[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
EXAMINING THE OLDER AMERICANS ACT:
PROMOTING INDEPENDENCE AND DIGNITY
OF OLDER AMERICANS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON CIVIL RIGHTS AND HUMAN SERVICES
COMMITTEE ON EDUCATION
AND LABOR
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, MAY 15, 2019
__________
Serial No. 116-23
__________
Printed for the use of the Committee on Education and Labor
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: www.govinfo.gov
or
Committee address: https://edlabor.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
36-598 PDF WASHINGTON : 2020
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COMMITTEE ON EDUCATION AND LABOR
ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman
Susan A. Davis, California Virginia Foxx, North Carolina,
Raul M. Grijalva, Arizona Ranking Member
Joe Courtney, Connecticut David P. Roe, Tennessee
Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania
Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan
Northern Mariana Islands Brett Guthrie, Kentucky
Frederica S. Wilson, Florida Bradley Byrne, Alabama
Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin
Mark Takano, California Elise M. Stefanik, New York
Alma S. Adams, North Carolina Rick W. Allen, Georgia
Mark DeSaulnier, California Francis Rooney, Florida
Donald Norcross, New Jersey Lloyd Smucker, Pennsylvania
Pramila Jayapal, Washington Jim Banks, Indiana
Joseph D. Morelle, New York Mark Walker, North Carolina
Susan Wild, Pennsylvania James Comer, Kentucky
Josh Harder, California Ben Cline, Virginia
Lucy McBath, Georgia Russ Fulcher, Idaho
Kim Schrier, Washington Van Taylor, Texas
Lauren Underwood, Illinois Steve Watkins, Kansas
Jahana Hayes, Connecticut Ron Wright, Texas
Donna E. Shalala, Florida Daniel Meuser, Pennsylvania
Andy Levin, Michigan* William R. Timmons, IV, South
Ilhan Omar, Minnesota Carolina
David J. Trone, Maryland Dusty Johnson, South Dakota
Haley M. Stevens, Michigan
Susie Lee, Nevada
Lori Trahan, Massachusetts
Joaquin Castro, Texas
* Vice-Chair
Veronique Pluviose, Staff Director
Brandon Renz, Minority Staff Director
------
SUBCOMMITTEE ON CIVIL RIGHTS AND HUMAN SERVICES
SUZANNE BONAMICI, OREGON, Chairwoman
Raul M. Grijalva, Arizona James Comer, Kentucky,
Marcia L. Fudge, Ohio Ranking Member
Kim Schrier, Washington Glenn ``GT'' Thompson,
Jahana Hayes, Connecticut Pennsylvania
David Trone, Maryland Elise M. Stefanik, New York
Susie Lee, Nevada Dusty Johnson, South Dakota
C O N T E N T S
----------
Page
Hearing held on May 15, 2019..................................... 1
Statement of Members:
Bonamici, Hon. Suzanne, Chairwoman, Subcommittee on Civil
Rights and Human Services.................................. 1
Prepared statement of.................................... 3
Comer, Hon. James, Ranking Member, Subcommittee on Civil
Rights and Human Services.................................. 4
Prepared statement of.................................... 5
Statement of Witnesses:
Archer-Smith, Ms. Stephanie, Executive Director, Meals on
Wheels of Central Maryland, Inc............................ 13
Prepared statement of.................................... 15
Ducayet, Ms. Patricia, LMSW, Texas State Long-Term Care
Ombudsman, Texas Health and Human Services................. 30
Prepared statement of.................................... 32
Girard, Ms. Lee, Director, Multnomah County Aging, Disability
and Veterans Services...................................... 7
Prepared statement of.................................... 9
Whiting, Ms. C. Grace, J.D., President and CEO National
Alliance Caregiving........................................ 22
Prepared statement of.................................... 24
Additional Submissions:
Chairwoman Bonamici:
ADRC Business Case: Final Report......................... 59
Questions submitted for the record by:
Chairwoman Bonamici
Schrier, Hon. Kim, a Representative in Congress from the
State of Washington.................................... 106
Responses to questions submitted for the record by:
Ms. Archer-Smith......................................... 107
Ms. Ducayet.............................................. 109
Ms. Girard............................................... 112
Ms. Whiting.............................................. 114
EXAMINING THE OLDER AMERICANS ACT:.
PROMOTING INDEPENDENCE AND
DIGNITY OF OLDER AMERICANS
----------
Wednesday, May 15, 2019
House of Representatives
Committee on Education and Labor,
Subcommittee on Civil Rights and Human Services
Washington, DC.
----------
The subcommittees met, pursuant to notice, at 10:18 a.m.,
in room 2175, Rayburn House Office Building. Hon. Suzanne
Bonamici [chairwoman of the subcommittee] presiding.
Present: Representatives Bonamici, Schrier, Hayes, Trone,
Lee, Comer, Thompson, Stefanik, and Johnson.
Also present: Representatives Scott, and Foxx.
Staff present: Nekea Brown, Deputy Clerk; Ilana Brunner,
General Counsel Health and Labor; Brutrinia Cain, HHS Detailee/
Health Fellow; Emma Eatman, Press Aide; Alison Hard,
Professional Staff; Carrie Hughes, Director of Health and Human
Services; Ariel Jona, Staff Assistant; Stephanie Lalle, Deputy
Communications Director; Katie McClelland, Professional Staff;
Richard Miller, Director of Labor Policy; Max Moore, Office
Aide; Veronique Pluviose, Staff Director; Banyon Vassar, Deputy
Director of Information Technology; Cyrus Artz, Minority
Parliamentarian, Courtney Butcher, Minority Director of Member
Services and Coalitions; Bridget Handy, Minority Communications
Assistant; Amy Raaf Jones, Minority Director of Education and
Human Resources Policy; Kelley McNabb, Minority Communications
Director; Jake Middlebrooks, Minority Professional Staff
Member; Casey Nelson, Minority Staff Assistant; Brandon Renz,
Minority Staff Director; Mandy Schaumburg, Minority Chief
Counsel and Deputy Director of Education Policy; Meredith
Schellin, Minority Deputy Press Secretary and Digital Advisor;
and Heather Wadyka, Minority Operations Assistant.
Chairwoman BONAMICI. The Subcommittee on Civil Rights and
Human Services will come to order. I note a quorum is present.
This meeting will hear the testimony on examining the Older
Americans Act, promoting independence and dignity for older
Americans.
Pursuant to committee rule 7c opening statements are
limited to the Chair and ranking member. This allows us to hear
from our witnesses sooner and provides all members with
adequate time to ask questions.
I recognize myself now for the purpose of making an opening
statement.
We are here today to examine the Older Americans Act, a
critically important pillar of our efforts to improve the
quality of life for older Americans and their families.
In 1965, Congress passed the Older Americans Act, or OAA,
to provide basic supports to aging Americans. Since then,
Congress has repeatedly updated and strengthened the OAA in a
bipartisan manner to fulfill its mission of helping more
Americans live independently and age with dignity.
OAA programs have been consistently successful, which has
led to a gradual expansion of the services it provides. The Act
now supports a range of community-based programs that target
assistance to those who need it most.
Of the many vital OAA programs, one of the most recognized
is nutrition assistance offered through both congregate meal
sites and home-delivered programs such as Meals on Wheels.
OAA's nutrition assistance programs provide more than 900,000
healthy meals to older Americans each day.
OAA also supports elder justice activities and funds
programs to prevent elder abuse. Additionally, the Act offers
community service employment opportunities to low-income
seniors, allowing them to access part-time work that both
supports them economically and provides purpose and social
engagement.
OAA also provides family caregivers with much needed
training, respite, and support. And based on my own experience
caring for my 90-year-old mother, who has Alzheimer's, I can
particularly appreciate the importance of the National Family
Caregiver Support Program.
Collectively, OAA programs serve about 11 million older
adults, 3 million of whom regularly look to OAA services for
basic needs. Importantly, OAA programs work together to make
sure that aging adults retain independence and avoid costly
institutionalized care for as long as possible.
Despite the success of the Older Americans Act, in recent
years our investment has not kept pace with inflation and has
not recognized the rising number of older Americans and the
challenges they continue to face.
Although the population of Americans age 60 and over has
grown more than 60 percent since 2001, OAA funding has only
grown by roughly 20 percent. And, accounting for inflation, OAA
funding has steadily declined by 16 percent.
The disinvestment has weakened OAA programs at a time of
growing demand for the services they provide. Nearly 1 in 10
Americans over the age of 65 lives in poverty, and they are not
getting the support they need. A 2015 Government Accountability
Office study found that 83 percent of food insecure, low-income
older Americans did not receive any meal services, and 2 in 3
older Americans who struggle with daily activities received
limited or no home-based care.
As the number of older Americans continues to increase,
Congress must strengthen our support for OAA's proven, long-
standing programs. We must recommit to providing basic services
and compassionate care to vulnerable members of our
communities.
Not only is this the right thing to do, but the economics
also make sense. OAA allows older Americans to delay or
altogether avoid costlier care by promoting healthier--healthy
behaviors, such as chronic disease management, and by providing
the supportive services that allow seniors to age in place.
That is the responsibility and the opportunity facing this
committee and the 116th Congress. We are in a position to
advance a reauthorization of the Older Americans Act that will
allow millions of Americans across the country to age with
dignity.
This hearing is an important first step. Today, we will
discuss the challenges facing older Americans, what OAA
programs look like across the country, and how the OAA supports
millions of seniors and their families.
Today we are also continuing the law's tradition of strong
bipartisan support. I was honored to be involved in the 2016
reauthorization when both the House and Senate unanimously
supported the legislation and I look forward to once again
working with Ranking Member Comer, Ranking Member Foxx, and of
course Chairman Scott, and all my colleagues on both sides of
the aisle to advance a robust Older Americans Act
reauthorization bill this year.
Thank you to the distinguished witnesses for being here
today. I look forward to this discussion.
And I now recognize the distinguished ranking member for
the purpose of an opening statement.
[The statement of Chairwoman Bonamici follows:]
Prepared Statement of Hon. Suzanne Bonamici, Chairwoman, Subcommittee
on Civil Rights and Human Services
We are here today to examine the Older Americans Act, a critically
important pillar of our efforts to improve the quality of life for
older Americans and their families.
