 2025. https://rupri.org/wp-content/uploads/Nursing-Home-
Chartbook.pdf
(iii) National Council on Aging. What is the USDA Home Repair
Loans and Grants Program? Published October 2, 2024. Accessed
November 12, 2025. https://www.ncoa.org/article/what-is-the-
usda-single-family-housing-repair-loans-and-grants-program
(iv) Bishaw A, Posey K. A comparison of rural and urban
America: Household income and poverty. US Census Bureau Blog.
Published 2016. Accessed October 28, 2019. https://
www.census.gov/newsroom/blogs/randomsamplings/2016/12/a--
comparison--of--rura.html
(v) Robert Wood Johnson Foundation. Housing and health.
Published May 2011. Accessed November 12, 2025. https://
www.rwjf.org/en/insights/our-research/2011/05/housing-and-
health.html
(vi) Gunja MZ. Rural Americans struggle with medical bills and
health care affordability. The Commonwealth Fund. Published
July 24, 2023. Accessed November 12, 2025. https://
www.commonwealthfund.org/blog/2023/rural-americans-struggle-
medicalbills-and-health-care-affordability
(vii) Siuba JM, Carroll E, Haire E, et al. Addressing social
isolation in older adults as a determinant of health. In: Pack
MH, ed. 2023. Accessed November 12, 2025. https://imph.org/wp-
content/uploads/2023/06/imph-social-isolation-2023-
accessible.pdf
(viii) Bureau of Labor Statistics. Occupational Employment and
Wage Statistics (OEWS) tables. Published April 2, 2025.
Accessed November 12, 2025. https://www.bls.gov/oes/current/
oes291141.htm
(ix) National Rural Health Association. Rural nursing home
landscape: White paper. Accessed November 12, 2025. https://
www.ruralhealth.us/nationalruralhealth/media/documents/
advocacy/white%20paper/rural-nursing-home-landscape-white-
paper-.inal.pdf
(x) The Food Trust. The grocery gap: Who has access to healthy
food and why it matters. Accessed November 12, 2025. https://
thefoodtrust.org/wp-content/uploads/2022/06/
grocerygap.original.pdf
(xi) US Department of Agriculture Economic Research Service.
Food Access Research Atlas: Documentation. Accessed November
12, 2025. https://www.ers.usda.gov/data-products/food-access-
research-atlas/documentation
U.S. Senate Special Committee on Aging
"Renewing Our Commitment: How The Older Americans Act
Uplifts Families Living With Aging-Related Diseases"
November 5, 2025
Statements for the Record
VISIONS/Services for the Blind and Visually Impaired Statement
As the President and CEO of VISIONS/Services for the Blind
and Visually Impaired-one of New York State's oldest and most
trusted nonprofit organizations serving older adults who are
blind or visually impaired-I thank you for your leadership in
advancing the reauthorization of the Older Americans Act.
For nearly a century, VISIONS has empowered tens of
thousands of older adults to remain active, independent, and
engaged in their communities despite vision loss. Today, the
four leading causes of blindness-age-related macular
degeneration, cataracts, glaucoma, and diabetic retinopathy-
affect millions of Americans, and their prevalence increases
dramatically with age. These are not just medical conditions;
they are life-changing diagnoses that threaten safety,
mobility, and emotionalwell-being-think of not being able to
prepare food safely for yourself in your own home, not being
able to take a walk safely on your own, or communicate through
your smartphone that you need help.
Through programs supported in part by the Older Americans
Act and by our partnerships with the New York State Commission
for the Blind and local area agencies on aging, VISIONS
provides the essential services that make independence
possible:
Vision rehabilitation training that helps older adults
safely navigate their homesand neighborhoods;
Orientation and mobility instruction that restores
confidence to walk, travel, andparticipate in community life;
Assistive technology support that teaches individuals to
use adaptive devices,magnifiers, and screen readers to stay
connected to loved ones; make telehealth appointments, support
and social engagement programs that combat isolation and
depression, financial independence through online banking,
allowing older adults to continue living where they choose-with
dignity and purpose.
Caregiver support services that equip unpaid family
members with the resources,respite, and guidance they need to
sustain care at home, helping older adults remain safely in
their communities and reducing the need for costly nursing home
placement.
As our population ages, the need for these services will
more than double in the next 25 years. Without reauthorization
and sustained investment in the OAA, the network of providers
like VISIONS-those who are on the front lines every day helping
older adults maintain independence-cannot keep pace with the
growing demand.
At VISIONS, we witness daily the transformative impact of
coordinated, community-based care envisioned by the OAA. A 78-
year-old New Yorker who has lost her sight to glaucoma can
learn to cook safely again. A retired veteran with diabetic
retinopathy can use speech-enabled technology to pay bills and
stay connected to family. These are not extraordinary stories-
they are everyday outcomes made possible because Congress has
chosen, time and again, to invest in independence, dignity, and
community for older Americans.
I urge Congress to reauthorize and strengthen the Older
Americans Act, ensuring that older adults with vision loss and
other disabilities have continued access to the vital supports
they need to live full and meaningful lives.
Thank you for your commitment to our nation's seniors and
to the organizations that serve them.
Respectfully submitted,
Molly E. Eagan
President & CEO
VISIONS/Services for the Blind and Visually Impaired, New
York, NY
[all]