[Senate Hearing 119-301]
[From the U.S. Government Publishing Office]
S. Hrg. 119-301
AGING IN PLACE:
THE IMPACT OF COMMUNITY
DURING THE HOLIDAYS
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
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WASHINGTON, DC
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DECEMBER 3, 2025
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Serial No. 119-20
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
62-922 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......................................................... 3
PANEL OF WITNESSES
John Offerdahl, President, Offerdahl's Hand-Off Foundation
Oakland Park, Florida.......................................... 4
Jason Resendez, CEO National Alliance for Caregiving Washington,
DC............................................................. 5
Alison Barkoff, JD, Hirsh Health Law & Policy Associate Professor
and Director of the Hirsh Health Law & Policy Program, George
Washington University, Former Acting Assistant Secretary for
Aging and Administrator, Administration for Community Living,
Department of Health and Human Services, Washington, DC........ 7
Emily Ladau, Disability Rights Advocate and Author of
Demystifying Disability, West New York, New Jersey............. 9
APPENDIX
Prepared Witness Statements
John Offerdahl, President, Offerdahl's Hand-Off Foundation
Oakland Park, Florida.......................................... 28
Jason Resendez, CEO National Alliance for Caregiving Washington,
DC............................................................. 30
Alison Barkoff, JD, Hirsh Health Law & Policy Associate Professor
and Director of the Hirsh Health Law & Policy Program, George
Washington University, Former Acting Assistant Secretary for
Aging and Administrator, Administration for Community Living,
Department of Health and Human Services, Washington, DC........ 33
Emily Ladau, Disability Rights Advocate and Author of
Demystifying Disability, West New York, New Jersey............. 36
Questions for the Record
Alison Barkoff, JD, Hirsh Health Law & Policy Associate Professor
and Director of the Hirsh Health Law & Policy Program, George
Washington University, Former Acting Assistant Secretary for
Aging and Administrator, Administration for Community Living,
Department of Health and Human Services, Washington, DC........ 41
Emily Ladau, Disability Rights Advocate and Author of
Demystifying Disability, West New York, New Jersey............. 50
Statements for the Record
Statements from Alabama.......................................... 53
Statements from Alaska........................................... 59
Statements from Arizona.......................................... 60
Statements from Arkansas......................................... 68
Statements from California....................................... 70
Statements from Colorado......................................... 103
Statements from Connecticut...................................... 119
Statements from Delaware......................................... 123
Statements from District of Columbia............................. 126
Statements from Florida.......................................... 127
Statements from Georgia.......................................... 140
Statements from Hawaii........................................... 142
C O N T E N T S
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Page
Statements for the Record (cont'd)
Statements from Idaho............................................ 144
Statements from Illinois......................................... 146
Statements from Indiana.......................................... 155
Statements from Iowa............................................. 173
Statements from Kansas........................................... 176
Statements from Kentucky......................................... 183
Statements from Louisiana........................................ 184
Statements from Maine............................................ 188
Statements from Maryland......................................... 189
Statements from Massachusetts.................................... 201
Statements from Michigan......................................... 211
Statements from Minnesota........................................ 225
Statements from Mississippi...................................... 228
Statements from Missouri......................................... 230
Statements from Montana.......................................... 235
Statements from Newbraska........................................ 237
Statements from Nevada........................................... 238
Statements from New Hampshire.................................... 239
Statements from New Jersey....................................... 240
Statements from New Mexico....................................... 259
Statements from New York......................................... 261
Statements from North Carolina................................... 410
Statements from Ohio............................................. 418
Statements from Oklahoma......................................... 428
Statements from Oregon........................................... 432
Statements from Pennsylvania..................................... 438
Statements from Rhode Island..................................... 449
Statements from South Carolina................................... 450
Statements from South Dakota..................................... 456
Statements from Tennessee........................................ 457
Statements from Texas............................................ 462
Statements from Utah............................................. 477
Statements from Vermont.......................................... 479
Statements from Virginia......................................... 480
Statements from Washington....................................... 495
Statements from West Virginia.................................... 502
Statements from Wisconsin........................................ 505
Statements from Wyoming.......................................... 509
Statements from Organizations, Nonprofits, and Providers......... 510
Additional Statements............................................ 1032
AGING IN PLACE:
THE IMPACT OF COMMUNITY
DURING THE HOLIDAYS
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Wednesday, December 3, 2025
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:10 p.m., Room
216, Hart Senate Office Building, Hon. Rick Scott, Chairman of
the Committee, presiding.
Present: Senator Scott, Moody, 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's hearing is meant to bring
attention to an incredibly important issue for so many of
America's seniors, especially as we move into the holiday
season. We are here to focus on how to best serve older
Americans who want to spend their senior years in the comfort
of their own homes.
While there are so many positives about aging in place that
we'll highlight today, we're also here to shine a light on the
often-unreported crisis of isolation and loneliness. We should
be doing everything possible to support seniors who strive to
age in place, and today we'll focus on how Congress can
reauthorize the Older Americans Act, known as the OAA to
continue many critical programs that support seniors with this
goal.
Last week, we all celebrated Thanksgiving, and later this
month families across America will be celebrating Hanukkah and
Christmas. For many of us, that means spending time with family
and loved ones. My case, I got to help my five-year-old
granddaughter win UNO. She loved giving away plus fours to
people.
I learned two-thirds of how to do a Rubik's Cube because
that's what my twelve-year grandson does.
Senator Gillibrand. Wow. Impressed.
The Chairman. He told me that the last part was the
hardest. While these moments are a time to cherish time with
loved ones, they can also be a difficult reminder of loss for
older Americans who no longer have the ability to spend the
holidays with their friends, spouse or even their children.
We all know the importance of taking care of our seniors.
For many older Americans who choose to age in place, our goal
should always be to help them have the best possible care and
support. They should always have the opportunity to remain in
the homes and neighborhoods they love.
That is why community, strong families, faith-based
organizations, volunteers, OAA programs are so important to our
aging population, especially during this time of year. In my
home State of Florida, which is quite a bit warmer than it is
here, there are many seniors who cannot travel during the
holiday season.
Thankfully, many communities have the resources to give our
seniors the care and attention they deserve. Combating the
feeling of isolation and loneliness for our aging community has
endless benefits from better mental and physical health to
stronger multi-generational relationships with families and
communities, supporting healthier, more resilient communities.
We can all agree that community matters. Strong families,
faith-based organizations, volunteers, and the program
supported by the OAA create the foundation that allows older
Americans who choose to age in place to remain in the homes and
neighborhoods they love. That's why supporting the successful
programs made possible by the OAA ensuring how faith-based
groups, nonprofits, and service organizations strengthen
families is so important to the work of this Committee.
During the holidays, when both loneliness and the demand
for caregiving arise, these supports become even more critical.
Aging place is good for families, communities, and taxpayers.
Strengthening these programs is a bipartisan commitment to
dignity, independence, and the American way of life.
For 60 years, the OAA has helped innumerable seniors by
promoting social connection and life affirming support
programs. Over 10 million older Americans a year are helped by
programs covered by the OAA. The OAA continues to serve as the
backbone of many assistance programs that help ensure older
Americans can age in place with dignity.
I'm proud to work with Ranking Member Gillibrand as well as
Health, Education, Labor and Pension Committee Chairman Cassidy
and Ranking Member Sanders to fight for the reauthorization of
this important piece of legislation, which is a critical tool
in our arsenal to support seniors. I'm also working with fellow
committee member Senator Warnock on legislation to address
senior home loneliness through Older American Act funding. By
Senior Act expands the scope of grants to include services that
address the loneliness epidemic facing seniors.
I'm working to pass bipartisan legislation to create a non-
refundable tax credit aimed at adults who provide certain care
for their parents or older relatives in multi-generational
households. My hope is that with this hearing, we can examine
how strong community networks help older adult age in place,
especially during the holiday season when isolation caregiver
stress and multi-generational pressures peak.
Now, I can recognize Ranking Member Gillibrand from the
cold, cold state today of--it's snowy there?
Senator Gillibrand. It's cold.
The Chairman. It's snowy, too.
Senator Gillibrand. Yes, I bet it is.
The Chairman. For her opening statement.
OPENING STATEMENT OF SENATOR
KIRSTEN E. GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Thank you, Mr. Chairman. Thank you for
calling today's hearing. Thank you to our witnesses. Thank you
for being here. The holidays are when communities come
together. Whether you celebrate with family or friends or loved
ones, sharing this heartfelt season with the people you love
makes all the difference in the world.
However, building and participating in one's community is a
year-round endeavor and one that can pose unique challenges for
older adults and people with disabilities. The most important
mechanism that enables this kind of participation is home and
community-based services, or HCBS. HCBS is almost exclusively
available through Medicaid, and the availability of services is
tied to federal funding.
Our witnesses today will discuss the importance of these
programs and how they allow older adults and people with
disabilities to live in their communities, which is their
overwhelming preference to institutional care. With this in
mind, I am pleased to enter more than 600 statements from
people, families, and organizations about the impact of HCBS
for older adults and people with disabilities into the
congressional record.
Our witnesses will also discuss the importance of including
these populations in decision-making processes that directly
impact them. This is why today I'm reintroducing my Strategic
Plan for Aging Act. This bill will help states create multi-
sectoral plans for aging, including those who are aging with a
disability, while ensuring the needs, preferences, and views of
the people directly impacted are prioritized in the development
and implementation of a plan.
I'm especially proud to introduce this bill today on the
International Day of Persons with Disabilities. People with
disabilities should always be included in decisions about their
lives, health, and well-being. I look forward to the discussion
about my Strategic Plan for Aging Act that will help create
inclusive and effective state plans. Thank you, Mr. Chairman.
The Chairman. Thank you, Ranking Member. I'd like to
welcome our witnesses, all of whom work to ensure aging
Americans and seniors with disabilities age in place,
especially during the holidays, to ensure they remain safe and
engaged.
First, I'd like to introduce John Offerdahl. John, who
proudly hails from the great State of Florida is the president
of Offerdahl's Hand-off Foundation. In 2012, Mr. Offerdahl
established the Offerdahl Hand-off Foundation. His
organization's mission is to "Feed the needs of those in
crisis."
In partnership with business, government, civic, and faith-
based organizations. When the Covid pandemic hit our Nation,
Mr. Offerdahl saw a need and stepped up in a big way to serve
seniors in Broward County. Mr. Offerdahl thanks for being here.
Please begin your testimony.
STATEMENT OF JOHN OFFERDAHL,
PRESIDENT, OFFERDAHL'S HAND-OFF
FOUNDATION OAKLAND PARK, FLORIDA
Mr. Offerdahl. Chairman Scott, Ranking Member Gillibrand,
and members of the Committee, it is an honor to speak with you
today about an issue affecting millions of older Americans,
ensuring that seniors can age in place with dignity, safety,
independence, and meaningful human connection.
As mentioned, my name is John Offerdahl, and I'm the Hand-
Off Meals for Seniors president. We are an older American Act,
home delivered meals service provider in Broward County. I've
been a resident of Broward County since 1986, when Coach Shula
drafted me as a Miami Dolphin. I went on to spend my entire 8-
year NFL career in South Florida.
Since then, my wife and I have owned restaurants and been
involved in charitable work, including our own Offerdahl's
Hand-Off Foundation. How does an NFL linebacker become a
provider of senior meals? Hand-Off Meals was born during COVID
when Miami Dolphin owners, Stephen Ross, reached out to Dolphin
alumni, who are also restaurateurs to produce and deliver
emergency meals in the neighborhoods surrounding Hard Rock
Stadium.
With additional support from generous partners, we
delivered more than one million meals across Broward County,
many for homebound seniors. In the years that followed,
emergency COVID funding through the Area Agency on Aging of
Broward County and the Florida Department of Elder Affairs,
allowed us to continue this work. By 2023, our team had
delivered hundreds of thousands of fresh restaurant quality
meals to vulnerable seniors and families who needed them most.
The success of these efforts led the Broward AAA, under the
leadership of CEO Charlotte Mather Taylor, to rethink a new
model for its home delivered meals program. For the first time,
rather than awarding one contract to the lowest cost frozen
meal provider, our program, Hand-Off meals was one of four
contracts awarded after a competitive bidding process.
Today, Hand-Off Meals for Seniors is the leading meal
provider in Broward County, delivering more than 4,500 fresh
restaurant quality home delivered meals every week. Now, this
is why I'm here today. I want to emphasize why the improvements
in this model matter. Broward County reflects the future of our
Nation. Florida has one of the highest concentrations of
seniors in America and Broward's population of adults over 85
is projected to increase by 169 percent over the next 25 years.