In 1965, Congress passed the Older Americans Act, or O-A-A, to
provide basic supports to aging Americans. Since then, Congress has
repeatedly updated and strengthened OAA in a bipartisan manner to
fulfill its mission of helping more Americans live independently and
age with dignity. OAA programs have been consistently successful, which
has led to a gradual expansion of the services it provides. The Act now
supports a range of community-based programs that target assistance to
those who need it most.
Of the many vital OAA programs, one of the most recognized is
nutrition assistance offered through both congregate meal sites and
home-delivered programs such as Meals on Wheels. OAA's nutrition
assistance programs provide more than 900,000 healthy meals to older
Americans each day. OAA also supports elder justice activities and
funds programs to prevent elder abuse. Additionally, the Act offers
community service employment opportunities to low-income seniors,
allowing them to access part-time work that both supports them
economically and provides purpose and social engagement. OAA also
provides family caregivers with much-needed training, respite, and
support. And based on my own experience caring for my 90-year-old
mother, who has Alzheimer's, I can particularly appreciate the
importance of the National Family Caregiver Support Program.
Collectively, OAA programs serve about 11 million older adults 3
million of whom regularly look to OAA services for basic needs.
Importantly, OAA programs work together to make sure that aging adults
retain independence and avoid costly institutionalized care for as long
as possible.
Despite the success of the Older Americans Act, in recent years our
investment has not kept pace with inflation and has not recognized the
rising number of older Americans and challenges they continue to face.
Although the population of Americans age 60 and over has grown more
than 60 percent since 2001, OAA funding has only grown by roughly 20
percent. And, accounting for inflation, OAA funding has steadily
declined by 16 percent.
This disinvestment has weakened OAA programs at a time of growing
demand for the services they provide. Nearly one in ten Americans over
the age of 65 lives in poverty, and they are not getting the support
they need. A 2015 Government Accountability Office study found that 83
percent of food insecure, low-income older Americans did not receive
any meal services. And two in three older Americans who struggle with
daily activities received limited or no home-based care.
1
As the number of older Americans continues to increase, Congress
must strengthen our support for OAA's proven, long-standing programs.
We must recommit to providing basic services and compassionate care to
vulnerable members of our communities.
Not only is this the right thing to do, but the economics also make
sense. OAA allows older Americans to delay or altogether avoid costlier
care by promoting healthy behaviors, such as chronic disease
management, and by providing the supportive services that allow seniors
to age in place.
That is the responsibility and the opportunity facing this
Committee and the 116th Congress. We are in a position to advance a
reauthorization of the Older Americans Act that will allow millions of
Americans across the country to age with dignity.
This hearing is an important first step. Today, we will discuss the
challenges facing older Americans, what OAA programs look like across
the country, and how the OAA supports millions of seniors and their
families. Today we are also continuing the law's tradition of strong
bipartisan support. I was honored to be involved in the 2016
reauthorization when both the House and Senate unanimously supported
the legislation. I look forward to once again working with Ranking
Member Comer, Ranking Member Foxx, Chairman Scott, and all my
colleagues on both sides of the aisle to advance a robust Older
Americans Act reauthorization bill this year.
Thank you to the distinguished witnesses for being here today. I
look forward to this discussion and now yield to the Ranking Member,
Mr. Comer, for the purpose of an opening statement.
______
Mr. COMER. Thank you, Madam Chairman, for yielding.
Today's life expectancy in our Nation is at a historic
high, which is great news and it means we need to be doing all
we can to ensure that Americans have access to quality, timely
services which allow them to live in their homes as long as
possible.
This hearing will help us better understand what might be
done to ensure the law is aging as well as the people it saves.
Since 1965 the Older Americans Act, or OAA, has governed
the organization and delivery of services for senior citizens
throughout the country. With more than 41 million Americans 65
and older, the social and nutritional programs offered by OAA
are critical to helping them maintain independence. The reach
of this law is substantial and covers many aspects of elder
care.
In addition to well known programs like Meals on Wheels,
OAA support services provided by more than 300 State, tribal,
and native Hawaiian organizations and approximately 200,000
local providers. Some of these services include nutrition
programs, providing meals for senior citizens, schools, and
churches, care to prevent the abuse, neglect, and exploitation
of seniors, family care giver support systems, and community
service employment opportunities for older Americans.
These types of programs offer valuable assistance for
American seniors and the Federal Government should continue to
support them. I know that I do.
As our committee considers reauthorization of OAA, I am
confident that we can work together on bipartisan legislation
to support our Nation's seniors through effective policy.
I thank the witnesses for being here today and hope today's
discussion will offer insights into how we can build upon OAA's
flexible policies to promote consumer driven independent living
for older Americans.
Madam Chairman, I yield back.
[The statement of Mr. Comer follows:]
Prepared Statement of Hon. James Comer, Ranking Member, Subcommittee on
Civil Rights and Human Services
Thank you for yielding.
Today's life expectancy rate in our Nation is at a historic high,
which is great news, and it means we need to be doing all we can to
ensure that Americans have access to quality, timely services which
allow them to live in their homes as long as possible. This hearing
will help us better understand what might be done to ensure the law is
aging as well as the people it serves.
Since 1965, the Older Americans Act, or OAA, has governed the
organization and delivery of services for senior citizens throughout
the country. With more than 41 million Americans 65 and older, the
social and nutritional programs offered by OAA are critical to helping
them maintain independence.
The reach of this law is substantial and covers many aspects of
elder care. In addition to well-known programs like Meals on Wheels,
OAA supports services provided by more than 300 State, Tribal, and
Native Hawaiian organizations and approximately 20,000 local providers.
Some of these services include: nutrition programs providing meals at
senior centers, schools, and churches; care to prevent the abuse,
neglect, and exploitation of seniors; family caregiver support systems;
and community service employment opportunities for older Americans.
These types of programs offer valuable assistance for America's
seniors, and the Federal Government should continue to support them.
As our committee considers a reauthorization of OAA, I am confident
that we can work together on bipartisan legislation to support our
Nation's seniors through effective policy. I thank the witnesses for
being here and hope today's discussion will offer insights into how we
can buildupon OAA's flexible policies to promote consumer-driven,
independent living for older Americans.
______
Chairwoman BONAMICI. Thank you very much to the ranking
member.
Without objection, all other members who wish to insert a
written statement into the record may do so by submitting them
to the committee clerk electronically in Microsoft Word format
by 5 p.m. on May 29, 2019.
I will now introduce our witnesses. I am honored to
introduce Lee Girard, who is the director of Multnomah County
Aging, Disability, and Veterans Services Division, the
federally designated Area Agency on Aging, or AAA, from
Multnomah County, Oregon, and the largest AAA in the State of
Oregon. Multnomah County Aging, Disability, and Veterans
Services Division serves approximately 40 percent of the
State's caseload in long-term services and supports.
The Division operates Older Americans Act programs, State
funded programs, adult protective services, and Medicaid
eligibility for long-terms services and supports for older
adults, people with disabilities, and veterans. Lee has a staff
of 465, with 10 community centers and 11 meal sites, reaching
more than 136,000 consumers annually.
Lee currently serves as the chair of the Oregon Association
of Area Agencies on Aging, the member association representing
the area agencies in the State of Oregon. She is also a board
member of the National Association of Area Agencies on Aging,
or n4a.
We are going to come back to Ms. Archer-Smith.
Next is Christina Grace Juno Whiting. She is the president
and chief executive officer at the National Alliance for
Caregiving, where she continues her tenure from previous roles,
including chief operating officer and the director of strategic
partnerships.
Grace led the launch of the Caregiving in the U.S. 2015
research study with AARP and directed the first national public
policy study of rare disease caregivers with Global Genes.
She has contributed to several national reports on
caregiving, including Cancer Caregiving in the U.S., with the
National Cancer Institute and Cancer Support Community, and
Dementia Caregiving in the U.S., with the Alzheimer's
Association.
She is also a member of the American Society on Aging and
the Gerontological Society of America.
Next we have Patty Ducayet. She is a licensed master social
worker. She became the State long-term care ombudsman at the
Texas Department of Health and Human Services in January of
2007. As the State long-term care ombudsman, Patty oversees 28
local ombudsman programs, certifies and trains ombudsmen, and
advocates for policy and legislative change to positively
impact Texans living in nursing and assisted living facilities.
Patty has served on the Board of the National Association
of State Long-term Care Ombudsman Program since 2009, including
serving as president from 2014 to 2018. She currently serves as
chair of the Association's advocacy committee.
Mr. Trone is not here, so. Mr. Trone was going to introduce
Ms. Archer-Smith, but I am going to introduce her.
She is from his home State of Maryland. Stephanie Archer-
Smith is executive director of Meals on Wheels of Central
Maryland, a community based, nonprofit organization providing
congregate and home-delivered meals and support services to
individuals primarily age 60 and older through the Older
Americans Act nutrition program in Baltimore City and County,
as well as six surrounding counties.
Ms. Archer-Smith has 35 years of experience working with
vulnerable populations through the life cycle in private,
public, and not for profit human services organizations.
Stephanie has served on the board of directors for the
Baltimore Homeless Services and was a contributing author to
Journey Home, Baltimore's 10-year plan to end homelessness.
We appreciate all of the witnesses being here today and we
look forward to your testimony.
Let me remind the witnesses that we have read your written
statements and they will appear in full in the hearing record.
Pursuant to committee rule 7d and committee practice each of
you is asked to limit your oral presentation to a 5-minute
summary of your written statement.
Let me remind the witnesses that pursuant to Title 18 of
the U.S. Code section 1001, it is illegal to knowingly and
willfully falsify any statement, representation, writing,
document, or material fact presented to Congress or otherwise
conceal or cover up a material fact.
Before you begin your testimony please remember to press
the button on the microphone in front of you so it will turn on
and the members can hear you. As you begin to speak the light
in front of you will turn green. After 4 minutes the light will
turn yellow to signal that you have 1 minute remaining. When
the light turns red your 5 minutes have expired and we ask that
you please wrap up.
We will let the entire panel make their presentations
before we move to member questions. When answering a question,
please remember once again to turn your microphone on.
I will first recognize Ms. Girard.
STATEMENT OF LEE GIRARD, DIRECTOR, MULTNOMAH COUNTY AGING,
DISABILITY AND VETERANS SERVICES
Ms. GIRARD. Chair Bonamici, Ranking Member Comer, and
members of the subcommittee, I am Lee Girard, Director of
Multnomah County Aging, Disability, and Veterans Services.
Thank you for this opportunity to share our experiences and
recommendations for the Older Americans Act as you work toward
reauthorization.
In Oregon, we have set forth in statute the values of
independence, dignity, and choice as the foundation of our work
in supporting older adults. These values are also foundational
in the Older Americans Act. Area Agencies across the Nation
have worked to build a strong and dynamic network of services
and supports that allow older adults to have the kinds of
choices we all wish for, living in the communities of our
choosing in ways that are responsive to our diverse needs and
preferences.
When my agency conducted our last area plan community needs
assessment we talked to almost 500 older adults from diverse
communities across our county. The need for flexibility in
planning local services was highlighted by the variety of needs
that were raised in these community sessions. Based on these
listening sessions, our agency has continued to prioritize
expansion of services for older adults with the greatest
economic and social needs, with particular focus on LGBT and
racial and ethnic communities in our area.
Oregon is no different than the national trend. We now
enjoy a longer lifespan than previous generations. By 2025, it
is estimated that 20 percent of Oregon's population will be age
65 and over. Oregon's person-centered system prioritizes the
needs of the individual to provide better care, lower costs,
and a better quality of life for older adults and people with
disabilities.
Information and assistance and person-centered options
counseling are foundational services within the Older Americans
Act. As an individual finds that they need more help to remain
independent, these services provide the support to meet that
goal.
Several recent studies in Oregon have demonstrated the
impacts of this work. A recent business case study found an
11:1 return on investment for these services. The benefits that
were found included finding and keeping long-term services and
supports and housing, helping with basic needs to remain
independent, avoiding homelessness--which is a growing issue
for older adults--preventing abuse, and averting falls and
other debilitating situations.
A second study also found a distinct correlation between
avoiding preventable hospitalizations and the availability of
Older Americans Act funded information assistance and options
counseling services. These are significant numbers and
demonstrate the high value and return on investment for the
services provided via the Older Americans Act. Social
determinants of health can influence up to 60 percent of an
individual's health.
The Older Americans Act funds health promotion programs,
elder justice and abuse prevention, family caregiving support,
and nutrition services. It really is this holistic approach
that made the Older Americans Act truly ``ahead of its time''
when it was created in 1965.
As you begin your work on reauthorization, we encourage you
to consider important adjustments that could be made to the Act
to bring it into this new era of services and supports. We also
know that the needs of older adults' experiences can vary
widely and be significantly impacted by a variety of factors
and barriers. The Older Americans Act is founded on targeting
services to individuals with the greatest social and economic
needs. We ask that LGBT communities be specifically recognized
as one of those populations to be targeted.
Local flexibility is also a key program strategy for the
Older Americans Act. This provision has enabled Area Agencies
to meet the needs of their local communities in ways that makes
the most sense with the most efficient use of funds.
Supporting innovation and best practices must also be
another key priority. The Aging Network continues to evolve
through local planning and development efforts to expand a
network of services focused on interventions that lower the
overall cost curve in long-term care and healthcare.
Finally, a commitment for bipartisan support to increase
authorization levels as well as reauthorizing the Older
Americans Act is absolutely necessary to meet the goals of the
Older Americans Act going forward.
I would like to thank you for your time today and would be
happy to answer any questions later from the committee.
Thank you.
[The statement of Ms. Girard follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman BONAMICI. Thank you for your testimony.
And next I will recognize Ms. Archer-Smith for 5 minutes
for your testimony.
STATEMENT OF STEPHANIE ARCHER-SMITH, EXECUTIVE DIRECTOR, MEALS
ON WHEELS OF CENTRAL MARYLAND, INC.
Ms. ARCHER-SMITH. Good morning, Chairwoman Bonamici,
Ranking Member Comer, and members of the subcommittee. Thank
you for the opportunity to testify today.
My name is Stephanie Archer-Smith and I am the executive
director for Meals on Wheels of Central Maryland, a community-
based nonprofit that provides congregate and home-delivered
meals through the Older Americans Act nutrition program.
Each year we serve over a million nutritious meals; 800,000
of those are delivered to the door of nearly 3,000 homebound
seniors in Baltimore City and the surrounding counties.
Federally supported senior nutrition programs like ours are
leading the fight to improve senior health by combating hunger
and isolation. This unique combination of nutritious meals,
companionship, and other person-centered services is only made
possible by the Older Americans Act.
Title III-C of the Older Americans Act, the nutrition
program, is the only Federal program designed specifically to
meet both the nutritional and social needs of older adults in
order to reduce hunger and food insecurity, promote
socialization, and improve the health and wellbeing of older
individuals. In 2017 the Older Americans Act delivered on that
promise to 2.4 million seniors nationwide.
The Older Americans Act nutrition program is perhaps the
best example of the power of a successful public-private
partnership. At Meals on Wheels of Central Maryland, the Older
Americans Act funding we receive makes up 60 percent of our
budget. The remaining 40 percent is comprised of private
donations, other private and local government grants, and other
healthcare partnership programs. We mobilize more than 1,800
volunteers who provide over $2 million of in-kind contribution
annually to support our daily operations.
The reality of senior hunger and isolation in our country
is sobering. In Maryland more than 140,000 seniors face the
threat of hunger each day, often making difficult choices
between eating properly or paying for medication. Nationwide
nearly 9 million seniors struggle with hunger, and almost twice
as many live alone, leaving them at risk for negative health
outcomes associated with food insecurity, malnutrition, and
social isolation. Feelings of loneliness in particular are
associated with negative health effects comparable to smoking
15 cigarettes a day.
The economic burden associated with senior malnutrition
costs $51 billion annually, while senior falls account for $50
billion in medical costs. The good news is the infrastructure
to address these consequences already exists through the Older
Americans Act network. The majority of seniors receiving Older
Americans Act nutrition services report that participating in
the program helps them feel more secure and prevents falls,
avoiding hospitalization and reducing healthcare costs. One
year of Meals on Wheels services can be provided for the
approximate cost of 1 day in the hospital.
In Maryland the impact is clear. Ninety-four percent of our
participants report increase food security, ninety-eight
percent believe our services have extended the length of time
they can remain living at home, ninety-four percent report that
Maryland Meals on Wheels has improved their quality of life,
and one hundred percent report better medication compliance.
But it is best illustrated by the story of the seniors
themselves. Frederick, who is a 69-year-old Navy veteran, lives
alone in a mobile home in Harford County. He has been receiving
Meals on Wheels since 2015 because of his limited mobility.
Frederick also receives food for his dogs, who are always by
his side when we deliver.
During his annual home assessment, something all Meals on
Wheels clients receive, it was discovered that he had a roof
leak so severe that he was no longer able to use his bedroom
and mold was growing. Our case management team immediately
intervened, identifying resources for his roof replacement.
Today Frederick enjoys his home free of leaks and dangerous
mold due to a complete roof replacement, which was finished
earlier this month at no cost to him.
Ruth lives alone on a narrow street in Baltimore. During a
big snow storm last winter she wondered how the mobility van
that picks her up for dialysis would make it down her narrow
street. Despite the snow, her Meals on Wheels volunteer was
there. The Meals on Wheels team reached out to the police to
ask for their help in getting Ruth safely to her treatment.
Ruth shared her gratitude with me, stating ``I thought my
life depended on dialysis, but that day my life depended on
Meals on Wheels.''
Were it not for Meals on Wheels these seniors would be
hungry and alone and disconnected from their community. The
unacceptable truth is that for these seniors we are unable to
serve this is their reality.
A 2015 Government Accountability report found that 83
percent of low-income food insecure adults are not receiving
the meals they need. We currently have 186 people waiting for
space on the Older Americans Act funded program. How do you
tell a senior who needs your help that you cannot help them?
I urge this committee to keep a strong and on-time
reauthorization of the Older Americans Act a priority and
support local nutrition providers like me as we work tirelessly
to meet the unmet needs of seniors today and in the future.
Again, I thank you for holding this timely hearing during
Older Americans Act month, and for the opportunity to testify.
I stand ready to support this process in any way I am able and
look forward to answering any questions you might have.
[The statement of Ms. Archer-Smith follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman BONAMICI. Thank you for your testimony.
And I recognize Ms. Whiting for your 5 minutes for your
testimony.
STATEMENT OF C. GRACE WHITING, J.D., PRESIDENT AND CEO,
NATIONAL ALLIANCE FOR CAREGIVING
Ms. WHITING. Thank you so much, Chair Bonamici and Ranking
Member Comer, and members of this subcommittee. Chair Bonamici,
thank you especially for sharing your own personal experience
as a caregiver for your mother. We need champions like you on
these issues.
I appreciate the time today to talk about the Older
Americans Act, Title III-E, National Family Caregiver Support
Program.
My name is Grace Whiting and I am the President and CEO of
the National Alliance for Caregiving, a 501(c)(3) nonprofit
organization dedicated to advancing family caregiving through
research, innovation, and advocacy. We believe that OAA
programs, including the National Family Caregiver Support
Program, support our long-term care ecosystem in three key
ways.
First, healthcare providers rely on caregivers to fill gaps
in care and Older Americans Act's programs help caregivers
become better care providers.
Second, employers who face productivity losses due to
caregiving can use OAA programs as a resource to help
caregivers who are in the work force.
And, third, OAA programs can protect the health, wealth,
and wellbeing of aging caregivers themselves.
We believe that family caregiving is a public health issue.