The choice between aging in the home or entering
institutional care often hinges on improvements unleashed by
competition. Here are four improvements we have driven so far
in Broward County.
One, competition among providers promotes better quality,
better services, and outcomes. Providers like us are food
centric, not large institutional frozen meal brokers. Most
meals we deliver include fresh salads, sandwiches, fruits,
vegetables versus institutional frozen meals. While fresh
ingredients and real time production are more expensive, local
production and scattered restaurants across Broward County
creates decentralized pickup points that make the system
efficient and sustainable.
Two, competition among providers inspires innovation and
efficiencies that lower costs. Providers can leverage a
restaurant's purchasing power, fixed cost, and community
commitment to provide high quality meals at a sustainable rate.
Discounting profits and service of the community-oriented
mission.
Three, competition among providers invigorates public
private partnerships. Funding partnerships have expanded,
supported by organizations like the Jim Moran Foundation,
Community Foundation of Broward, Miami Dolphins Foundations,
public charities, Walgreens, to help cover the gap between
public funds and the elevated cost of quality restaurant fresh
meals.
Fourth, competition among providers give seniors more
choice. Seniors retain personal agency over their choice of
choice of meals, delivery, relationships, and aging in place
decisions. In conclusion, this is the kind of improvement we
all hope to see from our government programs. Better outcomes,
lower costs, invigorated partnerships, and more choice.
Competition among home delivered meal providers is good for
the body and soul of our aging and place seniors. At every
level, this work is a public private partnership, and the Older
American Act is the backbone of the team. As Coach Shula taught
us, in life as in football, it takes a team.
Chairman Scott, Ranking Member Gillibrand and members of
the Committee, the Hand-Off Meals for Seniors program
demonstrates what becomes possible when fresh high-quality
nutrition is paired with consistent human connection and
allowed to compete for the hunger and heart of our seniors.
I invite every member of this Committee to visit us in
Broward County, meet our volunteers, talk with our seniors, and
join my wife Lynn, and me on one of our weekly meal deliveries.
I truly believe you'll be inspired. Thank you.
The Chairman. Thank you, Mr. Offerdahl. Now, we're going to
hear from Jason Resendez. He's the CEO of National Alliance of
Caregiving. In this role, he spearheads research policy and
innovation initiatives to build wealth, health, and equity for
Americans, 53 million family givers. Please begin your
testimony.
STATEMENT OF JASON RESENDEZ, CEO NATIONAL
ALLIANCE FOR CAREGIVING WASHINGTON, DC
Mr. Resendez. Good afternoon, Chairman Scott, Ranking
Member Gillibrand, and members of the Committee. Thank you for
the opportunity to testify about the role that family
caregivers play in enabling older adults to age in place in
their communities. My name is Jason Resendez and I'm the
president and CEO of the National Alliance for Caregiving.
For nearly 30 years, we've documented the experiences of
America's family caregivers and right now we are living through
a profound demographic shift. Every day, 10,000 Americans turn
65. This is a tremendous achievement but it presents challenges
that largely fall on the shoulders of our Nation's family
caregivers who make up the backbone of our Nation's long-term
care system.
These are our neighbors, our coworkers, our friends, our
family members, many of you, and they've never been under more
pressure. According to our landmark caregiving in the U.S. 2025
research with AARP,63 million Americans, nearly one in four now
provide care for a loved one who is aging seriously ill or is
living with a disability. That's a nearly 50 percent increase
since 2015.
This surge mirrors a critical reality. 70 percent of older
Americans need long-term services and supports during their
lifetime. Caregiving has become more prevalent, more intensive,
and more isolating. One in three family caregivers are in the
sandwich generation, providing care for children and adults
simultaneously. On average, they spend 27 hours per week
providing care and nearly one in four provide 40 or more hours
weekly, the equivalent of a full-time job.
These caregivers provide complex support, more than half
administer medications, manage special diets, and change
feeding tubes and family caregivers enable something Americans
overwhelmingly desire, the ability to age and receive care at
home. This matters for two fundamental reasons.
First, dignity at home. When people age in place, they
maintain control over their care and their lives. Second,
simple economics. We can support more than two people at home
for the cost of one person in a nursing facility but despite
their heroism and their economic value, caregivers face a
growing crisis. Nearly two thirds experience high emotional
stress, 45 percent report physical strain.
Nearly half have experienced negative financial impacts
because of their care responsibilities and these impacts are
not evenly distributed. Caregivers of color, rural, lower
income and youth caregivers face the greatest hardships. For
example, 28 percent of lower income caregivers cannot afford
basic expenses like food compared to eight percent of higher
income caregivers. Congress recognized this reality 25 years
ago when it created the National Family Caregivers Support
Program through the Older Americans Act.
The program provides what caregivers need most. Respite
care, counseling, training, and referral services,
acknowledging the vital role that family caregivers play in
supporting older adults, yet we must go further. Under current
Medicaid rules, access to institutional care is an entitlement.
While staying at home requires a waiver, we need to flip this
paradigm. The right thing should be to remain in your home with
institutional care as an option, the backup not the default.
Consider this, as of 2020 just 12 states spent at least
half their Medicaid long-term care dollars on home and
community-based services for older adults and adults with
physical disabilities. That means 39 states still spend the
majority on institutional care. In these places, older
Americans and people with disabilities who need long-term
support often don't have real options to stay at home.
The older Americans Act demonstrates what's possible when
we invest in keeping people at home through home delivered
meals, transportation, and caregiver support. We must
reauthorize and fully fund Older Americans Act programs to
strengthen the aging network that connects family caregivers
with the support they need, and we must pair these investments
with smart economic policies that recognize the true value
family caregivers contribute to our economy. We already have a
strong legislative foundation to build on.
The multi-generational home caregiver tax credit led by
Senator Scott and Welch acknowledges the essential work that
family members provide within intergenerational households and
the Family Act introduced by Ranking Member Gillibrand would
establish a national paid family and medical leave program,
giving workers the security they need to care for loved ones
without sacrificing their financial stability.
Along with the Older Americans Act, these bills represent
concrete steps toward building a care infrastructure that
supports families across generations. After nearly three
decades of listening to family caregivers tell their stories,
one truth is undeniable. These are ordinary Americans doing
extraordinary work that benefits all of us.
When we invest in family caregivers, we strengthen families
and build communities where no one faces their hardest moments
alone. That's what makes community living possible.
Thank you for this opportunity to testify today and I'm
happy to answer your questions.
The Chairman. Thank you, Mr. Resendez. Now, I'd like to
recognize Ranking Member Gillibrand to introduce our next
witnesses.
Senator Gillibrand. Thank you, Chairman Scott. I'd like to
introduce our next witness, Alison Barkoff. Professor Barkoff
is the director of the Hirsh Health Law and Policy Program at
George Washington University. Professor Barkoff led the
administration for Community living ACL in the U.S. Department
of Health and Human Services from 2021 to October 2024, serving
as ACL administrator and assistant secretary for Aging.
Previously, she served as special counsel for Olmstead
Enforcement in the Civil Rights Division of the U.S. Department
of Justice. Professor Barkoff, you may begin your testimony.
STATEMENT OF ALISON BARKOFF, JD, HIRSH HEALTH LAW &
POLICY ASSOCIATE PROFESSOR AND DIRECTOR OF THE
HIRSH HEALTH LAW & POLICY PROGRAM, GEORGE
WASHINGTON UNIVERSITY, FORMER ACTING ASSISTANT
SECRETARY FOR AGING AND ADMINISTRATOR,
ADMINISTRATION FOR COMMUNITY LIVING, DEPARTMENT
OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC
Dr. Barkoff. Good afternoon, Chairman Scott, Ranking Member
Gillibrand, and members of the Committee. Thank you for
inviting me to participate in today's hearing on Community
Living and Aging in place. My name is Alison Barkoff, and I
have more than 25 years' experience in disability, aging, and
community living policy. The vast majority of older adults and
people with disabilities want to live in their own homes and
communities instead of in nursing homes or other institutions.
It allows them to be with family and friends, participate
in community activities, work or volunteer, and age in place.
Community living is cost effective and leads to better
outcomes, and federal laws and Supreme Court precedent
establish the right to receive services in the community
instead of institutions.
The demand for community living is growing exponentially
with more than 10,000 people turning 65 every day and disabled
people living longer, often with aging caregivers. There has
been bipartisan support for policies and programs that make
community living possible.
Many older adults and disabled people require assistance to
live in their own communities and age in place. I'm going to
briefly discuss the major programs that provide these supports.
First and most importantly, Medicaid funds, home, and
community-based services, or HCBS. HCBS includes home care,
senior day programs, disability employment supports, respite
care and more.
Neither private health insurance nor Medicare cover these
services and most people cannot afford to pay out of pocket.
Medicaid law requires states to provide institutional care but
HCBS are optional. States can cap enrollment in HCBS programs
leading to more than 600,000 people on waiting lists. The aging
and disability communities have urged Congress to address this
institutional bias and put HCBS on equal footing with
institutional care.
Despite their optional nature, states have been steadily
expanding their HCBS programs. These efforts must continue and
accelerate to meet growing demand and need, yet reductions in
Federal Medicaid spending to states could put optional services
like HCBS at risk for cuts. Older Americans Act programs also
help people age in place. They support one in five Americans
over 60 with personal care, transportation, family caregiver
supports home delivered meals and more.
OAA programs complement Medicaid. They can serve people who
aren't yet eligible or on HCBS' waiting list. Annually, they
save hundreds of millions of dollars to Medicare and Medicaid
by preventing unnecessary emergency room hospital and nursing
home admissions. Many OAA programs already have waiting lists
and demand is quickly growing.
Reauthorization of the OAA and increased investment in its
programs is critical to helping older adults age in place.
Other programs provide community living supports for disabled
people of all ages. This includes independent living services
and Developmental Disabilities Act programs that help people
access community services.
Demand for these programs similarly, outpaces need and
continued investment in them is essential. We often forget
about the "H" in home and community-based services, but people
cannot live in the community without a home that is both
affordable and accessible. Less than five percent of housing
stock is accessible, and many older adults and disabled people
spend more than a third of their income on housing, often
foregoing medical care or food.
Many are at risk of homelessness and the fact is, older
adults are the quickest growing homeless population. Federal
housing programs are also critical to community living.
Finally, the Administration for Community Living funds and
overseas community living programs and leads cross agency
initiatives to address barriers like housing and workforce
shortages. Importantly, ACL coordinates to ensure that older
adults and disabled people are considered across federal
policies.
ACL has been impacted by HHS' reduction in force, losing
almost half of its staff this calendar year. Congress should
ensure that ACL is sufficiently resourced to fulfill its
statutory mandates, support its programs, and coordinate policy
across the Federal Government. Thank you for this opportunity
to testify about the importance of community living and what it
takes to make that a reality for the millions of older adults
and people with disabilities in this country. Thank you.
Senator Gillibrand. I want to move to our next witness,
Emily Ladau. Ms. Ladau is a disability rights activist, author,
speaker, and digital communications consultant. In her current
role, she provides consultation and editorial services and
manages online presence and communications strategies for
multiple disability related organizations and initiatives.
In addition to her written work being published in outlets,
including New York Times, SELF, Salon, Vice, HuffPost, Ms.
Ladau is author of Demystifying Disability: What to Know, What
to Say, and How to Be an Ally. Ms. Ladau, you may now begin
your testimony.
STATEMENT OF EMILY LADAU, DISABILITY RIGHTS
ADVOCATE AND AUTHOR OF DEMYSTIFYING
DISABILITY, WEST NEW YORK, NEW JERSEY
Ms. Ladau. Chairman Scott, Ranking Member Gillibrand, and
distinguished committee members, I am honored to testify on
this auspicious day as December 3rd is the International Day of
People with Disabilities. I am a proud disability advocate and
my mission is to harness the power of storytelling as a tool to
expand accessibility and inclusion for all.
As a 34-year-old, my story may seem out of place at a
hearing about aging in place but the disability perspective is
especially pertinent to today's focus on the impact of
community. I want to emphasize that more than one in four
adults in the United States have a disability and of this
group, 43.9 percent are adults aged 65 or older. For those who
are not yet disabled, there is a significant likelihood of
aging into disability.
Neither a person's age nor disability status should ever be
a barrier to being among loved ones in our homes and
communities. When I was a teenager, my parents and I took a
trip to Florida to visit my grandparents for a holiday
celebration. At the time, my grandpa was in the midst of an
extended hospital stay but his doctor permitted him to come
home for a few hours to join us for a holiday meal.
As my family was cooking, I sat with my grandpa while he
opened the day's mail. He began to weep over the simple act of
being able to do a task in his own home. It is the only time I
ever saw him cry, and as I look back on this moment, I realized
just how strongly it underscores the immense importance of
being home and not just for the holidays.