In national research with AARP we estimate that there are
approximately 44 million people caring for older adults and
people with disabilities across a lifespan. That is one in five
Americans, roughly the same size as the population of the
country of Argentina. And when supported, caregivers can
improve the quality of care offered to individuals. They
support activities of daily living, such as helping people eat
and bathe, instrumental activities of daily living, such as
managing finances, and more than half are conducting medical
nursing tasks that would normally be provided through formal
care providers. Activities like giving injections, tube
feedings, catheters, and colostomy care, often without any
prior education on how to do these activities and no prior
support. Most help with transportation, which helps address
social isolation and allows people to stay engaged in their
communities longer. And we know that when supported, caregivers
can improve the health of populations and reduce health system
costs.
When surveyed, program participants in the Administration
for Community Living program, almost nine out of 10 caregivers
said that these services help them to be a better caregiver,
and more than half said that if they did not have the National
Family Caregiver Support Program, the person they care for
would be in a nursing home. In fact, if we replaced every
caregiver in America with a direct care worker, it would cost
our economy $470 billion a year. Health care providers are
aware of this cost savings and emerging trends in managed care
rely on caregivers to bridge gaps, to reduce health system
costs, and to improve shared savings.
In our written testimony we speak to the impact of
caregiving on the work force, including an estimated $36.5
billion a year in productivity losses to employers. Title III
programs can help employers offset the cost of caregiving. For
example, nutrition programs provide support when a caregiver
may not be available to make dinner, senior centers offer an
additional form of respite. Transportation support for seniors
can make it possible for caregivers to use that time for other
needs.
As family size shrinks, the number of available people to
care is shrinking too, meaning that we must act now to protect
caregivers.
More than half of the caregivers in America are 50 years
old or older, 7 percent are 75 years old or older, and
caregivers of adults with disabilities are aging too. Think,
for example, of the aging parents of an adult child with Down
Syndrome, or the aging wife of a wounded warrior from Desert
Storm. Yet the current program only supports 700,000
caregivers. Based on our prevalence estimate, this means that
the current program serves only 2 percent of America's
caregivers.
One quick personal story before I end. About 6 years ago I
had the honor of being invited to the White House for a
ceremony to celebrate caregivers of veterans, the Hidden Heroes
Initiative, led by former Senator Elizabeth Dole. And I was
standing in the green room talking to this caregiver whose
husband had been wounded in Iraq and I said I grew up in
Louisiana, I went to High School in Mississippi, I never in a
million years thought that I would be standing in the White
House looking outside at the tourists. And she looked at me, at
this celebration to honor the work that she was doing for her
husband, in a room that most Americans are never going to have
the chance to be able to stand in, and she said all I can think
about is my husband back at his hotel room and whether he is OK
without me. That is the type of person that this program
serves, people who are too tired, too overwhelmed, and too busy
to advocate for themselves. We know that family is the basic
unit of society, and our society needs these families to
survive.
Thank you.
[The statement of Ms. Whiting follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman BONAMICI. Thank you for your testimony.
And now I recognize Ms. Ducayet for 5 minutes for your
testimony.
STATEMENT OF PATRICIA DUCAYET, LMSW, TEXAS STATE LONG-TERM CARE
OMBUDSMAN, TEXAS HEALTH AND HUMAN SERVICES
Ms. DUCAYET. Thank you, Chair Bonamici and Ranking Member
Comer, thank you to the subcommittee. It is my pleasure to
testify today on behalf of the Texas State Long-Term Care
Ombudsman Program.
Title VII of the Older Americans Act authorizes State
ombudsman programs to protect the health, safety, welfare, and
rights of residents, people who live in nursing facilities and
assisted living facilities.
In Texas over 92,000 people live in a nursing home and over
45,000 live in an assisted living facility. Last year we
resolved 78 percent of our complaints that we received; that
was over 16,000 complaints in the State of Texas. We did that
through the use of 100 staff and over 400 volunteers in our
program.
Today you recognize the ombudsman program and the work we
do to prevent abuse and protect residents' rights. And you see
that as part of the system to protect independence and promote
dignity. Many Americans don't think of an assisted living as a
place where you can be independent, but it should be. And many
Americans don't think of a nursing facility as a place where
you can live a dignified life, but it must be.
Our program volunteers and staff are onsite in facilities
to the maximum extent possible, to ensure that residents have
independence and to address instances of indignity. Essential
elements of the ombudsman program include our confidentiality
provisions, systems advocacy, resolving complaints, and
preventing abuse and neglect. Confidentiality requirements are
specifically outlined in the Act and include strict
confidentiality of our ombudsman program records, so no
resident identifying information can be released by our program
without the permission of the person to which it pertains.
Based on the problems we observe in facilities our program
represents the interests of residents to decisionmakers in
Congress, to the State legislatures, and to Federal and State
agencies. We make recommendations and provide comments, which
we call systems advocacy, and aim to improve quality of life
and quality of care for residents, most of whom are Medicare
and Medicaid eligible.
In 2017, State ombudsman programs across the Nation
investigated almost 200,000 complaints, complaints ranging from
the use of chemical restraints to neglect to insufficient
staffing in facilities. But the most common complaint we
receive is about discharge. Because a nursing home is a
person's residence, a resident has a right not to be discharged
without cause. To protect this right, a resident can appeal to
the State Medicaid agency and nursing homes are required to
notify every resident and the ombudsman each time there is a
discharge. Ombudsmen help residents who want to stay in their
home file an appeal and represent them in a hearing. Ombudsmen
also negotiate with the facility to find solutions that are
other than discharge.
So as an example, I want to share with you a brief story
from Texas. A resident in a dementia unit was issued a
discharge notice for being a threat to others. The resident had
recently fallen, had limited mobility and vision, and had a
diagnosis of dementia. The facility was discharging him for one
incident of disrobing in public, which is a relatively common
symptom of dementia. His guardian appealed the discharge, and
while awaiting the hearing received a call at 6 p.m. on a
Friday night from the nursing home informing the guardian that
the resident had been discharged to a behavioral health
hospital.
The nursing facility refused to take the resident back. So
the resident remained in this behavioral health hospital for a
month before being transferred to a new nursing facility and
living only 1 week longer.
While the resident's case prevailed in the fair hearing,
because it was an improper discharge, the result came too late
to benefit him. So the guardian has given us permission to
share his story to honor him and to inform you of the effects
of improper discharge.
To prevent abuse, neglect, and exploitation, ombudsmen
train residents, family members, and facility staff on how to
prevent, identify, and report abuse. Each onsite visit that we
make also prevents abuse. And 2017 nationwide, ombudsman
programs made over 29,000 routine visits for that purpose.
Ombudsman programs also investigated over 5,000 cases of abuse,
neglect, and exploitation in an assisted living facility and
over 11,000 cases of abuse, neglect, or exploitation in a
nursing home.
Thank you for preserving the independence and dignity of
older Americans across the continuum, thank you for recognizing
that people who live in institutions and victims of abuse also
need dignity and independence.
On behalf of the Texas Ombudsman Program and my colleagues
around the country, I want to thank you. Thank you for your
support of the Older Americans Act and with it, ombudsmen will
be here in the future and are here today to prevent harm and
protect residents' rights.
Thank you very much.
[The statement of Ms. Ducayet follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman BONAMICI. Thank you so much to each of our
witnesses for your excellent and comprehensive testimony.
Under committee rule 8a we will now question witnesses
under the 5-minute rule. As chair I will go first and then
yield to the ranking member. We will then alternate between the
parties.
And I yield myself 5 minutes.
Ms. Girard, you discussed research that has been conducted
in Oregon regarding the return on investment for OAA programs.
I ask you unanimous consent to enter into the record the 2018
report commissioned by the Oregon Department of Human Services.
So how have you been able to achieve--you talked about an
11:1 return on investment you mentioned. And based on this
research and from your professional experience, are OAA
programs a good investment for the Federal Government and the
taxpayer?
Ms. GIRARD. Yes, I would say that they are an excellent
investment. The foundation for the return on investment that
was studied in Oregon is really person-centered options
counseling, and that really entails individuals who have been
trained on how to do motivational interviewing and really
person-centered care planning and work with individuals, meet
with individuals, and really focus in on their long-term
services and support needs, and really develop a very focused
plan that is person-centered to what that person and individual
needs and the very unique needs that they have.
Through the study what we were able to do is actually do
both a qualitative and quantitative analysis really looking at
what were the outcomes that were gained for each individual.
And then we used either State or national data around things
like if we were shown that we were able to prevent future
falls, we could--you can actually cost that out. You know what
the cost is when somebody falls and breaks a hip and ends up in
the hospital. And we were able to show that we were reducing
hospital readmissions. We know what the cost of that is in our
community.
And then able to do other things like helping somebody to
avoid homelessness. We know what the expense is for somebody
being homeless. So doing that we were able to really show that
this is a comprehensive service that really helps to connect
people to just a wide variety of very person-centered services
that results in a significant cost savings.
Chairwoman BONAMICI. Thank you for that work. And
continuing, Ms. Girard, you discussed tailoring your
department's services and supports to meet the distinct needs
of individuals from diverse communities, including the LGBT
community. We know that LGBT older adults often face structural
inequalities, including greater social isolation and higher
rates of poverty. But they also encounter barriers to accessing
culturally competent aging services and supports and in many
cases are less likely to have supportive family members and
more likely to face discrimination.
So I want to ask you, and then I will ask the others, how
does your department address the unique needs of the LGBT
community and why should LGBT older adults be designated a
population of greatest social need?
Ms. GIRARD. Thank you, Chair Bonamici.
One of the things that is really a challenge for us locally
is that there are not really good data sources around what is
the prevalence of folks that are LGBT in our community. And
there is actually a fear for people reporting. So one of the
things that we have done is we have a great network in our
area,--we do, we actually participate in both regional and
Statewide advocacy coalition to really raise awareness and to
really try to identify what the needs are. And one of the
things we really have done is we have actually met one-on-one
with individuals in our communities. We have done things like
we know that there are specific types of social events, so we
actually go and meet. We went to a dinner party with a group of
folks and really sat down and talked about what are the unique
issues and needs that you are experiencing. And when we did
some of that as part of our area plan, what we really found was
that the needs do differ across different populations.
Chairwoman BONAMICI. And what would the designation of
greatest social need mean? And I am going to ask the others as
well.
Ms. GIRARD. I really think it helps to--one of the things
that it does is it really focuses our area plan efforts. So we
have to do--it makes us really reach out into the community,
hear from communities, and then really be conscientious about
how we program for those needs.
Chairwoman BONAMICI. Thank you.
Does anybody else--please weigh in on that issue. Ms.
Whiting, did you have--
Ms. WHITING. So I would second the recommendation that
there needs to be more research. We know that there is
approximately 9 percent of caregivers in America identified as
LGBT and I have heard from the field that particularly people
who are transgender sometimes feel that the people they care
for get worse care from formal providers because of biases. So,
for example, a gentleman who is transgender said that his
mother received worse care in the nursing facility she was at
because the staff was uncomfortable with him and his identity.
So I think it is an area that needs more research. We had
in our written testimony, included some recommendations for OAA
reauthorization and one piece of that is to collect more data
in particular on caregiving and these OAA programs broadly.
Chairwoman BONAMICI. My time is expired, so I am going to
ask the others--well, we will submit a question for the record.
And I now yield to Dr. Foxx, the ranking member of the full
committee for 5 minutes for your questions.
Ms. FOXX. Thank you, Madam Chairman. And I want to thank
our witnesses for being here today to discuss this important
subject.
Miss Girard, I was pleased to hear that you appreciate the
value of local flexibility in the Older Americans Act. Can you
give us some examples of the differences between services you
provide to seniors in Portland versus some of the more rural
areas of Oregon?
Ms. GIRARD. Thank you, Representative Foxx.
I think probably a really key example is the provision of
transportation. We hear from older adults across Oregon that it
is a significant need, but it looks very different in Portland
than it does out in places like Ontario or Malheur County.
In our area we have a robust transit system and we can
purchase transportation services through that network. In rural
counties, the AAA is the transportation network. So that is
probably a really good example.
Ms. FOXX. Great.
This question is for all of you, and I will start on this
end of the panel so you are not always last. One of the
purposes of the Older Americans Act is to help people age 60
and older maintain independence in the home. Why is this
important and how does this goal potentially save taxpayer
dollars? And do keep in mind there are four of you to answer,
so.
Ms. DUCAYET. Well, as the representative of providing
services to people who live in an institutional setting, I will
make my answer quick to you and say I know that people want to
live in their home and prefer to. There will be a need
continuously for long-term care facilities, but emphasis does
need to be where people want to get their services at home.
Ms. WHITING. I would say it is in the title of the hearing
today, it is about dignity and independence. Our family sizes
are getting smaller, we have got I think roughly one out of
five Americans are over 60, and so we want people to be able to
thrive and to be cared for by their families in the setting
they choose.
Ms. FOXX. Ms. Archer-Smith.
Ms. ARCHER-SMITH. Yes, I would echo that the people that we
work with want to stay--they want to stay in their home and in
their communities, they want to age in place. It is more
economical to age in your home and I would argue that
intergenerational communities are stronger.
Ms. FOXX. All right.
Ms. GIRARD. In our community only 14 percent of people
getting long-term services and supports are in a nursing
facility. The Older Americans Act is the foundation of helping
people identify and figure out what additional kinds of
resources and services are available so that they don't have to
rely on nursing facility services unless it is absolutely
necessary.
Ms. FOXX. And let me ask a clarifying question, because I
have for years--I think, Ms. Archer-Smith, you mentioned that
it is less expensive--one of you mentioned it is less expensive
for people to remain in their homes. And I have also read over
the years that people are healthier, more alert, and in
better--generally in better health and better able to be
involved with activities the longer they are able to stay in
their home.
I am sure there is associations with having the ability to
do it, but also using the facility that you have while you are
in your home. Does the research continue to show that?
Any of you can respond.
Ms. WHITING. Especially in Alzheimer's and dementia, where
someone who is changing settings but might have mild cognitive
impairment, it can be very hard for both that person and the
family to continue to care for them.
Ms. GIRARD. And I would just add that in Oregon, because we
do have such a broad array for people that are often at the
same level of need, we are able to show that people can
function quite well at home and have pretty significant care
needs as long as you have a system that supports them.
Ms. FOXX. Great. Thank you all.
I yield back, Madam Chairman.
Chairwoman BONAMICI. Thank you, Dr. Foxx.
I now recognize Representative Lee from Nevada for 5
minutes for your questions.
Ms. LEE. Thank you, Madam Chair, for hosting this important
hearing on such an important issue.
Having a father who passed away after spending 4 years in a
nursing home and now dealing with a mother who is suffering
from--is an assisted living facility and having experienced her
struggles as a caregiver, I think that addressing these issues
is incredibly important.
I appreciate the question that Representative Foxx just
asked about the benefits the tax benefit and financial benefit
of allowing people to age in place.
I wanted to ask Ms. Girard, you know, as we know, these
supportive services and preventative health programs are
essential for older Americans in need of care. And in Nevada,
my home State, $3.5 million went to support that.
Can you please elaborate on how home healthcare services
can serve as preventive healthcare for older Americans?
Ms. GIRARD. Yes. We have had--In Oregon we have had a
foundation of both State and Older Americans Act funded in-home
service supports for older adults since 1981. Well, the Older
Americans Act actually before that. And we have been able to
show that it really helps people to avoid further decline, it
helps them to avoid spending down to have to go on Medicaid and
use more expensive Federal supports, and actually keeps them
more engaged in their communities.
Ms. LEE. Thank you.
Miss Whiting, one of your recommendations was to develop a
national resource center for caregiving. Can you explain what
the benefit of establishing that would be?
Ms. WHITING. Absolutely. And that recommendation builds on
some of the language in the RAISE Family Caregivers Act that
was enacted last year, which talks about finding efficiencies
between different Federal agencies. So, for example, there is
the VA Caregiver Support Program, there is the National Family
Caregiver Support Program under Older Americans Act, there were
supports across CMS, looking at different types of caregiver
supports within Medicaid and community-based service models.
So the idea here is let us put all that information in one
place and make it more efficient for caregivers to navigate
across these different centers, as well as identify other
community-based supports that might be available to families
across the country.
Ms. LEE. Yes that--Speaking from a personal point of view,
my father broke his hip and because of Medicare requirements
and Medicaid requirements, was really forced--you know, they
quit--we quit rehab, which led him to unfortunately go into a
nursing home. So I find that sort of looking across all of
these issues and doing as much as we can to keep someone in
home is really important.
So I look forward to working with you on that.
I wanted to turn real quickly to nutrition. In Nevada
80,000 older Americans were deemed to be food insecure in 2016.
Estimated by 2025 17,000 more older Nevadans will need
nutrition services than those today, totaling almost 100,000
older Nevadans.
And we all know the great work that Meals on Wheels
accomplishes carrying out home-delivered services.
I would like to ask Ms. Archer, can you please speak a
little bit about the other option, congregate nutrition option,
and how it is important to fulfilling the social needs of many
of our older Americans?
Ms. ARCHER-SMITH. Yes, thank you.
The congregate meal program as I see it, it is kind of a
continuum of service. So the congregate meal program is really
good for people who might be able to get to it, either they
have transportation provided for them or they are still a
little bit more mobile. So they don't quite need the home-
delivered meal program yet. So it is a good continuum of
service. That opportunity to socialize with your peers is
invaluable. And what often happens is they come for the meal
and then they engage in other programs and other activities
that will keep them healthier, more mobile, stronger, things
like that. So it is a really important part of the continuum of
service.
Ms. LEE. Great.
I will yield the rest of my time. Just thank you all for
the important work you do.
Chairwoman BONAMICI. Thank you for your questions. And as I
am yielding to Ranking Member Comber, I want to encourage all
of my colleagues to do what I have done, which is to deliver
Meals on Wheels and to visit a congregate meal site, because I
think you will really appreciate everything that happens there.
And now I yield to Ranking Member Comer for 5 minutes for
your questions.
Mr. COMER. And I agree with that, Madam Chair. I have done
that as well.
Miss Ducayet--did I pronounce that right? I am from rural
Kentucky, it is hard for me to pronounce a name like that, but
so glad you are here. You mentioned the importance of
flexibility in the location of a State long-term care ombudsman
program. Can you expand on what factors might play into this
decision?
Ms. DUCAYET. Thank you for the questions. And, yes, I know
I have a difficult last name and career name as well--it is
hard to pronounce.
Yes, so we are in, in Texas, the State unit on aging, a
pretty traditional setting for the State Ombudsman Program. And
we coordinate with the Area Agencies on Aging in our State to
deliver ombudsman services locally. That is a fairly standard
practice in many States, but not all States operate in the same
manner, and they do so successfully. The flexibility is needed
because of different State structures and the different jobs
that are done in a State unit on aging, or in an Area Agency on
Aging, because ombudsman programs need to be free of any
conflicts of interest so that we are sure we are assured that
we are serving the needs of the resident first and foremost and
that none of our work is compromised by the location that we
operate within.
And so my placement within my State agency, for example,
ensures that I have independence from other functions that are
performed by the State Medicaid agency, for example. And it
works very well for us.
Mr. COMER. Great.
Ms. DUCAYET. Thank you.
Mr. COMER. Great.
Miss Girard, how do the agencies on aging, senior citizens,
and other providers of elderly services work together to
deliver services?
Ms. GIRARD. I think the foundation is we start with our
area plan. Every Area Agency on Aging needs a robust area plan
that really engages all of the community. And then we actually
in our area have an aging and disability resource connection
network, and so we really are able to have a no wrong door
system. We fund a wide variety of services out in community-
based organizations, some of which are culturally responsive,
some are culturally specific, and it is really that aging and
disability resource connection network that allows the
consumer--it doesn't really matter where they show up, we are
going to be able to help them.
Mr. COMER. Great.
This question is for everyone on the panel. As Ms. Foxx
said, we have limited time, but are there any provisions in the
current law or regulations that are particularly burdensome to
your efforts that we in Congress need to address this year? Can
anyone think of anything?