I was born with my physical disability, so I know well the
essential nature of supports and services that empower me to
thrive at home and in my community and how fortunate I am to
have had access to them throughout my life. When my mom, who
has the same disability as me, was born in 1961, a family
member suggested that my grandparents place her in an
institution.
Thirty years later when I was born, no one made this
suggestion to my parents. Instead, following my stay in the
neonatal intensive care unit, a public health nurse connected
my mom with resources to ensure that I would receive the care I
needed. Because of this, I was able to have regular physical,
occupational and speech therapy starting at just a few months
old.
By the time I began kindergarten, I was approved for
ongoing Home and Community-Based Services, or HCBS, thanks to
the New York State Care at Home Medicaid Waiver. Medicaid
provided me access not only to vital therapeutic services, but
also to home modifications that enabled me to function as
independently as possible in my family's home. Medicaid also
assisted in the acquisition of durable medical equipment such
as my power wheelchair.
As you can see by the fact that I'm here today, my
wheelchair gives me freedom to be out and about in the
community. Unfortunately, the Medicaid asset limit, which has
been a mere $2,000 for over 35 years, became prohibitive to my
future career and relationship goals. In my early thirties, I
found myself at an inflection point. I wanted to forge ahead in
my career and build a life with my partner, but I was trapped
in an inflexible system that imposes caps and penalties on
people in exchange for access to life saving services.
With family support, which most people cannot afford, I
took a risk and decided not to reapply for Medicaid. That said,
what I am sharing is not a success story about transitioning
off Medicaid as this choice has meant foregoing needed care,
such as in-home physical therapy multiple times per week, which
I can only access through the Medicaid program.
The story here is that HCBS provided by Medicaid was what
set me up for success. This past October, I married the love of
my life and my husband and I are now seeking a community to
call home near our families in New Jersey. We are searching for
somewhere accessible for my physical needs at this stage of our
lives as well as for our future needs so we can safely age in
place. This search has proven arduous in a housing market where
accessible homes are nearly non-existent.
Our experiences are a stark reminder that the stakes of
today's hearing are much higher than heartwarming tales of
being home for the holidays. Without access to HCBS and without
efforts to prioritize housing in communities that work for
everyone, people with disabilities and older adults will all
too easily be pushed out of our homes and communities and into
institutionalized settings, denied opportunities for everything
from education and employment to recreation and socialization.
We won't be the only ones missing out. Our friends,
families, colleagues, and neighbors will miss out on all we can
contribute to our communities, both socially and economically.
This isn't just about making treasured holiday memories with
loved ones, although that is a beautiful part of the human
experience. It's also about fostering a country where all of us
can grow older, assured by the notion that we will always have
a place to call home. Thank you.
The Chairman. You have a choice. It's cold in New Jersey.
It's not so bad in Florida. It's pretty nice right now. Now,
we'll go to questions. Let's start with Senator Moody.
Senator Moody. Thank you, Chairman Scott, and I think
Florida is experiencing a massive influx at the moment. He
continues to be a cheerleader, having been the former Governor
and contributing so much to its success now and why so many
people want to move there, but we will always welcome others.
In fact, we are known as the Sunshine State but we're also
known as the Silver State. For good reason, almost a quarter of
our population is considered seniors, and that is why on this
small committee you have the two Florida Senators both
participating and engaging on these very important issues. They
affect so many of Floridians and we think it's important and we
welcome a Floridian with us today.
We're so glad to have you, so proud of you and your career,
but not just what you accomplished on the field, but certainly
what you have done for your community since. Such a benefit to
the State of Florida and those that call Florida home, so,
thank you for being with us. Aging in place is so very
important and we know that the Older Americans Act in many ways
helps with stability and meaningful assistance to families who
are often stretched thin by caregiving responsibilities.
I think a hearing like this is so very important. I thank
Chairman Scott and Ranking Member Gillibrand for convening this
hearing focusing on specific programs, yes, but also overall on
the Older Americans Act and how it provides critical support to
seniors and their families. It also helps build community for a
growing number of seniors in America who are living alone.
Some of the statistics, according to the National Council
on Aging show that 28 percent of adults, 65 and older live
alone, and as we approach the end of the year, we're reminded
that many seniors will face this holiday season in isolation,
and so, we want to ensure that the Older American Act continues
to offer programs that help older adults strengthen their
connections and build supportive communities so this doesn't
have to be the case.
With that said, I have a few questions for our witnesses,
and certainly, listening to your testimony, I'm kind of going
to go off. I planned some subjects I wanted to talk about, but
I was really interested in your testimony, Mr. Resendez. You
were talking about how there's kind of a flop of where we
should be prioritizing, where we're focusing our resources.
Right now, I believe you have to have a waiver to stay at
home, and you were commenting on some proposed legislation
specifically by Senator Scott regarding a tax credit. Can you
tell us would any of those concerns be addressed by either the
proposed legislation and if not, what would you recommend for
Congress to address to kind of right size that approach?
Mr. Resendez. Absolutely. One of the key things to your
question around Senator Scott's legislation is the immense
financial strain that family caregivers face or nearly 50
percent of family caregivers report experiencing at least one
negative financial impact due to caregiving. Out of pocket
costs conservatively due to caregiving is around $7,000 a year,
and a lot of those expenses are not tax deductible.
Anything we can do for the tax code to better recognize the
contributions and expenses associated with caregiving can help
to alleviate some of those financial strains that family
caregivers face, and then on the imbalance, what we see is an
imbalance between home and community-based spending at the
state level and spending on institutional care.
There are examples where states are making efforts to set
targets for rebalancing dollars toward more or less costly
home-based care versus institutional care, so, there are
options to explore, to rebalance that spending at the state
level.
Senator Moody. I know there are many of us that are pushing
to re-up the Older Americans Act. I've co-sponsored that, I
know. Both our Ranking Member and our Chairman are pushing for
that. Are there specific things within that legislation that
would address that imbalance?
Mr. Resendez. The Older Americans Act as Alison highlighted
greatly compliments home and community-based services. Fully
funding and reauthorizing the Older Americans Act, increasing
funding for the Older Americans Act. One of the things that we
see in our data is between 2015, in 2025 we've seen a nearly 50
percent increase in the number of family care. It's 20 million
more family caregivers.
Senator Moody. What was that span that you were saying that
increased by----
Mr. Resendez. Ten years.
Senator Moody. Ten years.
Mr. Resendez. Ten years. Twenty million more caregivers in
ten years. Yet, funding for the Older Americans Act and the
National Family Caregiver Support Program specifically has
remained relatively the same. The demand has increased
significantly.
Senator Moody. Wait, in your testimony though, you
mentioned that you believe, if we took away the incentives that
would push people into institutional care as opposed to at home
caregiving, that you believe we might even be able to save
money by doing that, because I think you said, and I could be
wrong, that it's twice as costly to care for someone in organ
institution setting versus being at home, so, with this rise in
demand, are you saying that we could still save money per
person if we were to shift those resources to in-home
caregiving?
Mr. Resendez. Absolutely. Helping folks provide care in
their homes for longer enables us to save on things like the
cost of institutionalized care, the cost of ER visits, so, when
we support people providing care in the home, we can save money
over the long term. We've seen that within the Older Americans
Act.
For example, one of the things that we've seen from
research for Older Americans Act programs like the National
Family Caregiver Support Program in respite, is that family
caregivers report that when they have that support, they can
provide care for longer durations.
Senator Moody. We may be able to mitigate the increased
costs associated with the increased demand 50 percent more in a
decade by shifting that to more in-home care?
Mr. Resendez. Absolutely.
Senator Moody. Thank you, Chairman.
The Chairman. Thank you, Senator Moody. Senator Kim.
Senator Kim. Thank you, Chairman. Thank you to the four of
you for coming on out here. Ms. Barkoff, I'd like to bring you
in on this conversation. Just given your background here, in
your testimony you stated home and community-based services
include a wide range of care and support that neither private
health insurance nor Medicare even cover.
Medicaid funding allows for services to exist and ensure
people can comfortably age in place. Yet there are lots of
concerns about Medicaid cuts and I guess I wanted your thoughts
on this. Could you share how cuts to Medicaid can lead to
devastating impacts for home and community-based services and
what consequences this would have on programs that serve older
adults and people with disabilities?
Dr. Barkoff. Thank you, Senator Kim for that question, and
as you mentioned, the primary funder and the way we are able to
help keep the majority of older adults and people with
disabilities in their own homes is through the Medicaid funded
Home and Community-Based Services Program. States must have
balanced budgets and we have seen historically that despite the
huge demand for more home and community-based services, that
when budgets are reduced, states, the first thing to go are
optional services.
As my colleague, Mr. Resendez spoke about the fact that
institutional care must be provided to anyone who meets that
level, but if you want to choose to get in-home care, you have
to sit on a waiting list. What we saw, actually, I conducted a
study with other researchers about what states did during the
Great Recession when we saw cuts and every single state cut
home and community-based services around the 2010 to 2013
timeframe, despite wanting to be able to serve more people.
As states are beginning to look at their State Medicaid
budgets, implement new laws, it's very, very important for the
aging and disability communities to make sure people understand
it is a pennywise and a pound foolish to make those kinds of
cuts.
Senator Kim. As we're thinking about strengthening the home
and community-based services, we also need to be addressing the
workforce shortages that limit access to those services, so,
the administration for community living, ACL, is critical
component of achieving that, which is why it's so critical that
it stays intact.
From your experience Ms. Barkoff with ACL, could you share
what federal strategies would be most effective to support
recruitment, training, and retention in the direct care
workforce?
Dr. Barkoff. I was very proud that during the time that I
was leading ACL we really heard from stakeholders about the
importance of strengthening the direct care workforce and
launched the Direct Care Workforce Strategy Center. It's very
critical to work directly with states on how we can improve
these jobs.
We need to have better pay, we need better opportunities to
advance in these careers and we really need to bring respect to
these jobs. It's critical that as states are implementing these
new rules, we are already starting to see cuts in rates to
providers, which translates to even lower rates to direct
support professionals and direct care workers.
If someone can get paid more working at Target or at
McDonald's than doing this incredibly important but not well-
paid work, the shortages that we have will be so much worse.
Senator Kim. Yes. Ms. Ladau, I wanted to just bring you in
on this as well. You said "Without access to HCBS and without
efforts to prioritize housing and communities that work for
everyone, people with disabilities and older adults will all
too easily be pushed out of their homes." You also shared the
risk you are taking as well by not applying for Medicaid due to
asset limits being so restrictive.
I guess I wanted to ask you, how should Congress address
the reality? Even with HCBS, many people with disabilities
cannot benefit from these programs because of a lack of readily
accessible housing and the financial reality that qualifying
for HCBS makes it difficult to rent or buy a home?
Ms. Ladau. Thank you so much for this question, Senator
Kim, and as a newer resident of your state who is currently in
the process of searching for a home, I really do appreciate the
opportunity to talk about this because people with disabilities
are so often trapped in this catch 22 of wanting to be able to
live at home and thrive in their communities, but then facing
the significant red tape that comes with getting the supports
and services that they need.
For me, I faced the quite frankly, impossible choice of do
I stay on these life sustaining Medicaid services or do I
recognize that the asset cap is holding me back and take a
flying leap, quite frankly, to leave this program. It is an
unfair choice that no one should have to face.
I really want to name that this is not a choice that anyone
should have to make, but the answer is not to cut funding for
HCBS, it's actually to make economically savvy policy choices
that would first of all focus on incentivizing accessible
housing stock and raising the asset limit for Medicaid.
Right now, the asset limit, which I mentioned in my
testimony, is $2,000, that hasn't been adjusted for inflation,
that hasn't been adjusted since before I was born, so, when you
think about that, I mean, that alone is reason enough to deter
people from wanting to pursue a career, to pursue finding a
house because they're stuck by this asset limit.
The other thing I want to name is I did a little research
and double checked and there's a study from 2023. The Kaiser
Family Foundation found that the cost of long-term
institutionalized care was around $11,000 more expensive than
HCBS for Medicaid beneficiaries, so, ensuring policies that
complement rather than contradict each other just makes good
financial sense.
Senator Kim. Thank you. With that, I'll yield back
Chairman.
The Chairman. Thank you, Senator Kim. Mr. Offerdahl, what
role do local partnerships such as nonprofits or faith-based
groups play in extending the reach of OAA services?
Mr. Offerdahl. Okay. Nonprofits play a huge role
specifically this year in the fourth quarter, our Hand-Off
Meals for Seniors kicked off a campaign for volunteer delivery
drivers. We find that volunteers coming, especially through
faith-based organizations like churches and synagogues really
have a heart for people and to serve them, not only to deliver
them food.