Well, I will--before I yield back I will say this, of all
the government programs that I am aware of, and there are many,
in my opinion in my district there is nothing more popular that
Meals on Wheels. Very popular district and anytime there is
mention of potential cuts to that we get a lot of calls and
messages in my office on that. So I appreciate everything that
you all do and we look forward to working with you as we
continue to try to make life better for you and for the great
people that you serve.
Madam Chairman, I yield back.
Chairwoman BONAMICI. Thank you very much, Mr. Comer.
I now recognize Representative Hayes from Connecticut for 5
minutes for your questions.
Ms. HAYES. Good afternoon, everyone, and thank you for
having this very important hearing and for you all coming here.
I am struggling a little this morning because I have this
lovely binder with these prepared questions and all I can think
about is my grandma right now. And so I really have to shift
gears and just go in a different direction just for a minute,
if you would indulge me.
I was raised by my grandmother. My mom struggled with
addiction and my grandmother raised my brother and I, and
really was the backbone of our family. And I would say that,
you know, this is over 30 years ago, but in my experience,
recently as a teacher and even seeing it every week in my
church, there are so many aging adults who are over 60 who are
now raising their grandchildren. So I know we are talking a lot
about, you know, our elderly community receiving care, but
there are so many of them that are still giving care.
So I guess what I want to first start with, the Senate held
a similar hearing last week and they talked about the National
Family Caregiver Support Programs.
I guess, Ms. Whiting, has the opioid crisis impacted the
rate of aging Americans, especially grandparents, who are
having to be the de facto guardians and in fact raising their
grandchildren?
Ms. WHITING. Thank you for the question. It is incredibly--
something that has been on our minds as we look out at the
field and we interact with people, that the rate of substance
abuse--even I would say other populations, such as military
veterans where you have wounded warriors coming home and they
are not able to care for their own children and so sometimes
their parents take on care of those minor children. So I think
you have hit on something that is critically important and, of
course, is recognized within the Older Americans Act program
overall.
I would say that some have proposed flexibility in allowing
States to, you know, put some of the caregiver funding into the
kinship care, the grandparents raising grandchildren. We would
just encourage you to think about expanding authorization and
appropriations for the program as a whole, because there are
many people over 50 who are also caring for other adults and
kids with disabilities.
Ms. HAYES. Thank you. And I think that is exactly where I
was going, because currently there is a proposed 10 percent cap
on the NFCSP programs that fund older adults caring for
children in this country. And I don't want to us to get caught
up addressing one problem, but not addressing the flip side of
that problem because fast forward 30 years and the same
grandmother who I just told you was the backbone of our family
went through stages of dementia, Alzheimer's, hospice, at home
in bed. My aunt didn't leave the house for a year because she
had to take care of my grandmother.
So I want to make sure that we are addressing all aspects
of this problem. It is not just about providing nutrition and
supports and getting health care services, but really the
entire family is affected when this happens. You know, whether
they are the children, who now the only reliable person in
their life can no longer care for them, or the adults who are
now tasked with caring for their parents and have to put their
careers on hold, their families, their lives on hold.
So I guess my question for--and this is the same thing that
everyone here has kind of said--how can we provide supports
to--what is it that we need to be asking for when we are
legislating programs to ensure that we are touching all of
those needs and not just pinpointing one area? Because I
recognize how broad those things are.
Ms. DUCAYET. Thank you for the question and your personal
story.
One thing that occurs--
Ms. HAYES. Everything is personal here, I swear.
Ms. DUCAYET. One thing that occurs to me is the need for
person-centered services. And the Older Americans Act actually
does an incredible job of emphasizing that. But I think there
is always room for improvement in terms of how we coordinate
those person-centered services across the different Older
Americans Act services. So that is something I would recommend
to look at and see if that is a point where we could improve
upon.
Ms. WHITING. I would also just thank you for your personal
story and for talking about that. My grandmother had dementia
and my aunt was her primary caregiver, and it was very
difficult for her to access services because some of the
restrictions in these laws around ages. So, for example, in the
caregiver program, you know, it is caring for people over 60
and then caring for people with dementia of any age. And it is
sometimes difficult for people to understand how those programs
could be administered. So that is an area where, you know,
thinking about how the program aligns and making sure people
understand at the State level how the program can be
administered.
Ms. HAYES. Thank you, Madam Chair. That is all I have.
Chairwoman BONAMICI. Thank you very much, Representative.
I now recognize Representative Thompson from Pennsylvania
for 5 minutes for your questions.
Mr. THOMPSON. Chairwoman, thank you so much. Thank you for
this session. As someone who worked a career for almost 30
years serving mostly older adults, therapists, previously a
licensed nursing home administrator, the Older Americans Act is
incredibly important.
I was pleased when a few years back here we did the last
reauthorization, we made some really good improvements, tried
to focus on some of the chronic and disabling conditions, did
some investment in our senior centers. A lot of good things.
But this is the reason we do periodic reauthorizations, so we
make sure that we are always getting it better and getting it
right.
And thank you for what each of you do and the perspectives
that you bring here. You know, one of the covered--and this was
mentioned briefly--one of the covered populations under the
Older Americans Act obviously are those who are living with
Alzheimer's disease. I experienced that. My mother lived with
Alzheimer's for 10 years. It stole her identity, her memories,
and then her life eventually. You know, these individuals
receive the vital care and assistance needed to help maintain
their independence. However, there is an estimated 200,000
Americans under the age of 60 that are now living with
Alzheimer's disease, or more commonly referred to as early
onset Alzheimer's. Kind of an area I worked on when I practiced
rehabilitation.
Now, those with early onset Alzheimer's face difficult
challenges when it comes to family and work and finances.
Things kind of compound. It is almost like an accelerated aging
to some extent.
So starting with Ms. Whiting, you know, what are your
thoughts as we look forward to reauthorization--and I know that
we have got an age group of 60 that we define with the Older
Americans Act, but quite frankly, when you look at things like
Medicare, we do make accommodations for certain disabling
conditions, end State renal disease--there may be more--you
know, where folks are younger than that normal eligibility age.
Any thoughts on what we should do in terms of early onset
Alzheimer's? Any revisions or thoughts for changes as a result
of the next reauthorization of the Older Americans Act?
Ms. WHITING. So under the current Family Caregiver Support
Program my understanding is that if you are caring for someone
with Alzheimer's or related dementias of any age that you can
receive services. But I would say when we look at other places
in the Federal Government where they are providing support to
caregivers, this is an area that is definitely underserved.
So, for example, there is an estimated 5.5 million people
caring for military veterans and the support for those programs
is over $1 billion. Likewise, with Alzheimer's and dementia,
you know, that community was able to reach an appropriation and
authorization level to support it.
I think the other piece, though, is just looking at
research and where is it that we don't know what we don't know.
Mr. THOMPSON. And there was an early onset bill that has
been introduced in the House and the Senate that I think would
be perfect to incorporate into any future Older Americans Act
reauthorization.
I want to kind of revisit just briefly, to anyone that
wants to comment further, on the whole issue of just everywhere
I go, you know, obviously the public health crisis of our
lifetime is substance abuse. Maybe it is opioids, maybe it is
crack, maybe it is prescription drugs--it changes based on a
host of factors, but it is the underlying substance abuse. And
a tremendous number of--I don't want to call them older adults
because I put myself in that category of, you know,
grandparents who find themselves now back in a primary care
role. And there is a reason we have our kids when we are
younger, we have the endurance for it. And when you, you know,
assume those roles say in your 50's and 60's and 70's, it is a
challenge.
And I heard some general responses, but are there any
concrete, any specific at this point recommendations that you
would have for--I am not one that just likes to throw money
into a program and hope that good people do good things, I like
to have clear direction. And maybe it is more study that we
need to do to figure out what are the supports that folks--I
guess technically it would be 60 and older because the Older
Americans Act, of how can we help those grandparents that find
themselves in a parenting role once again?
Ms. GIRARD. I think That is a really, really great
question. There are--I think there are some really good
evidence-based programs that some communities are really
starting to utilize that are helping to destigmatize and bring
resources for older adults who are experiencing many behavioral
health issues, including substance use disorders, because they
are often co-occurring with other issues. And I know in our
State we have actually been looking at studying what some of
the barriers are for people getting the support that they need.
And it is actually more challenging for somebody that is older,
somebody 65 and older to get the supports that they need
because of issues around how Medicare is structured. So if we
can be looking at ways that we can use evidence-based programs,
that we can use peer supports, where peers can actually support
other people that are going through the same thing, I think
that would be excellent.
Mr. THOMPSON. Thank you, Madam Chair.
Actually, let me just say if any other witnesses have any
thoughts on inputs or specific strategies, if you wouldn't mind
forwarding to the committee. I think that would be very
helpful, how do we help these grandparents who find themselves
in--
Chairwoman BONAMICI. Yes, Representative Thompson, if you
put that in writing as a question for the record we will make
sure that happens and we have a full record.
Thank you.
I now recognize Representative Trone from Maryland for 5
minutes for your questions.
Mr. TRONE. Thank you, Madam Chairman. Thank you all for
coming out today. This is a really important subject.
I want to talk a little bit about social determinants of
health, SDOH. It is a new term in health. I wasn't that
familiar with it whatsoever. For the Older Americans Act, has
been way ahead of the curve in recognizing the importance in
addressing the social determinants of health through community
interventions. Category under the SDOH that is starting to get
more attention is loneliness and social isolation. It is a
growing concern and one that has serious health consequences.
A 2010 study at Brigham Young University found that
loneliness can shorten a person's life by 15 years. Another at
Rush University found connection between loneliness and a whole
wide range of health problems, especially increased risk of
Alzheimer's.
So Ms. Archer-Smith, first of all I want to thank you again
for coming out. You are a--You work in my district in
Montgomery County, so it is great. You serve over 40,000
seniors throughout Maryland, and we really appreciate the help
with Meals on Wheels. But a quarter of our seniors are living
alone. And, you know, I know the fantastic volunteers are
serving many of these seniors nutrition, and that is the only
human interaction they get often, and those connections are so
important to have during the day.
So you spoke about the benefits of home-delivered meals and
reducing isolation among these homebound adults. Can you share
some examples of individuals who particularly benefit from
social contact provided by the program and how this program is
doing more than just substance, but performing other duties on
isolation?
Ms. ARCHER-SMITH. Yes, and thank you for the question.
So I can give countless examples of volunteers who tell us
about the person who they wait for the end of the route so that
they can spend more time with them, play cards with them, talk
with them about, you know, what is in the news.
I can share with you a personal experience that was in my
written testimony of a woman named Doreen who was 92 years old
and lived alone. And I actually delivered to her personally. I
was covering for someone and I liked to do that periodically
to, you know, engage with our clients. And she didn't know me
when I came in, but her face was so excited to see me and her
eyes lit up so, you know, so wide and she wanted to know
everything about me, what was my name and what did I do at
Meals on Wheels and why was I there today and where was her
other volunteer. And those are the questions. She was just
hungry for someone to talk to. And I think is true of many of
the people that we serve, but many of the things that we do, we
call ourselves more than a meal because we are delivering more
than just a meal, and that goes beyond that interaction with
the volunteer. We also have other services that act as other
touch points for them. So if it is a companion visit or if it
is a phone pal, or something like that. That is another touch
point. If it is someone to help them with some grocery shopping
and household things that we don't deliver, those are other
touch points and those are opportunities for them to interact
more. And we have many, many stories of people who receive our
full offering of services.
Mr. TRONE. Yes, I was with a friend of mine last night, he
has worked with Meals on Wheels for probably four or 5 years
and he had a lot of similar stories about, you know, saving one
person toward the end of the route to spend some time with them
and one-on-one, and that made their day.
So I think it is really great work that you guys are doing.
What are the limitations that you are facing right now to
be able to cover everybody appropriately, and, you know, what
are the barriers?
Ms. ARCHER-SMITH. So the barriers obviously are the
funding. I mean, you know, that is the easy answer. But, you
know, there are so many other things that our clients need. So
being able to create those services and a plan for them that is
unique to their individual needs is important. So being able to
be creative about how we can deliver those services, whether it
is grocery shopping through volunteers or companion visits, or
whether it is professional case management and care
coordination services.
Mr. TRONE. And what is your volunteer stream? Do you have
an adequate number of volunteers?
Ms. ARCHER-SMITH. We have an aging group of volunteers, so
we have some very, very loyal volunteers that have been with us
for many, many years. And so we are able to recruit a lot of
volunteers by way of word of mouth because they are so loyal to
us and they tell their friends about it.
But we are struggling to keep volunteers with growth. So
there needs to be a more intentional approach with that, which
we are addressing.
Mr. TRONE. Well, it is very rewarding work. Thank you.
Ms. ARCHER-SMITH. Thank you.
Chairwoman BONAMICI. Thank you, Mr. Trone.
I now recognize Mr. Johnson from South Dakota for 5 minutes
for your questions.
Mr. JOHNSON. Thank you, Madam Chair.
Ms. Ducayet, maybe start with you. Of course, as we talk
about reauthorizing the Act we want to make sure that it is
well positioned for the future. I feel like I have read in a
number of different places that number of older Americans,
seniors, will double like in the next 30 or 40 years. And I
think despite our best efforts to help people age in place, I
assume that will mean a lot more folks who will call nursing
homes, long-term care facilities, home.
No. 1, is my assumption right about the data from what you
know?
And then, No. 2, will that place a burden on the
ombudsman--ombudspeople across the country?
Ms. DUCAYET. Thanks. Yes. So absolutely we know that the
numbers are really skyrocketing in terms of our aging
population, and that is going to affect our need for long-term
care facilities.
Where we are really seeing the biggest boom, and it has
really been happening for decades now, is in assisted living
facilities. If we can make those affordable everywhere, and
that is a big question in all States, then people will choose
assisted living facilities instead of a nursing home if they
could at all possibly have it. It gives you more freedom and
independence. It is less expensive to provide services in that
setting. That boom has completely overwhelmed our ombudsman
programs across the country.
And so we hope to see a new appropriation for us to serve
people in assisted living facilities, frankly because we have
never seen that given to us in reauthorizations before and we
have been very overwhelmed by the addition of assisted living
facilities to our responsibilities.
Mr. JOHNSON. Yes, of course, resources are a big part of
the equation. I mean nationally do we see a change in how
services are deployed in a way that provides for more
efficiency or effectiveness in meeting the mission?
Ms. DUCAYET. Well, I think big States like mine tend to use
localized services and don't have a State operation hub for all
services to be provided, and that makes sense for us to have
localized offices of our program so that we can get to the
residents quickly and visit facilities frequently. We need to
use volunteers and we are allowed to use volunteers. That is a
cost savings to the government. Our volunteers do a lot for our
program, but our volunteer work force is aging as well and that
has been a challenge for us too as we need to replenish those
services.
So another thing that would help the ombudsman program with
volunteers is to be able to recognize the role of the volunteer
more specifically in the Act, be able to reimburse volunteers
specifically for mileage costs and training costs that are
associated with it. Because volunteers save money for the Older
Americans Act, but it isn't entirely free to have a volunteer
in your program either. You have got to have a well trained
force.
Mr. JOHNSON. So I just want to make sure I am tracking,
more specific language making it clear that those volunteer
expenses could be reimbursed as a part of the program would be
helpful?
Ms. DUCAYET. Yes, yes. Yes, it would.
Mr. JOHNSON. Okay, very good.
So then, Ms. Whiting, as we look at--we talked about aging
in place, and I thought you did a nice job of outlining the
value proposition. When we have effective caregivers that
allows people to maybe put off going to a long-term care
facility or assisted living.
So a similar question, if we have this many more older
Americans in the future, and you mentioned that we are only
providing supports to 2 percent of the caregivers out there,
are there ways that we should be looking nationally to deploy
services in a different way that can help meet the goals, meet
the mission?
Ms. WHITING. I think, Congressman, the ultimate goal here
is that we would have people taking care of each other and we
would be fostering that, not just through the appropriations
process and expanding the program, but just to bring to your
attention the RAISE Family Caregivers Act advisory council has
yet to meet and it is on a 3-year sunset and will end in 2021.
And that council, you know, proposes an opportunity to examine
those exact kind of questions. And so we would encourage you to
think about extending the life of that so we can actually get a
plan that has employers, providers, older Americans, and others
putting in what they really need, and where there could be more
efficiencies in the system.
I think the other piece of this is--if I can respectfully
call it the Golden Girls model--where we have peers living
together because increasingly we have younger generations of
caregivers who are not having as many kids, they are more
isolated, and so how can we help people age in healthy ways,
using things like respite and senior centers and these other
types of OAA programs so that they can care for each other as
peers.
Mr. JOHNSON. Yes. So and then Ms. Archer-Smith, Ms. Girard,
I just wanted to give you an opportunity briefly to comment on
anything it is we are talking about, increasing number of
seniors and if there are different deployment mechanisms to
provide supports, allow for aging in place. Any other thoughts?
Ms. GIRARD. Well, I don't know if it is an opportunity, it
is definitely a challenge. One of the things that families need
is they need respite care and they actually often can be a
better caregiver if somebody else is coming in to do
caregiving, like giving somebody a bath. And what we are really
experiencing is a challenge in the availability of the work
force.
So I think work force development for people so that there
are people that view this as a viable option for them for
employment would be really, really beneficial. And I know that
there are both many State and national efforts looking at work
force issues, but that is going to be a big one.
Mr. JOHNSON. Thank you very much.
Madam Chair, I yield back.
Chairwoman BONAMICI. Thank you very much.
I now recognize Representative Stefanik from New York for 5
minutes for your questions.
Ms. STEFANIK. Thank you, Chairwoman, and thank you to our
panelists for being here today on such an important topic.
I represent New York's 21st district, which is one of the
most rural districts on the East Coast, but it is also one of
the most aged districts if you look at the percentage of
seniors that I represent. So your programs and the great work
that you do has a direct impact on my constituents.
I wanted to followup on Mr. Thompson's line of questioning
related to Alzheimer's. As we know, there are approximately
200,000 Americans suffering from early onset Alzheimer's
disease and too often people living with this disease in their
30's, 40's, and 50's can have young children, new homes, or
growing careers. They are shut out of vital services just
because they are young and the disease hits them earlier.
Alzheimer's forever changes people's lives. It has impacted
my family and we have heard from stories on both sides, both
individuals in the audience here today, witnesses, as well as
Members of Congress who have been impacted. I introduced the
Younger Onset Alzheimer's Act this year, that was the
legislation Mr. Thompson was referencing, that would amend the
Older Americans Act to ensure the availability of programs and
services for those impacted by Alzheimer's by allowing patients
younger than 60 to access them.
So my question, Ms. Whiting, this legislation would allow
the National Family Caregiver Support Program and the Long-term
Care Ombudsman Program to serve this population, but can you
shed more light on how expanding these programs to those under
the age of 60 would greater support family caregivers,
especially those in the work force or those caring for young
children? I am really interested in the caregiver piece aspect
of this.
Ms. WHITING. Thank you for that question.
I think Alzheimer's is probably one of the biggest threats,
for lack of a better word, facing us. In particular for
caregivers, we know from research that it impacts their health,
it impacts their ability to stay engaged in the work force, and
we know that employers are starting to think about the impact
of Alzheimer's. So actually in Kentucky the ranking member's
home State, the Louisville Healthcare CEO Council has been
trying to come up with business solutions for caregivers at
work.
I think where Older Americans Act programs can be most
helpful to people with Alzheimer's, one would be respite,
expanding the availability of respite. The second is, you know,
really being a State laboratory to test Alzheimer's
interventions that work. So, for example, the REACH
intervention is an amazing intervention in New York, Mary
Mittelman's program that she has done, hospital to home, that
helps educate caregivers at discharge is also an excellent
program. So thinking about how the AAA network can test that in
different types of communities and then use that to spread
those best practices.
Ms. STEFANIK. Thank you.
Ms. Girard, I wanted to followup on your recommendation
about work force development when it comes to caregivers. The
issue of caregivers is something that not only I have engaged
on this committee, but also on the House Armed Services
Committee when it comes to military caregivers. There was a
program through the VA for military caregivers, but they did
not anticipate just how many applications there would be. So it
was underestimated.