Our efforts were pretty strident. Our goal was 150, we got
to about 35 but it isn't over, and we're going to continue to
work hard on that because we find that our paid delivery
drivers engage. They do wellness checks, but they have a
delivery that has to go onto the next house.
Volunteers really are the ones that are looking for a
relationship, a connection with our seniors, and they have the
ability to come in and just address and look for those concerns
in the environment of the home, maybe appliances or things that
concern them with the behavior or the acuity of maybe their
seniors, and then refer them back to our aging district. That
type of connection is so much more valuable.
Volunteers are huge part of that. Again, our faith-based
agencies that hopefully provide most of those will becoming
stronger and stronger, and it takes a while. We've been in this
for a year and a half going on two and we've got another three
years, so we really want to build that up.
The Chairman. Thank you. Mr. Resendez, what local
approaches other than congregate meals have been most
successful in reducing social isolation among older adults,
especially during the holiday season?
Mr. Resendez. Absolutely. Through the Older Americans Act
specifically, there are a range of services provided through
the Aging Services Network that help to address social
isolation including, and especially for family caregivers. We
see in our research that one in four family caregivers
experiences social isolation.
That's actually up from what we saw just five years ago,
so, things like individual counseling, support groups, and
training for family caregivers provided through the National
Family Caregiver Support Program helps us to address that
growing trend around social isolation.
The Chairman. Thank you. Ms. Barkoff, what we hear
frequently about the sandwich generation concerning people who
are caring for both children and aging adults, how do a OAA
programs better support these families and benefit seniors who
are trying to age in place?
Dr. Barkoff. The Older Americans Act, actually, one thing
people don't know about the Family Caregiver Support Program is
that it supports basically any family caregiver who is caring
for--who is more than 50 years old and caring for anyone other
than a child with a disability.
It actually has a whole breadth of caregivers that are part
of those programs, and the Older Americans Act provides
supports like respite and the support groups that Jason
mentioned, but it also helps families access services, so, if
you are caring for a child as well as an aging parent, you may
be able to take advantage of senior centers and adult day
programs that can really help.
Respite care is critical to family caregivers and that
combined with some of the disability programs that the ACL also
funds can really provide a great compliment of programs to
support all types of caregivers, including Sandwich caregivers.
The Chairman. Thank you. Ms. Ladau, what steps can local
communities take to make holiday programs more accessible for
older adults who are not only trying to age in place, but also
have disabilities as well?
Ms. Ladau. Thank you so much for this question, and as I
mentioned during my testimony, this has far reaching
implications, well beyond simply celebrating the holidays, but
during the holidays, people should be able to access
festivities like anyone else, and first and foremost, I think
about the fact that many festivities are closed to certain
people simply because they cannot access their family members'
homes because those homes are not accessible.
When we're thinking about how we can increase inclusion
within the community, we first need to be thinking about the
housing stock and how we can improve and incentivize creating
accessible homes. For programming within the community, we need
to be thinking about how we can do it in an accessible way.
For example, many local towns, including the one that I
used to live in, have holiday shopping events where you go
around, you support local businesses. It's meant to be a boon
for the local economy. However, as a wheelchair user, I often
cannot get into many of these local shops because they are not
made wheelchair accessible, thereby excluding me from the
festivities, but also excluding my wallet from the festivities.
When we're thinking about how we can create fun and
accessible holiday festivities, we need to be mindful of the
fact that these shops need to be accessible, not just for a
Christmas shopping experience or a Hanukkah shopping
experience, but all year round, and the economic impact will
pay in dividends.
The Chairman. Thank you. Let me turn it over now to Senator
Alsobrooks.
Senator Alsobrooks. Thank you so much to Chair and invite,
and our Ranking Member for holding this hearing today, and
thank you as well to each of our witnesses for taking time to
be here. I often speak in this Committee about my own
experience and I know that my experiences is so similar to so
many other Americans. As a caregiver, as a member of what's
known as the sandwich generation, and it is true that every
single day I balance my role as a United States Senator with
that of being a mother and a daughter, ensuring that my aging
parents have the care they need as they navigate the health
challenges that if we live long enough, we'll surely come.
Countless Americans share my story and strive to make their
own family members live with dignity and access to the care
they need, and yet, so many are left without the resources or
necessary community support and many more seniors are without
family to advocate for them or the resources they need to
afford to care.
They unfortunately slip between the cracks. I just can't
imagine what the average American does. I have to tell you, in
my own experience, I had a really sweet moment just last night
with my mother who has dementia and my father has been her
caregiver now for the last couple of years.
Like so many families, it is often the caregiver who then
becomes sick, and so he was recently given a really, really
serious cancer diagnosis, and so it has just brought to bear
the struggles that so many have with having the care they need
at night and so on and so forth.
It has really--it continues to help me understand how
important this is, so, I'm joined here today by tremendous
advocates for seniors and individuals with disabilities,
including the former Assistant Secretary for Aging and Head of
the Administration for Community Living under the Biden
administration.
I'm also proud to introduce the Strategic Plan for Aging
Act, along with Ranking Member Gillibrand, building upon the
great work that my state is already doing to support community
living for seniors and individuals with disabilities, and so,
my first question for Ms. Barkoff is, professor, I want to just
mention that Secretary Kennedy has gutted the agency that you
used to lead with a reduction in force.
I would be remiss if I didn't ask you to briefly share for
the record the importance of that agency's work in advancing
independence for older adults and people with disabilities?
Dr. Barkoff. Thank you so much, Senator Alsobrooks for that
question. ACL is the only federal agency focused on community
living for older adults and people with disabilities, and what
many people don't appreciate is that ACL does not only fund and
oversee and support the incredible programs that we've been
talking about throughout this hearing, but it plays a critical
role in coordinating across of all of HHS and the Federal
Government to make sure that older adults and disabled people
are considered in all policies.
As you mentioned, ACL has been significantly impacted by
the reduction in force. Less than half the staff remain, the
entire policy team, evaluation team, every single one of its
regional staff, the grant team, the budget team, the
communication team, and external affairs, and ACL is having a
hard time doing what it needs to do to be able to play its
critical role in supporting the aging and disability networks,
and the unique role that it plays in coordinating programs.
I hope that Congress will continue to fund ACL and HHS will
continue to staff ACL to be able to meet its statutory mandates
and the critical role it plays in community living.
Senator Alsobrooks. Thank you, and you mentioned the staff
cuts but there have been staff cuts in the proposed
reorganization of the Administration for Community Living. As
you mentioned, undermine the agency's mission to help seniors
and others living with disabilities, and the Baltimore Sun
reported last month as well on the disturbing proliferation of
unlicensed assisted living facilities in my own state.
These facilities are housing elderly and vulnerable
residents in substandard conditions, all in exchange for their
social security or disability checks, and they're engaging in a
practice experts called benefit or senior trafficking, and so,
Professor Barkoff, you have extensive experience working both
to protect seniors and individuals with disabilities and going
after bad actors that abuse these populations from both your
time at HHS and the Department of Justice.
Can you talk to us about how can we give states the tools
to better monitor and go after these bad actors and prevent
them from operating unchecked?
Dr. Barkoff. Thank you for that question, and I also saw
this report, and the abuse and neglect and exploitation in
these types of unlicensed assisted living facilities,
unfortunately is not limited to Maryland. It exists really
across a number of states in these boarding care homes or adult
care homes.
It's incredibly important, ACL plays a major role in
implementing Elder Justice, the Adult Protective Services
Programs, the Long-term Care Ombudsman Program, really working
with states to prioritize how to identify this type of abuse
and neglect, how to make sure law enforcement knows how to work
with these networks.
What I can unequivocally say is when you look at and this
Committee has had a number of hearings on the resources
available to Adult Protective Services and Ombudsmen, it is
minuscule compared to the serious abuse and neglect that is
happening to older adults and people with disabilities.
Senator Alsobrooks. Thank you so much.
The Chairman. Thank you, Senator. Ranking Member
Gillibrand.
Senator Gillibrand. Thank you. To Alison Barkoff, average
electricity costs have risen 11 percent since January of this
year, which is more than three times the rate of inflation.
Families just can't keep up with the spiking costs,
particularly older adults on fixed income in the winter when
heating costs are necessary to keep them alive.
Approximately 2.4 million Americans rely on the LIHEAP
program, Low-Income Home Energy Assistance Program just to
afford their energy bills and make cost efficient repairs to
their heating systems. Can you tell us what ways does LIHEAP
support older adults and people with disabilities the ability
to live in their community of choice? How would funding cuts to
LIHEAP impact this population?
Dr. Barkoff. As you mentioned, so many older adults and
people with disabilities are living on fixed incomes and are
low income, and programs like LIHEAP are incredibly important
to help them be able to afford to stay in their own homes and
communities. LIHEAP is a program that is targeted to the people
who are most vulnerable to adverse health conditions when they
don't have access to adequate cooling or heating, and the
statistics based on HHS' own data is over 42 percent of LIHEAP
goes to households with older adults and more than 35 percent
to households with people with disabilities.
Cuts to this program can make remaining in the community
and aging in place both unaffordable and unsafe.
Senator Gillibrand. Thank you. For Emily Ladau, this past
weekend, we commemorated the 50th anniversary of the
Individuals with Disabilities Act or the IDEA. The IDEA
guarantees students in preschool and K-12, a free and
appropriate public education at the least restrictive setting
possible. The Department of Education plays a crucial role in
making this guarantee a reality for millions of students across
the country, including 550,000 students in New York State.
However, I was alarmed at the targeted reduction and forced
notices that were sent to the Office of Special Education
Programs within the Department of Education during the
government shutdown and they sent a letter imploring the
administration to immediately reverse these RIF notices.
Ms. Ladau, can you talk about how important accessibility
and reasonable accommodations are for students K-12 and how
cuts to the Department of Education will impact our students
with disabilities?
Ms. Ladau. Thank you, Senator Gillibrand. First of all, for
your advocacy to ensure that access to education for all
children remains intact, and also, for bringing up this very
vital topic, and I really want to be sure to draw a very clear
connection between this question and the topic of community
living.
Because being able to live at home and be the beneficiary
of HCBS is such a vital part of the equation that actually
allows kids with disabilities to attend school, which was true
for me because I grew up attending a local public school and I
had a section 504 plan that secured the reasonable
accommodations that I needed to fully participate and succeed
in school.
Both IDEA and also section 504 of the Rehab Act are really
essential protections for students, and the Department of
Education plays such a vital role in enforcing these laws and
distributing resources, so I, like you, have grave concerns
about these efforts to dismantle the Department of Education
through reductions in force, funding cuts, and also relocation
of key programs like moving the Office of Special Education
Programs to exist under HHS.
Which I do believe could send this country backward toward
segregating students based on diagnosis rather than expanding
educational opportunities, so, I'll just wrap up by saying that
I believe the changes that this administration is currently
pushing are not going to, as they claim, "Improve outcomes by
empowering parents, states and communities," but instead
threaten the futures of more than seven and a half million
students with disabilities who, like all students should have
access to education as a pathway to graduation, college or
career training, employment, and of course economic opportunity
in the community. Thank you.
Senator Gillibrand. Thank you. For Mr. Resendez, today we
have highlighted the services and supports that older adults
and people with disabilities need to live independently. These
services and supports are often provided by direct care workers
who assist older adults and people with disabilities, with
activities of daily living, such as dressing, and bathing in
home settings.
Unfortunately, these workers may face systemic challenges
and turnover in this workforce approaching 80 percent, they
already faced this in 2023. More recently, the Department of
Labor has published a proposed rule that would exclude home
care workers for minimum wage and overtime pay protections.
It's why I'm introducing my Domestic Workers Bill of Rights
Act next week to patch the flaws in existing labor laws to
ensure that workers who provide home and community-based
services and other domestic workers have the same rights and
dignity as workers in other professions. Could you please speak
to the importance of the direct care workforce and to both home
and community-based services and elaborate on some of the
challenges this workforce faces and how protections like those
outlined in my domestic workers bill of rights could help?
Mr. Resendez. Thank you for the question, Senator
Gillibrand. One thing is clear; family caregivers rely on
direct care workers. We see this in our research. One third of
family caregivers use paid help, direct care workers, home
health aides to help support their care recipients. This
partnership between family caregivers and direct care workers
is essential.
Without adequate paid help, family caregivers will shoulder
more intensive responsibilities. With 24 percent already
providing 40 or more hours of care a week. Our research shows
that 28 percent of family caregivers now have difficulty
finding affordable services like in-home healthcare up from 22
percent in 2015.
Anything that we can do to stabilize the direct care
workforce benefits not just these essential workers, but also
millions of family caregivers who rely on them as being part of
care teams to deliver care in the home sustainably for long
periods of time.
Senator Gillibrand. Thank you. Thank you, Mr. Chair.
The Chairman. Thank you, Ranking Member. Mr. Offerdahl,
what lessons from the Broward County pilot could be replicated
nationwide to modernize home delivered meals?
Mr. Offerdahl. Great question. One of the things that our
district did was our FPD for multiple service providers and the
four service providers that got awarded, two of them were
restaurant centric service providers, two of them were catering
service providers. The combination kind of covers all the
gamuts.
It's a great combination. Personally, I think one of each
category is probably more manageable by the aging district but
giving that the catering can do customized, they can do kosher,
they can do a lot of different things, the restaurants can do
on time production with fresh quality food. It provides a great
choice, a specialization of both service providers, but a
choice to the senior that I think they need, right?
The agency for a senior is critical in-home care, but in
also the choice of food, so, I think that alone, at the same
time the restaurant providers can contract out with other
restaurants for specific meals to create variety. We had a
relationship with Padrino's Cuban cuisine, that type of fresh
quality food and Broward County really connects, so, the
ability to do that along with others, it has to be--it has to
be profitable for the for the subcontractor, but they often
will discount their profits to be part of a community
engagement program that brings a lot of awareness and charity
to them.
I'm very excited because I have another three years to kind
of test this model and continue to improve it, and at the end
of the day, I totally believe that the seniors who are home
bound will receive the benefit of that effort.
The Chairman. That's great. Mr. Resendez, how would a
targeted tax credit for adults caring for aging parents help
families manage the pressures associated with multi-
generational living?
Mr. Resendez. We see one of the ripple effects of family
caregiving is financial impact. Nearly 50 percent of family
caregivers experiencing at least one negative financial impact.
Two thirds experiencing two or more negative financial impacts,
including going into debt, taking out high interest rate,
credit cards and loans.
Anything we can do to recognize the economic value that
family caregivers contribute and the economic cost of
caregiving on families is a step in the right direction. We
know that family caregivers spend on average $7,000 or more on
out-of-pocket expenses to support caregiving. Think about
things like adult diapers and things to make your home more
suitable for caring. Those things are not tax deductible, so,
targeted tax credits can help us in the tax code better
recognize and value the contributions of family caregivers,
particularly those within intergenerational household.
We know that 40 percent of family caregivers are living
with their care recipient. That could be a grandparent taking
care of a grandchild. It could be a son caring for his spouse
or his wife, or his grandmother, or mother with a serious
illness or a functional limitation.
The Chairman. Thank you. Ranking Member Gillibrand.
Senator Gillibrand. For Alison Barkoff. Today, we have
highlighted how we can support older adults and people with
disabilities so that they can live in their communities. One
way to enhance supports and services for older adults is multi-
sector plans for aging. These plans are state led cross-sector
strategic planning resources that help states transform the
infrastructure and coordination of services for older adults
and their families.
Today I will reintroduce my Strategic Plan On Aging Act.
The Strategic Plan for Aging Act creates a grant program under
the older Americans Act to incentivize and support states to
create their own multi-sector plans for aging and for people
with disabilities. Professor Barkoff, could you speak to how a
multi-sector plan for aging can improve supports and services
for older adults? What benefits and of including direct input
from older adults and people with disabilities in the
development of these plans?
Dr. Barkoff. Thank you for the question and thank you for
your leadership here. As we've talked about today, it takes a
lot of different supports and services for people to age in
place and stay in the community. That includes community-based
services and affordable housing, and accessible transportation,
and affordable healthcare.
Those services and supports cut across so many state and
local agencies, sectors, providers, and types of advocates, and
comprehensive and coordinated planning is absolutely critical,
and that's why more than a dozen states have begun this
comprehensive planning through multi-sector plans on aging. I
so appreciate your bill and in your comments, you're
highlighting that the experience of people with lived
experience is critical.
They are best positioned to be able to say what works and
doesn't work in the current system and where gaps are. It's
also incredibly important and we're seeing more and more with
states that people are including the disability community in
those efforts. As we've heard today, the largest population of
disabled people is older adults with disabilities, and the
common needs and priorities cut across so many areas.
Finally, I'll just mention when I was at ACL, seeing the
huge momentum, we worked on developing a strategic framework
for a national plan on aging and we tried to model exactly what
we were seeing in states bringing together agencies and
departments with expertise, so, thank you again for
reintroducing that act that I think will give a lot of momentum
and resources to existing state efforts and really encourage
that important aging and disability partnership.
Senator Gillibrand. Thank you, Alison. Emily, I want to ask
about some of the challenges during the holidays that people
with disabilities are often facing. First of all, accessibility
for air travel. In 2013, 11,527 wheelchairs and scooters were
mishandled by airlines. This mishandling can lead to costly
repairs and leave wheelchair users without the technology they
need to get around.
For many people, it's not just losing a chair, it's losing
their independence. Chairs are extremely expensive. That's why
I was disappointed to see the Department of Transportation was
delaying the implementation of regulation that would address
these harmful trends, so, can you discuss the importance of
accessible transportation, especially accessible air travel and
how delaying implementation of this regulation and impact will
impact people with wheelchair users?
The second question I have is about web accessibility,
because obviously when you're planning any time to go home, you
use the internet to book your air travel, you use the internet
to find hotels, you use the internet to do everything, and
we've really not met our requirements of making the internet
accessible at all. In 2022, this Committee released a report
that found web accessibility failures throughout the Federal
Government, including at agencies such as the Centers for
Disease Control and Prevention in the Department of Veterans
Affairs.
The VA's own reporting said approximately 90 percent of
websites at the Department of Veterans Affairs were not fully
accessible for people with disabilities as required by law, so,
maybe just touch on these two things and anything else you want
to bring up?
Ms. Ladau. Thank you, Senator Gillibrand. I am happy to
talk about these issues. I want to first actually address the
web accessibility part. This is very much intertwined with
travel because you often need to book your travel through a
website, and if that website is not accessible, it immediately
precludes you from being able to book your travel
independently, and this is an issue not just for people with
disabilities, but for older Americans who may struggle to keep
up with ever evolving technology.
Think of engaging with video content, think of watching a
movie with captions, accessibility benefits, everybody. It just
makes sense to implement accessibility and it makes the user
experience easier for everyone, and when it comes to air
travel, goodness knows, we need all of the improvements on
experience we can get. I will say that I am one of the 11,000-
plus people who has had my wheelchair damaged in the course of
a given year.
I'm going to be very honest that it made it very difficult
for me to go visit my grandmother before she passed away. She
lived in Florida. I was not able to go see her because I was so
afraid of my wheelchair breaking on an airplane that I instead
chose not to make that trip because it was going to be so
incredibly challenging knowing that my wheelchair had
previously been broken.
When I flew across the United States from New York to
Oregon, I found that my joystick had been completely sheared
off when I landed and had to hold it together with duct tape
and with zip ties, and I would just ask everyone to imagine if
that was somebody's legs that were being held together with
duct tape and zip ties.
All of that is to say that whether you are visiting a loved
one, whether you are taking a holiday trip, whether you're a
grandparent using a scooter who just wants to enjoy Disney
World with their grandkids, you should be able to travel
knowing that your mobility equipment will arrive intact, and
this is an essential form of community living because it is
indeed participating in the community.
It's not just the right thing to do, it also makes economic
sense to keep people moving around the world safely. Thank you.
Senator Gillibrand. This question is for Jason. Thank you
for discussing the Family Act in your opening statement, the
Family Act would create a national family and medical paid
leave program. Specifically, it would establish 12 weeks of
paid leave for serious medical and family events, including the
need to care for a loved one.
Can you go into further detail on why the Family Act is
necessary? What kind of hard choices are American families
forced to make when paid family leave is unavailable? Does the
National Alliance for Caregiving have any caregiver stories
that highlight those challenges?
Mr. Resendez. Absolutely. Thank you so much, Senator
Gillibrand. First, I want to say that there are 35 million
family caregivers who provide care while working at the same
time, so, without paid leave, these millions of family
caregivers face impossible choices between providing essential
care for loved ones, including older adults with serious
conditions like Alzheimer's or cancer, or maintaining their
financial security, and according to our data, they often
sacrifice both, leave jobs, deplete savings, and take on debt
with long-term consequences for their own retirement security
and economic stability.
In fact, half of all working caregivers report going in
late, leaving early or taking time off to provide care. We
heard from one such family caregiver, Marcy, a family caregiver
in Kansas, who provides care for both her mother and also her
grandson, who is ultimately forced to leave her job because of
her caregiving responsibilities.
She told us, "They needed more time than what I had, and I
couldn't take any more time off work. I was working 60 hours a
week and coming home and doing everything too, to lose that
income, it was a big hit." If we don't do more to help family
caregivers balance both the care that they need to provide and
the work they want to do, we're going to see more and more
examples like Marcy's.
The Chairman. One, the Ranking Member and I would like to
thank everyone for being here today and for the work you all do
to support older Americans and the families who care for them.
Aging in place is not only what many older Americans want, it's
also better for their health and better for their families. The
pressures on the sandwich generation are real and they'll grow
heavier this time of year. Community-based support and OAA
programs help lighten that burden and keep families strong. For
60 years, the OAA has been the backbone of critical services
that promote independence and social connection for older
adults.
That is why this Committee remains committed to working in
a bipartisan way to re-authorize the OAA and strengthen
programs that help seniors age in place. I look forward to
continue to work with members on this Committee.
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.
The Chairman. I thank each of you.
[Whereupon, at 4:27 p.m., the hearing was adjourned.]
=======================================================================
APPENDIX
=======================================================================
Prepared Witness Statements
=======================================================================
U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Prepared Witness Testimony
John Offerdahl
Chairman Scott, Ranking Member Gillibrand, and Members of
the Committee - It is an honor to speak with you today about an
issue affecting millions of older Americans: ensuring that
seniors can age in place with dignity, safety, independence,
and meaningful human connection. This is important every day of
the year, but especially during the holiday season, when social
isolation and food insecurity among older adults rise sharply.
Introduction
As mentioned, my name is John Offerdahl. I became a proud
resident of Broward County 40 years ago, when drafted by the
Miami Dolphins in 1986. I spent my entire eight-year NFL career
in South Florida, and for 36 of those 40 years, my wife Lynn
and I have owned and operated regional restaurant chains, which
we continue to run today. Throughout these decades, we have
remained deeply involved in charitable work across South
Florida-including through our Offerdahl's Hand-Off Foundation.
Background and COVID Experience
Now you ask, how does an NFL linebacker become an Older
American Act Home Delivered Meal service provider for the Area
Agency on Aging of Broward County? Let me tell you the story!
The Hand-Off Meals for Seniors program was born during the
onset of the COVID pandemic, when Miami Dolphins owner Stephen
Ross reached out to several of his Miami Dolphins alumni
players, who were also restaurateurs, to help produce & deliver
$1MM of weekly emergency meals to families and seniors in the
neighborhoods surrounding Hard Rock Stadium. With additional
support from generous partners, we delivered more than one
million meals across Broward County - many for homebound
seniors.
In the years that followed, emergency COVID funding through
the Area Agency on Aging of Broward County and the Florida
Department of Elder Affairs, allowed us to continue this work.
By 2022, our team had delivered hundreds of thousands of FRESH
meals to vulnerable seniors & families who needed them most.
These experiences revealed a truth still urgent today:
homebound seniors are a hidden population, often forgotten,
isolated, and deeply in need of dependable nutrition and
meaningful human contact.
A New Model for Home-Delivered Meals
The success of this effort led the Area Agency on Aging of
Broward County-under the leadership of current CEO, Charlotte
Mather-Taylor-to rethink its 48-year Older American Act home-
delivered meals program. Rather than awarding one contract to
the lowest-cost frozen meal provider, the Agency on Aging
awarded competitive contracts to multiple service providers.
This ultimately offered variety and choice to Broward County
homebound seniors.
Our foundation's program, Hand-Off Meals for Seniors, was
selected in 2023 for a six-month pilot contract based on our
proven ability to deliver fresh, restaurant-quality meals
paired with compassionate, relationship-centered service.
Seniors responded with overwhelming appreciation, and on
January 1, 2024, our program was one of four service providers
in Broward County awarded a five-year Older American Act Home
Delivered Meals contract.
Today, Hand-Off Meals for Seniors is the leading service
provider in Broward County delivering more than 4,500 fresh
home-delivered meals and wellness visits every week to over 450
homebound seniors across Broward County.
Why the Older Americans Act Matters
Broward County reflects the future of our nation. Florida
has one of the highest concentrations of seniors in America,
and Broward's population of adults over 85 is projected to
increase by 169% over the next 25 years.