You talk about work force development specifically for
caregivers. What can we do to ensure that we have a trained,
qualified, and well paid work force when it comes to
caregiving?
Ms. GIRARD. That is a really great question as far as what
kind of infrastructure is needed. I think we need to be looking
at making sure that it is seen as a viable career, that it pays
a living wage. That can be a challenge where sometimes the in-
home caregivers are actually receiving public benefits. So the
more we can promote a living wage for folks where they might be
able to get some benefits.
I had the opportunity to be on our Oregon Home Care
Commission and they really have developed Statewide a strategic
plan. So I think encouraging communities to develop strategic
planning that really looks at their work force and how they can
really boost it, because really we are funding that work force
in our area through both Medicaid, through State funds, and
Older Americans Act funds. And it impacts really all the
individuals getting those services. So it is a real vital
thing.
Ms. STEFANIK. Absolutely. Any other feedback on those
questions from other panelists? Ms. Archer-Smith?
Ms. ARCHER-SMITH. Yes. I would just encourage the
reauthorization at levels that help meet the unmet need,
because when you are providing the meal for the person with
Alzheimer's, you are supporting that caregiver. When you are
bringing other resources into the home, you are supporting that
caregiver.
We have stories, of you know, people that we have been able
to help navigate a very complicated system of resources that
are out there. And without the support of a case manager or a
client support specialist, they may not have known how to get
that, those extra hours of in-home care that they were eligible
for. So making sure that we are meeting the unmet need is
serving both the participant and the caregiver.
Ms. STEFANIK. Thank you.
My time has expired.
Chairwoman BONAMICI. Thank you. I now recognize the
chairman of the full committee, Representative Scott from
Virginia, for 5 minutes for your questions.
Mr. SCOTT. Thank you.
Miss Whiting, I wanted to followup on one of the things you
talked about, respite care. Can you talk about the value of
respite care, both to the senior and to the caregiver?
Ms. WHITING. Absolutely, and thank you for the question.
So respite care is one of those evidence-based benefits
that we know improves the ability of the caregiver to actually
be a provider of care and it provides the individual who is
receiving care a chance to essentially take a break. I mean one
of the challenges is we think about caregiving in these real
tactical terms, but there is research coming out that shows
that if you are going to improve the relationship and the way
that the caregiver and recipient communicate with each other,
you cannot only improve the health of the older person or the
person with disabilities, but you can improve the health of
that caregiver as well.
So being able to give people a break from each other and a
chance to just be the sister, the wife, the brother, the
friend, has a tremendously positive benefit on families.
Mr. SCOTT. Thank you.
Ms. Girard, you talked about the cost of caregiving. Is it
realistic to think that you could provide funding for
caregivers without subsidy?
Ms. GIRARD. Well, I do know a good example. I am probably
actually a good example because I am doing caregiving for my
father. He lives about 30 miles from me and I have been
searching for a caregiver that I am willing to pay in my
community and I can't find anybody. So it is a struggle. I mean
there are many families who are willing to cover the cost of
that, and especially when you look at a return on investment of
they get a break if you can have somebody come in 5 hours a
week to just do some of the really heavy work.
So I think looking at how we can encourage families to do
that, individuals to do that. But then also I do think we have
to look at a bit of a safety net for people that really can't
afford to pay for caregiving and if you look at the return on
investment.
Mr. SCOTT. If you are going to pay the caregiver a living
wage, most of the seniors can't pay someone else a living wage
because they are hardly making it themselves.
Ms. GIRARD. That is true. So that is where really we do
have to subsidize that. But if you look at the cost of the in-
home caregiving and compare it to the cost of either a
community-based care, like assisted living or a nursing
facility, it is still much, much cheaper. We have some State
funded programs where it is really only costing the State, and
Older Americans Act actually, about $300 a month. But if that
person was in an assisted living, it would be probably $3,000 a
month. And if they were in a nursing home it would be closer to
$6-8,000 a month. So if you look at it that way, it is actually
very cheap.
Mr. SCOTT. Thank you.
The Older Americans Act supports a number of evidence-based
health interventions. Ms. Girard, one of these is fall
prevention, where evidence shows that fall prevention programs
can reduce problems. Can you say a word about that?
Ms. GIRARD. Yes. For our Area Agency on Aging we look at
the development of those programs at multiple levels. We
participate in a network that includes us, it includes public
health, it includes health care providers, and it includes our
community partners, like our nutrition programs. We develop a
plan in our area and then we look at different ways that we can
all pool funding to start really developing a network of fall
prevention programs, evidence-based fall prevention programs.
And some of the funding is coming from Older Americans Act, but
some of the funding is coming from other sources. And we really
try to embed it in local community-based organizations because
then it is more likely to get out to the folks that actually
need it.
Mr. SCOTT. When you talk about evidence-based, do the fall
prevention programs prevent falls?
Ms. GIRARD. Yes, the evidence-based--they have been
studied, they have been compared to control groups where people
have not been getting the program, and has shown a really
significant return in reduction of falls. And I know that in
our area falls is actually, for older adults, one of the
biggest disease injury kind of issues in our county.
So it is something that our whole health network is really
looking at.
Mr. SCOTT. Thank you.
And, finally, Ms. Ducayet, can you say a word about the
ombudsman model addressing problems of elder abuse?
Ms. DUCAYET. Yes, thank you. So I would say that our model
includes surprise visits, frequent visits to facilities where
our eyes and ears are in those buildings. And I think that
absolutely prevents abuse. It is something different far and
away from a regulatory function that is there to cite a
facility and bring them into compliance. Our focus is on the
resident and being person-centered and finding a resolution
that the resident wants and seeks to feel safe and secure after
abuse, neglect, or exploitation.
I think those are really key factors. We resolve 73 percent
of complaints to the satisfaction of the resident or the
decisionmaker of the resident every year.
Mr. SCOTT. Thank you.
Ms. DUCAYET. Thanks.
Mr. SCOTT. Thank you, Madam Chair.
Chairwoman BONAMICI. Thank you, Mr. Chairman.
And I see no other members.
I want to remind my colleagues that pursuant to committee
practice, materials for submission for the hearing record must
be submitted to the committee clerk within 14 days following
the last day of the hearing, preferably in Microsoft Word
format. The materials submitted must address the subject matter
of the hearing. Only a member of the committee or an invited
witness may submit materials for inclusion in the hearing
record. Documents are limited to 50 pages each. Documents
longer than 50 pages will be incorporated into the record via
an internet link that you must provide to the committee clerk
within the required timeframe, but please recognize that years
from now that link may no longer work.
So, again, I want to thank the witnesses for their
participation today. What we have heard is incredibly valuable
and I know members of the committee may have some additional
questions for you. We ask the witnesses to please respond to
those questions in writing. The hearing record will be held
open for 14 days to receive those responses.
And I remind my colleagues that pursuant to committee
practice, witness questions for the hearing record must be
submitted to the majority committee staff or committee clerk
within 7 days. Questions submitted must address the subject
matter of the hearing.
I now recognize the distinguished ranking member for his
closing statement.
Mr. COMER. Thank you, Madam Chairman. And I just want to
again thank the witnesses for being here today and thank you
for everything that you do in the people that you serve. Your
knowledge and experience and testimony today will help us
better serve older Americans as we move forward.
It is crucial that we hear from people on the front lines,
like yourselves, and I think this committee hearing has been
very beneficial to us. We must acknowledge the challenges
facing the Older Americans Act given the rapidly growing senior
population and constraints of a limited Federal budget.
As we explore ways to further empower seniors, we must
enhance coordination within the program to effectively serve
those with the greatest social and economic needs. A critical
aspect of this is maintaining and strengthening the local
flexibilities within the law to meet the needs of individual
communities.
We have the opportunity today to begin the committee's
process of improving the law to better provide care for older
Americans.
Again, thank you for being here today and I look forward to
working with you in the future.
Madam Chairman, I yield back.
Chairwoman BONAMICI. Thank you.
I now recognize myself for making a closing statement.
Thank you, again, to the witnesses for providing such
insightful testimony. And I think I also want to thank my
colleagues who shared--and you heard the intensely personal
stories--because this is an issue that affects us all and
affects our constituents.
People in the United States of America should be able to
retire and age with dignity. And by passing the Older Americans
Act in 1965, Congress did make a commitment to provide
Americans the support they need to age independently in their
homes and communities for as long as possible. And today, as
our witnesses testified, the Older Americans Act programs
empower millions of adults every day to remain independent
while avoiding or significantly delaying costly
institutionalized care.
The population of older Americans continues to grow, but
unfortunately commitments--investments by Congress in OAA
programs have not sufficiently kept pace. And this has reduced
our ability to meet the increased demand for these effective
and widely used services.
Just Monday at home in Oregon I heard about an 80-year-old
woman who was living in the back seat of her car. And I think
far too many Americans continue to live in poverty across our
districts, face discrimination, face barriers to basic
necessities in part because OAA programs are underfunded and
not well enough supported.
So today's hearing has underscored our responsibility. We
can help stop this cycle of disinvestment which is eroding the
original purpose of the Older Americans Act and creating
additional challenges for too many older Americans, and
actually costing us more in higher cost care.
As this committee considers the OAA reauthorization I hope
we can work together so its programs have the support and
resources needed to provide essential services and
compassionate care to all aging Americans.
Just 3 years ago both parties came together in each chamber
of Congress to reauthorize and improve the OAA programs. Today,
I appreciate my colleagues joining me in renewing that
commitment to honoring the promise made to older Americans more
than a half a century ago. By continuing the Older Americans
Act tradition and bipartisan support we can make clear that
this committee and this Congress will continue to stand up for
older Americans.
So thank you, again, to the witnesses for being here. I
look forward to working with you and all of my colleagues on
both sides of the aisle as we move forward.
And if there is no further business, without objection,
this committee stands adjourned.
[Additional submission by Chairwoman Bonamici follows:]
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[Questions submitted for the record and their responses
follow:]
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[Whereupon, at 11:49 p.m., the subcommittee was adjourned.]
[all]