Vulnerable, homebound seniors often live alone, without
family, caregivers, transportation, or the ability to shop and
cook making the need for support so huge that the Area Agency
on Aging maintains a long waiting list underscoring the urgent
need for strong, sustained investment in the Older Americans
Act.The choice between aging in the community or entering
institutional care often hinges on access to basic supports.
Allow me to highlight five "Basic Support" takeaways we
have learned in Broward County for the Committee to consider:
1. Healthy competition among meal providers drives better
quality, service and outcomes - Providers like us are food-
centric-not large industrial frozen-meal brokers. Most meals we
deliver offer FRESH salads, sandwiches, fruits, and vegetables
vs institutionalized frozen tv meals. While FRESH ingredients &
real time production are more expensive, local production in
scattered restaurant locations across Broward County create
decentralized pickup points that make the system efficient and
sustainable.
2. Healthy competition among meal providers inspires
innovation and efficiencies that mitigate costs - Providers can
leverage a restaurant's purchasing power, fixed costs, and
community commitment to provide high-quality meals at
sustainable rates-discounting profits in service of the
community-based mission.
3. Healthy competition among meal providers invigorates
stronger public-private partnerships - Funding partnerships
have expanded, supported by organizations like the Jim Moran
Foundation, Community Foundation of Broward, Miami Dolphins
Foundation, and Publix Charities to help cover the gap between
public funds & the elevated costs of restaurant quality, FRESH
meals.
4. Healthy competition among meal providers engages the
soul - A meal in our model is never just a meal. Delivery
drivers visit the same seniors each week, building trust and
companionship. These visits are also the moments when someone
notices memory decline, hazardous living conditions, or failing
appliances.
5. Healthy competition among meal providers gives seniors
the CHOICE! - Seniors retain personal for their choice of
meals!
Conclusion
This is the kind of improvement we all hope to see from
government programs: invigorated partnerships, better outcomes,
more choice, and an "age in place" option for seniors that will
cost less and be more innovative, responsive and personal, than
institutionalized care. Healthy competition among meal
providers is good for the body & soul of our aging in place
seniors. during the holidays and beyond!
At every level, this work is a public-private partnership-
and the Older Americans Act is the backbone of the team. As
Coach Shula taught us, "In life as in football. it takes a
team."
Chairman Scott, Ranking Member Gillibrand, and Members of
the Committee: aging in place is not merely a policy objective-
it reflects who we are as a nation. The Hand-Off Meals for
Seniors program demonstrates what becomes possible when FRESH,
high-quality nutrition is paired with consistent human
connection and allowed to compete for the body & soul of our
senior.
I invite every member of this Committee to visit us in
Broward County, meet our volunteers, talk with our seniors, and
join my wife and me for one of our weekly meal deliveries. I
give you my promise-you will be inspired!
Thank you for your time, your leadership, and your
commitment to strengthening the golden years of America's older
adults.
U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Prepared Witness Testimony
Jason Resendez
Good afternoon, Chairman Scott, Ranking Member Gillibrand,
and Members of the Committee:Thank you for the opportunity to
testify about the role that family caregivers play in enabling
older adults to age in place, in their community.
My name is Jason Resendez, and I am the President and CEO
of the National Alliance for Caregiving, a national
organization focused on transforming how our nation values its
more than 63 million family caregivers.
For nearly 30 years, we've documented and amplified the
experiences of family caregivers-their challenges, hardships,
and joys-while measuring our country's progress in supporting
their critical work.
We are living through a profound demographic shift. Every
single day, roughly 10,000 Americans turn 65. Medical advances
mean people are living longer than ever.\1\
---------------------------------------------------------------------------
\1\ U.S. Department of Health and Human Services, Aging.
Washington, D.C.: U.S. Department of Health and Human Services.
Available at: https://www.hhs.gov/aging/index.html
---------------------------------------------------------------------------
This is a tremendous achievement, but it also presents new
challenges-challenges that largely fall on the shoulders of our
country's family caregivers.
Today, these Americans make up the backbone of our nation's
long-term services and support system.Family caregivers are our
neighbors, our friends, and our family. They fill our schools,
workplaces, and places of worship.
And as we head into the holidays, many Americans will be
talking about caregiving issues with their family and friends.
It has become a "kitchen table" issue.
For those caring for older relatives, you might hear
someone talk about Dad's recent fall, his time spent in the
hospital and then his discharge home where he suddenly needs
someone to help him bathe, dress and prepare meals.
Change the name and the illness or health incident, but
this is going on daily, across America, and family caregivers
are the ones who step up and do the hard work - often on a
moment's notice.
The Growing Need
And their numbers are growing. According to new data from
the National Alliance for Caregiving and AARP's landmark
Caregiving in the US 2025 research, 63 million or one in four
Americans is now a family caregiver-representing a nearly 50
percent increase since 2015.\2\
---------------------------------------------------------------------------
\2\ AARP and National Alliance for Caregiving, Caregiving in the US
2025. Washington, D.C.: AARP. July 2025. Available at: https://
www.caregivingintheus.org
---------------------------------------------------------------------------
That's 20 million additional caregivers in just one decade.
This surge directly mirrors our aging population and a
critical reality: 70 percent of older Americans will need some
form of long-term services and supports during their
lifetime.\3\
---------------------------------------------------------------------------
\3\ ACL Administration for Community Living, "How Much Care Will
You Need?" Washington, D.C.: U.S. Department of Health and Human
Services. Available at: https://acl.gov/ltc/basic-needs/how-much-care-
will-you-need
---------------------------------------------------------------------------
Understanding who provides this care is essential. Sixty-
one percent of family caregivers are women and 38% are men,
with an average age of 51. The vast majority-89%-care for
relatives, most commonly a parent or parent-in-law (47%), and
nearly half support someone age 75 or older. Twenty-nine
percent are "sandwich generation" caregivers responsible for
both young children and older adults, with African American and
Latino American caregivers more likely to be in this dual
role.\4\
---------------------------------------------------------------------------
\4\ Op. cit.
---------------------------------------------------------------------------
Often, this care occurs within intergenerational
households-40% of caregivers live with their care recipient, a
figure that rises among lower-income caregivers, men, and
caregivers of color. The caregiver population reflects
America's diversity: 61% are non-Hispanic white, 16% Latino
American, 13% African American, and 6% Asian American/Native
Hawaiian/Pacific Islander. One in five caregivers lives in a
rural area, and nearly one-quarter are juggling care for
multiple recipients simultaneously.
Across these demographics, caregiving now requires greater
commitment-both in duration and intensity. Thirty percent of
caregivers have been providing care for five or more years.
They spend an average of 27 hours per week on caregiving
duties, with nearly one in four putting in 40 or more hours-
equivalent to a full-time job, and for 61%, this comes on top
of paid employment.
Family caregivers deliver comprehensive, complex support
that would otherwise require teams of paid professionals.
Seventy percent monitor their loved ones' health conditions and
adjust care accordingly. Nearly two-thirds communicate directly
with healthcare providers, serving as the crucial link in care
coordination.
More than half perform complex medical and nursing tasks
such as administering medications, managing special diets, and
providing wound care. Many provide around-the-clock support for
the people they love. Yet only 22 percent of caregivers
performing these complex medical tasks received any training.
When training is provided, 96 percent feel it prepared them
well highlighting both the gap and the opportunity.
As one caregiver, Maylia from California, shared: "I had to
give up a prosperous career and took jobs to work around their
schedule. I took a 90% pay cut and lived out of my savings,
which has been depleted." She went on to say, "Being a
caregiver is the hardest role... You are playing three or more
roles: taking care of your family members, the house, yourself,
your job."\5\
---------------------------------------------------------------------------
\5\ Op cit. p. 36 and p.39.
---------------------------------------------------------------------------
The Foundation of Our Healthcare System
As Maylia's story makes clear, family caregivers are
essential to healthcare delivery. They enable something
Americans overwhelmingly desire: the ability to age and receive
care at home, in their communities, surrounded by what's
familiar and meaningful to them.
This matters for two fundamental reasons:
First, dignity and freedom. When people remain in their own
homes, they maintain control over how and when they receive
care, and importantly, who provides that care. These choices
profoundly impact quality of life.
Second, basic economics. Annual nursing home costs average
approximately $120,000, compared to roughly $44,000 for 30
hours of weekly home-based care at $30 an hour.\6\ Put simply,
the cost of supporting one person in a nursing facility could
support more than two people at home, and when family
caregivers provide a substantial portion of this care-with
appropriate support-the savings to Medicaid grow exponentially.
---------------------------------------------------------------------------
\6\ Genworth Financial, Inc., Genworth and CareScout Release Cost
of Care Survey Results for 2024. Richmond, VA: Genworth Financial,
Inc.; March 2025. Available at: https://www.businesswire.com/news/home/
20250301584443/en/Genworth-and-CareScout-Release-Cost-of-Care-Survey-
Results-for-2024.
---------------------------------------------------------------------------
Congress recognized this reality nearly 25 years ago when
it amended the Older Americans Act to create the National
Family Caregiver Support Program. This program acknowledges
that supporting the caregiver is inseparable from supporting
the person receiving care. Yet funding has never matched the
growing need even as caregiver numbers have surged by 20
million in a decade.
The Crisis of Strain
Despite their heroism and economic value, family caregivers
face a growing crisis. Nearly two-thirds experience moderate or
high emotional stress, 45 percent report physical strain, and
nearly half have experienced at least one negative financial
impact. One-third have stopped saving entirely. Nearly one in
four report feeling alone, a figure that has increased since
2020.
Strikingly, 56 percent of caregivers felt they had no
choice in taking on their role, with profound consequences:
these caregivers experience nearly twice as many poor mental
health days as those who felt they had a choice.
Over the past decade, National Alliance for Caregiving data
show that family caregivers are struggling more-and for longer-
than ever before. Black, Latino, rural, and other
underrepresented communities - especially women -
disproportionately bear these hardships.
The financial toll is particularly acute for these
communities. African American and Latino American caregivers
are significantly more likely to take on debt, use up savings,
and be unable to afford basic expenses like food. Lower-income
caregivers, those already least able to weather financial
storms, are hit hardest, with 28 percent unable to afford basic
expenses compared to eight percent of higher-income caregivers.
Seven in ten working-age caregivers balance employment with
caregiving responsibilities. Half experience work disruptions-
arriving late, leaving early, or taking time off. Working
caregivers actually report feeling more isolated than non-
working caregivers and face greater financial strain.
While access to caregiver-friendly workplace benefits has
improved, salaried workers enjoy significantly better access
than hourly workers creating an equity gap that policy must
address.
This is where Older Americans Act programs become
essential. The National Family Caregiver Support Program-a
cornerstone of the OAA-provides the very services caregivers
need most: respite care, counseling, training, and information
services. Delivered through our national aging network of Area
Agencies on Aging, these programs offer a lifeline to
caregivers struggling to manage alone.
Dianne, a family caregiver from Green Bay, Wisconsin, put
it this way: "The Older Americans Act helped me, the primary
caregiver, have a few precious moments to myself to recharge.
It provided relief to an already tight budget stretched thin
with additional supply costs. I cannot imagine what other
families are having to sacrifice in order to care for their
loved ones."\7\
---------------------------------------------------------------------------
\7\ National Alliance for Caregiving, Dianne's Story. Washington,
D.C.: National Alliance for Caregiving; n.d. Available at:https://
www.caregiving.org/care--stories/dianne-2/
---------------------------------------------------------------------------
U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Prepared Witness Testimony
Alison Barkoff
Good afternoon, Chairman Scott, Ranking Member Gillibrand,
and Members of the Committee. Thank you for inviting me to
participate in today's hearing.
My name is Alison Barkoff. I have more than 25 years'
experience in disability, aging, and community living policy. I
am the Hirsh Health Law and Policy Associate Professor and
Program Director at George Washington University.\1\ I
previously served as the Acting Assistant Secretary for Aging
and Administrator of the Administration for Community Living
and held leadership roles related to community living in the
Centers for Medicare & Medicaid Services, Departments of Labor
and Justice, and several non-profit organizations. I also bring
my lived experience as a sibling of a brother with intellectual
disabilities to my work.
---------------------------------------------------------------------------
\1\ I am testifying in my individual capacity and not on behalf of
the university.
---------------------------------------------------------------------------
Preference for and Benefits of Community Living
The vast majority of older adults and people with
disabilities want to live in their own homes and communities
instead of in nursing homes or other institutions.\2\ It allows
them to remain with their families and friends, participate in
community activities, work or volunteer, and age in place. With
appropriate supports, people are generally happier and
healthier in the community.\3\
---------------------------------------------------------------------------
\2\ https://www.aarp.org/pri/topics/livable-communities/housing/
2024-home-community-preferences/
\3\ https://acl.gov/about-community-living
---------------------------------------------------------------------------
Supporting an individual in the community costs a fraction
of providing care in a nursing home or other institution.\4\ In
addition, federal laws and the U.S. Supreme Court have
recognized that people have a right to receive services in the
most integrated setting appropriate to their needs.\5\
---------------------------------------------------------------------------
\4\ https://acl.gov/about-community-living
\5\ See Olmstead v. L.C., 527 U.S. 581 (1999); https://
archive.ada.gov/olmstead/olmstead--about.htm; https://www.ada.gov/
topics/community-integration/
---------------------------------------------------------------------------
There has been strong bipartisan support for policies,
programs, and services that help older adults and people with
disabilities live in the community and age in place, such as
the Older Americans Act (OAA) programs and the Money Follows
the Person program that helps people transition from nursing
homes back to the community. The demand for community living is
expanding exponentially, with more than 10,000 people turning
65 every day and a growing population of disabled people living
longer (often with aging caregivers).\6\
---------------------------------------------------------------------------
\6\ https://www.kiplinger.com/retirement/turning-65-key-things-to-
know
Supporting Older Adults and People with Disabilities in the
---------------------------------------------------------------------------
Community
Medicaid-funded Home and Community-Based Services
Many older adults and disabled people require assistance to
live in their own homes and communities. Medicaid is the
primary funder of these supports, known as Home and Community-
Based Services (HCBS). HCBS include a wide range of services
such as home care, senior day programs or disability employment
supports, respite care, family caregiver supports, and
accessible transportation. Neither private health insurance nor
Medicare cover these services (despite many older adults
mistakenly believing they do), few people have private long-
term care insurance, and most people cannot afford to pay out-
of-pocket.\7\
---------------------------------------------------------------------------
\7\ https://www.kff.org/medicaid/issue-brief/10-things-about-long-
term-services-and-supports-ltss/
---------------------------------------------------------------------------
Medicaid is a state-federal partnership, and states design
their own Medicaid systems within federal law and guidelines.
States must provide nursing home and other institutional
services to people who are eligible because they are
"mandatory" services under Medicaid law. In contrast, HCBS are
"optional," meaning that states are permitted to cap enrollment
in their HCBS programs. Currently there are over 600,000 people
on waiting lists for HCBS.\8\ A top policy priority for the
aging and disability communities is to reverse this
"institutional bias" in Medicaid and put HCBS on equal footing
with institutional care.
---------------------------------------------------------------------------
\8\ https://www.kff.org/medicaid/a-look-at-waiting-lists-for-
medicaid-home-and-community-based-services-from-2016-to-2025/
---------------------------------------------------------------------------
Despite the optional nature of HCBS, states have expanded
their investments in HCBS over time, with increased funding,
new authorities and "rebalancing" funding from nursing homes
and other institutional settings to HCBS programs to better
match people's preferences. Nationally, 65 percent of state
Medicaid long-term care spending goes towards HCBS,\9\ but the
percentage varies significantly both by state and by aging and
disability sub-populations.\10\ Continuing efforts to expand
HCBS is essential to helping people remain in their community
and age in place, particularly in light of the growing demand
and need. Yet reductions in federal Medicaid funding to states
could put optional services, like HCBS programs, at risk for
cuts.\11\
---------------------------------------------------------------------------
\9\ https://www.medicaid.gov/medicaid/long-term-services-supports/
downloads/ltss-rebalancing-brief-2022.pdf
\10\ https://aspe.hhs.gov/sites/default/files/documents/
ad7cf66fb2a7ae1a0bd91b288363fc71/rebalancing-ltss-medicaid-enrolled-
brief.pdf
\11\ https://geigergibson.publichealth.gwu.edu/history-repeats-
faced-medicaid-cuts-states-reduced-support-older-adults-and-disabled-
people
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Older Americans Act ProgramsThe OAA funds a range of community-
based services to help older adults, including older adults
with disabilities, age in place, maintain their health, and
engage in their communities. This includes personal care
services, respite, transportation, family caregiver supports,
and senior nutrition programs. OAA programs support one in five
Americans over 60.\12\
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\12\ https://www.advancingstates.org/sites/default/files/2024-oaa-
roi-infographic-national.pdf
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OAA programs complement, but do not duplicate, other
programs like Medicaid HCBS. OAA programs often serve
individuals who are not yet eligible for Medicaid due to their
level of need or financial situation or who are on HCBS waiting
lists in their state. OAA programs also provide services that
other programs do not cover, like family caregiver supports or
meals.
OAA programs are cost effective. For example, one year of
home delivered meals costs less than one day in the hospital.
They also save hundreds of millions of dollars annually to
other programs like Medicare and Medicaid by preventing
unnecessary emergency room, hospital, and nursing home
admissions; OAA programs led to nearly two million extra days
living in the community instead of in hospitals or nursing
homes. Every dollar invested in OAA generates $3.39 in
community value and taxpayer savings.\13\
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\13\ https://www.advancingstates.org/sites/default/files/2024-oaa-
roi-infographic-national.pdf
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As the population of older adults continues to quickly
grow, the demand for OAA-funded services has outpaced their
capacity. Many programs already have long waiting lists,
including one in three Meals on Wheels Providers.\14\ In
addition, the demand on OAA programs is expected to increase as
federal funding to other programs that older adults rely upon,
like Medicaid and the Supplemental Nutrition Assistance Program
(SNAP), decrease.
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\14\ https://www.mealsonwheelsamerica.org/news/meals-on-wheels-
america-calls-for-donations-this-giving-tuesday-and-all-giving-season-
long-to-ensure-no-senior-is-left-hungry-and-alone-during-the-holidays/
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The OAA has long had bipartisan support. In the 118th
Congress, the Senate passed bipartisan legislation to
reauthorize the OAA and strengthen its programs.
Reauthorization of the OAA and increased investment in its
programs is a top priority for the aging community and an
important step to supporting older adults to age in place.
Independent Living and Other Disability Programs
Independent living programs, authorized and funded under
the Rehabilitation Act, help support disabled people of all
ages to live, work, and participate in their communities. Local
Centers on Independent Living (CILs) provide a wide range of
supports, including assistance to people at risk of entering or
transitioning from institutions to the community, training on
independent living skills, transportation, and assistance with
finding a job or housing.\15\ Other programs funded under the
Developmental Disabilities Act, including State Councils on
Developmental Disabilities,\16\ Protection and Advocacy
Systems,\17\ and University Centers on Excellence in
Developmental Disabilities,\18\ help people with intellectual
and developmental disabilities and their families in accessing
community-based services. As with OAA programs, demand outpaces
growing need; continued investment in these programs is
essential to supporting the growing population of disabled
people, including those aging with and into disability.
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\15\ https://acl.gov/sites/default/files/programs/2023-12/CIL--
FactSheet--2023.508.pdf
\16\ https://acl.gov/sites/default/files/programs/2023-12/
DDCouncils--FactSheet.508.pdf
\17\ https://acl.gov/sites/default/files/2025-03/protection-
advocacy-factsheet-acl.pdf
\18\ https://acl.gov/sites/default/files/programs/2023-12/UCEDD--
FactSheet--2023.508.pdf
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Affordable Accessible Housing
For many older adults and disabled people, the lack of
affordable, accessible housing is a barrier to community
living. A recent AARP report found that housing affordability
and accessibility are a significant challenge for nearly half
of older adults.\19\ Less than five percent of housing stock is
accessible.\20\ Many older adults and disabled people pay more
than one-third of their income on housing, often requiring them
to spend less on food or needed medical care and placing them
at risk of homelessness.\21\ As a result, these populations
comprise the majority of people experiencing or at risk of
homelessness, with older adults being the quickest growing
homeless population.\22\ Supporting community living and aging
in place will require increased investments in affordable,
accessible housing; cuts to housing programs could force people
into more expensive nursing homes and other institutional
settings or into homelessness.
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\19\ https://press.aarp.org/2024-12-10-New-AARP-Report-Majority-
Adults-50-plus-Age-Place-Policies-Communities-Catch-Up
\20\ https://www.housingwire.com/articles/less-than-5-of-american-
homes-are-accessible-for-the-disabled-elderly/
\21\ https://aspe.hhs.gov/sites/default/files/documents/
9ac2d2a7e8c360b4e75932b96f59a20b/addressing-older-adult-
homelessness.pdf
\22\ https://endhomelessness.org/blog/paint-by-numbers-older-
americans-and-homelessness/
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Multisector Plans to Support Community Living
Supporting older adults and people with disabilities to
live in the community and age in place requires coordination
across systems, ensuring access to community-services,
affordable housing, accessible transportation, affordable
healthcare, and more. More than a dozen states have begun this
type of comprehensive planning - bringing together relevant
state and local agencies, community leaders, businesses, and
stakeholders - through a process to develop Multisector Plans
for Aging.\23\ Several states have explicitly included
disability in their planning efforts, recognizing the
significant number of people aging with and into disability and
the many common priorities between the communities. The
Strategic Plan for Aging Act, introduced by Ranking Member
Gillibrand, would help support states to develop and implement
Multisector Plans for Aging and Aging with Disabilities,
providing momentum to the important work already happening in
states and encouraging the important partnerships between aging
and disability in this effort to support community living.
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\23\ https://multisectorplanforaging.org/
The Role of the Administration for Community Living in
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Supporting Community Living
The Administration for Community Living (ACL) plays a
critical role in helping older adults and people with
disabilities live and participate in their own communities and
age in place. ACL is the only federal agency focused on
community living, elevating the issue and ensuring that older
adults and disabled people are considered in federal policies
across the Department of Health and Human Services (HHS) and
the federal government.
ACL funds and implements a wide range of aging and
disability programs that support community living, including
those under the OAA, Rehabilitation Act, and Developmental
Disabilities Act discussed above.\24\ACL has also launched
numerous initiatives to address barriers and increase
opportunities for community living for both older adults and
disabled people, including efforts to support family
caregivers,\25\ strengthen the direct care workforce,\26\ and
expand affordable, accessible housing.\27\
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\24\ https://acl.gov/programs/aging-and-disability-networks
\25\ https://acl.gov/ncsc
\26\ https://acl.gov/DCWcenter
\27\ https://acl.gov/HousingAndServices
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ACL has been impacted by HHS' proposed reorganization and
reductions in force. ACL has lost almost half of its staff over
this calendar year, threatening its ability to fully implement,
oversee, and support its aging and disability programs.
Consistent with the bipartisan support that ACL has enjoyed,
Congress should ensure that ACL is sufficiently resourced to
fulfil its statutory mandates, support its programs, and
continue its important coordination role across HHS and the
federal government.
Thank you for this opportunity to testify about the
importance of community living and what it takes to make that a
reality for the millions of older adults and people with
disabilities in this country. I'm happy to answer your
questions.
U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Prepared Witness Testimony
Emily Ladau
Chairman Scott, Ranking Member Gillibrand, and
distinguished Committee members, I am honored to testify on
this auspicious day, as December 3rd is the International Day
of Persons with Disabilities.
I am a proud disability advocate, and my mission is to
harness the power of storytelling as a tool to expand
accessibility and inclusion for all. As a 34-year-old, my story
may seem out of place at a hearing about aging in place, but
the disability perspective is especially pertinent to today's
focus on the impact of community. I want to emphasize that more
than 1 in 4 adults in the United States have a disability\1\
and of this group, 43.9% are adults aged 65 or older.\2\ For
those who are not yet disabled, there is a significant
likelihood of aging into having a disability. Neither a
person's age nor disability status should ever be a barrier to
being among loved ones in our homes and communities.
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\1\ Centers for Disease Control and Prevention. Disability Impacts
All of Us Infographic. Accessed November 26, 2025.https://www.cdc.gov/
disability-and-health/articles-documents/disability-impacts-all-of-us-
infographic.html.
\2\ Centers for Disease Control and Prevention, National Center on
Birth Defects and Developmental Disabilities, Division of Human
Development and Disability. Disability and Health Data System (DHDS)
Data. Acessed November 26, 2025. https://dhds.cdc.gov
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When I was a teenager, my parents and I took a trip to
Florida to visit my grandparents for a holiday celebration. At
the time, my grandpa was in the midst of an extended hospital
stay, but his doctor permitted him to come home for a few hours
to join us for a holiday meal. As my family was cooking, I sat
with my grandpa while he opened the day's mail. He began to
weep over the simple act of being able to do a task in his own
home. It's the only time I ever saw him cry. As I look back on
this moment, I realize just how strongly it underscores the
immense importance of being home-and not just for the holidays.
I was born with my physical disability, so I know well the
essential nature of supports and services that empower me to
thrive at home and in my community, and how fortunate I am to
have had access to them throughout my life. When my mom-who has
the same disability as me-was born in 1961, a family member
suggested my grandparents place her in an institution. Thirty
years later, when I was born, no one made this suggestion to my
parents. Instead, following my stay in the neonatal intensive
care unit, a public health nurse connected my mom with
resources to ensure I'd receive the care I needed.
Because of this, I was able to have regular physical,
occupational, and speech therapy starting at just a few months
old. By the time I began kindergarten, I was approved for
ongoing home and community-based services, or HCBS, thanks to
the New York State Care at Home Medicaid Waiver.
Medicaid provided me access not only to vital therapeutic
services, but also to home modifications that enabled me to
function as independently as possible in my family's home.
Medicaid also assisted in the acquisition of durable medical
equipment, such as my power wheelchair. As you can see by the
fact that I am here today, my wheelchair gives me freedom to be
out and about in the community.
Unfortunately, the Medicaid asset limit, which has been a
mere $2,000 for over 35 years, became prohibitive to my future
career and relationship goals. In my early 30s, I found myself
at an inflection point. I wanted to forge ahead in my career
and build a life with my partner, but I was trapped in an
inflexible system that imposes caps and penalties on people in
exchange for access to life-sustaining services, so, with
family support, which most people cannot afford, I took a risk
and decided not to reapply for Medicaid.
That said, what I am sharing is not a success story about
transitioning off Medicaid, as this choice has meant foregoing
needed care, such as in-home physical therapy multiple times
per week, which I can only access through the Medicaid program.
The story here is that HCBS provided by Medicaid were what set
me up for success.
This past October, I married the love of my life. My
husband and I are now seeking a community to call home near our
families in New Jersey. We're searching for somewhere
accessible for my physical needs at this stage of our lives as
well as for our future needs so we can safely age in place.
This search has proven arduous in a housing market where
accessible homes are nearly nonexistent.
Our experiences are a stark reminder that the stakes of
today's hearing are much higher than heartwarming tales of
being home for the holidays. Without access to HCBS and without
efforts to prioritize housing and communities that work for
everyone, people with disabilities and older adults will all
too easily be pushed out of our homes and communities and into
institutionalized settings-denied opportunities for everything
from education and employment to recreation and socialization.
But we won't be the only ones missing out. Our friends,
families, colleagues, and neighbors will miss out on all we can
contribute to our communities both socially and economically.
This isn't just about making treasured holiday memories with
loved ones, although that's a beautiful part of the human
experience. It's also about fostering a country where all of us
can grow older assured by the notion that we will always have a
place to call home.
Thank you.
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Questions for the Record
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Questions for the Record
Alison Barkoff
Senator Raphael Warnock
Question:
More than 47,000 older adults and individuals with
disabilities in Georgia rely on Medicaid Home and Community-
Based Services (HCBS) for critical personal care assistance,
meal delivery, and employment support. On July 4, 2025,
President Trump signed the One Big Beautiful Bill Act (OBBB)
into law, which cut nearly $1 trillion in Medicaid funding for
the next several years.
How will cuts to Medicaid from OBBB affect Georgians'
access to HCBS?
Response:
As I discussed in my written testimony, the Congressional
Budget Office has estimated that OBBB will lead to over $900
billion in reduced federal Medicaid funding to states over the
next 10 years. This is the largest cut to Medicaid in the
program's 60 years history.
States must have balanced budgets. To navigate reduced
federal Medicaid funding, states will either have to find new
funding - from new taxes or taking funding from another program
like education - or make cuts to their Medicaid spending.
Optional services under Medicaid are at highest risk for cuts.
Under Medicaid law, institutional services like nursing home
care are mandatory, but HCBS are optional.
History has shown that when states have funding shortfalls
in their Medicaid programs, HCBS are among the first to be cut.
I, together with researchers from University of California and
UMass Boston, examined state behavior during the Great
Recession in the 2010s. We found that every single state made
cuts to their HCBS programs in response to Medicaid budget
shortfalls. The full article is available here, and a table of
state-by-state cuts is here.
Cuts to HCBS can happen in different ways. States might
eliminate HCBS programs or reduce the number of HCBS "waiver
slots," leading to even longer waiting lists. They might cut
the hours or types of services available in an HCBS program. Or
states may reduce HCBS provider reimbursement rates, which are
already so low that they are limiting access to HCBS. KFF has
recently published a report on ways that states may manage
their HCBS spending in response to OBBB. All of these types of
cuts will hurt people with disabilities, older adults and their
families; these cuts could force people unnecessarily into
institutions and/or force families to take on even more care to
fill these gaps.
On a personal level, I am very concerned about cuts to
Georgia's HCBS programs. My adult brother with intellectual
disabilities is on Georgia's COMP Waiver. His waiver provides
him supports to live independently in an apartment with a
roommate, with a job coach that supports him at his job at the
Georgia Aquarium, and with supports and transportation to
participate in community activities. Our parents are in their
80's and would be unable to take on additional care if his
waiver supports are cut. Many families across Georgia are in
similar situations.
Question:
How will Georgians' access to these services compare to
individuals in states like Louisiana that have expanded
Medicaid?
Response:
It is difficult to compare the impacts of OBBB on HCBS
access between Medicaid-expansion and non-expansion states. All
states will face significant cuts to their federal Medicaid
funding, regardless of whether they have expanded Medicaid. For
non-expansion states like Georgia, the biggest impacts will
likely be from new limits on provider taxes, a strategy
virtually all states (including Georgia) use to finance their
share of Medicaid costs. In addition, Georgia may also be
impacted by OBBB's new limits on the use of state directed
payments to increase provider rates, limiting state strategies
for addressing low reimbursement rates for HCBS providers. The
Center for Law and Social Policy has recently released a
publication about the impact of Medicaid cuts in non-expansion
states, with state-level information. The publication is
available here.
As discussed in my previous answer, because all states will
face reductions in federal Medicaid funding, optional services
like HCBS are at risk of being cut to address those shortfalls.
Georgia already has approximately 7,300 people on its waiting
list for HCBS waivers. It is facing a direct care workforce
crisis due to low wages, and Georgia is still implementing a
settlement agreement with the U.S. Department of Justice to
expand access to HCBS in its developmental disabilities and
mental health systems to address its historical overreliance on
institutional care and underinvestment in HCBS. Cuts to HCBS
would undermine the efforts in that settlement, would place
people at risk of unnecessary institutionalization, and worsen
the long HCBS waiting list and workforce challenges.
Question:
The Trump administration cut the workforce at the
Administration for Community Living (ACL) by nearly half on
April 1, 2025 and proposes to dissolve the agency. Given your
prior experience as the Acting Assistant Secretary for Aging
and Administrator of the ACL, how will cuts to ACL's workforce
affect its important mission of serving older Americans and
individuals with disabilities?
Response:
ACL is the only federal agency focused on community living
for older adults and people with disabilities. Not only does
ACL fund, oversee and support important community living
programs like those funded under the Older Americans Act,
Developmental Disabilities Act, and more, but it plays a
critical role in coordinating across HHS and the federal
government to ensure that the unique needs of older adults and
disabled people are considered in federal policy.
ACL has been significantly impacted by the reductions in
force that have occurred at HHS. Nearly half of the staff is
gone, with the termination of the entire teams that work on
policy and evaluation, grants and budget, communications and
external affairs, as well as all regional staff. The
termination of staff has had significant impacts on ACL's
ability to get funding out to ACL grantees in a timely manner,
forcing grantees like Meals on Wheels providers and Protection
and Advocacy Systems to reduce services due to delays in
receiving funding following the passage of the Continuing
Resolutions in March 2025 and again this November 2025. The
elimination of the policy team has meant that there are no
staff remaining to continue ACL's important work with other HHS
agencies on policies that impact people with disabilities and
older adults, particularly policies related to HCBS issued and
implemented by the Centers for Medicare and Medicaid Services
(CMS), and the elimination of all regional staff has meant that
there are no staff in the field to provide technical assistance
to grantees and to coordinate responses in emergencies like
natural disasters.
Not only has ACL been impacted by termination of staff, but
HHS has proposed to eliminate ACL as its own agency and move it
as a sub-agency into the Administration for Children and
Families. This will further hinder ACL's ability to fulfill its
role coordinating aging and disability policy across HHS and
with other federal agencies.
In May, I testified at a hearing led by Senators Welch and
Baldwin entitled "Trump's Destruction of HHS: Mass Firings,
Reorganizations, and the Human Harm Caused." In my testimony, I
discussed the devastating harms caused by the termination of
staff, reorganization, and cuts proposed in the President's
Budget. Senator Welch's press release is here, with a link to a
video of my testimony. I also am attaching a copy of my written
testimony. In addition, I recently published an article in the
Public Policy and Aging Report, a peer-reviewed publication of
the Gerontological Society of America, entitled "How the
reorganization, staff terminations, and proposed program cuts
at the U.S. Department of Health and Human Services will impact
older adults and disabled people," with a focus on the impacts
at ACL. I also am attaching a copy of that article here.
Alison Barkoff - Attachment for "Questions for the Record"
Attachment 1: Alison Barkoff written testimony from May 21,
2025 Senate Democratic Spotlight Hearing, "Trump's Destruction
of HHS: Mass Firings, Reorganization, and the Human Harm
Caused."
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Alison Barkoff - Attachment for "Questions for the Record"
Attachment 2: Alison Barkoff. "How the Reorganization, Staff
Terminations and Proposed Program Cuts at the U.S. Department
of Health and Human Services Will Impact Older Adults and
Disabled People." Public Policy and Aging Report (Fall 2025).
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Questions for the Record
Emily Ladau
Senator Raphael Warnock
Question:
More than one in four adults live with a disability in the
United States. Employees with disabilities at the Department of
Health and Human Services (HHS), including Centers for Disease
Control and Prevention (CDC) workers in Georgia, are facing
unjust and haphazard policies that rescind reasonable
accommodations (RA) and create obstacles for reapplication.
As a disability rights advocate, why is teleworking an
important part of providing RAs?
How can Congress protect the rights of employees with
disabilities against unjust accommodation policies?
Response:
Thank you, Senator Warnock, for inquiring about these
essential topics. First, I'd like to address the value of
teleworking as a reasonable accommodation. I've been
teleworking in some capacity since 2013, well before it became
a more standard practice because of the COVID-19 pandemic. As a
physically disabled woman who did not yet have my driver's
license after I graduated college-because I needed more
intensive adapted lessons and an adapted vehicle-I worked
remotely starting with the first full-time job I had. This
reasonable accommodation proved to be essential as I began to
build a career in disability advocacy and communications,
allowing me to work from an environment that was fully
accessible for me (my home) so I could deliver my best work.
In the face of the devastation of the COVID-19 pandemic, it
was heartening to see how employers and employees alike
benefitted from implementing telework policies. It opened up
flexible and safe work opportunities, creating pathways to
employment for disabled people who could not previously sustain
jobs for any number of reasons, such as being immunocompromised
or having a chronic condition. As employers now continue to try
to shift back to in-person work, I urge them to keep in mind
that telework is not a barrier, but a boon for workplaces.
Regarding accommodation policies more broadly, I urge
Congress to recognize that reasonable accommodations are not
"special treatment" and to better understand the purpose that
they serve in the workplace. While some policymakers may
believe that reasonable accommodations are simply part of
"diversity, equity, and inclusion" initiatives that they are
insistent upon shutting down, the reality is that disability
does not choose political sides. Anyone can acquire a
disability at any time due to an accident or onset of an
illness, regardless of their views. As such, all employees
should always have access to reasonable accommodations. Beyond
that, reasonable accommodations are tools that empower
employees to fulfill their duties, maximizing workplace
productivity and overall success. There should not be a culture
of fear around requesting reasonable accommodations, nor should
the request process be a cumbersome waste of time, as this is
only to the detriment of progress in the sphere.
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Statements for the Record
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U.S. Senate Special Committee on Aging
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December 3, 2025
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Mississippi
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Missouri
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Montana
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Newbraska
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Nevada
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from New Hampshire
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from New Jersey
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from New Mexico
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from New York
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from North Carolina
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Ohio
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Oklahoma
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Oregon
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Pennsylvania
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Rhode Island
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from South Carolina
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from South Dakota
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Tennessee
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Texas
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Utah
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Vermont
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Virginia
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Washington
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from West Virginia
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Wisconsin
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Wyoming
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Statements from Organizations, Nonprofits, and Providers
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U.S. Senate Special Committee on Aging
"Aging in Place: The Impact of Community During the Holidays"
December 3, 2025
Statements for the Record
Additional Statements
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