[Senate Hearing 111-842] [From the U.S. Government Publishing Office] S. Hrg. 111-842 THE OLDER AMERICANS ACT MAKING REAUTHORIZATION WORK FOR WISCONSIN'S SENIORS ======================================================================= FIELD HEARING before the SPECIAL COMMITTEE ON AGING UNITED STATES SENATE ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION __________ MILWAUKEE, WI __________ SEPTEMBER 7, 2010 __________ Serial No. 111-24 Printed for the use of the Special Committee on Aging Available via the World Wide Web: http://www.gpoaccess.gov/congress/ index.html ---------- U.S. GOVERNMENT PRINTING OFFICE 63-679 PDF WASHINGTON : 2011 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC 20402-0001 SPECIAL COMMITTEE ON AGING HERB KOHL, Wisconsin, Chairman RON WYDEN, Oregon BOB CORKER, Tennessee BLANCHE L. LINCOLN, Arkansas RICHARD SHELBY, Alabama EVAN BAYH, Indiana SUSAN COLLINS, Maine BILL NELSON, Florida GEORGE LeMIEUX, FLORIDA ROBERT P. CASEY, Jr., Pennsylvania ORRIN HATCH, Utah CLAIRE McCASKILL, Missouri SAM BROWNBACK, Kansas SHELDON WHITEHOUSE, Rhode Island LINDSEY GRAHAM, South Carolina MARK UDALL, Colorado SAXBY CHAMBLISS, Georgia KIRSTEN GILLIBRAND, New York MICHAEL BENNET, Colorado ARLEN SPECTER, Pennsylvania AL FRANKEN, Minnesota Debra Whitman, Majority Staff Director Michael Bassett, Ranking Member Staff Director (ii) C O N T E N T S ---------- Page Opening Statement of Senator Herb Kohl........................... 1 Panel I Statement of Kathy Greenlee, U.S. Assistant Secretary For Aging, U.S. Department of Health and Human Services................... 3 Panel II Statement of Kay Brown, Director, Education Workforce Income Security Team, U.S. Government Accountability Office........... 17 Statement of Dorothy Williams, Family Caregiver, Wauwatosa, WI... 40 Statement of Stephanie Stein, Director, Milwaukee County Department on Aging............................................ 43 Statement of Heather Bruemmer, Executive Director and State Ombudsman, Wisconsin Board on Aging and Long-Term Care......... 51 APPENDIX Testimony submitted by Loree Cook-Daniels, FORGE Transgender Aging Network.................................................. 62 Testimony submitted by John Hendrick, Coalition of Wisconsin Aging Groups (CWAG)............................................ 64 Statement submitted by Latoya White, homecare worker............. 65 (iii) THE OLDER AMERICANS ACT: MAKING REAUTHORIZATION WORK FOR WISCONSIN'S SENIORS ---------- -- TUESDAY, SEPTEMBER 7, 2010 U.S. Senate, Special Committee on Aging, Milwaukee, WI. The Committee met, pursuant to notice, at 1 p.m. in the Main Hall, Wilson Senior Center, 2601 West Howard Avenue, Milwaukee, WI, Hon. Herb Kohl, presiding. Present: Senator Kohl [presiding]. Moderator. Good afternoon and thank you all for coming today to our hearing on Older Americans Act. This is an official Senate hearing that will be transcribed and placed in the Congressional Record. As such, there will not be an opportunity for questions from the audience today. However, if you'd like to submit a written statement, we'll be happy to include it in the hearing record, and on all your chairs are forms which you can use to write comments and ideas to the Senator and members of the panel. The deadline for testimony is Tuesday, September 21, and if you have any additional questions, please see Cara Goldstein or myself immediately after the hearing and we'd be happy to help you in any way. OPENING STATEMENT OF SENATOR HERB KOHL, CHAIRMAN The Chairman. Thank you very much, and thank you, ladies and gentlemen, for allowing us to come here today to the Wilson Senior Center. It's very nice to be holding an Aging Committee here in my hometown. Back in 1965, President Johnson signed into law the Older Americans Act which provides the bulk of aging-related programs. Today, it serves over 10 million Americans all across our country and over 386,000 seniors right here in our State of Wisconsin. The Older Americans Act helps seniors live independently in their communities through home care, home-delivered and group meals, family caregiver support, transportation, as well as other services, and last year the Federal funding for these OAA programs was $2.3 billion. Every 5 years, the government takes a look at OAA programs to assess whether they're meeting the needs of the people they serve. Today, we are here to listen to your ideas for strengthening and improving OAA programs. I am Chairman of the Senate Aging Committee. I'll work closely with my other Senate colleagues to ensure that your recommendations play a prominent role in the debate over the future of these very important programs. I also have been a strong supporter for a long time for adequate funding for OAA programs each and every year. I've long championed the National Family Caregiver Support Program which provides needed assistance and respite services to family members who care for an elderly or disabled relative. Also, I'm a long-time supporter of the Long-Term Care Ombudsman Program which provides an advocate for elderly and disabled patients to help resolve complaints of abuse and neglect in long-term care programs. Not surprisingly, the need for such vital OAA programs has increased during these difficult economic times. Over the next year we'll be looking to find the areas in which OAA programs are not meeting the needs of today's seniors so we can fill in those gaps during the next reauthorization next year. Today, we're very fortunate to be joined by the United States Assistant Secretary for Aging Kathy Greenlee. We're particularly proud to host her here in our State because our State is a model for OAA programs in many ways, as you will hear from our other witnesses. So we thank you again for being here today and we look forward to hearing your input and ways that we can improve on the OAA Act during reauthorization, not only here in Wisconsin but for seniors all across our country. Thank you so much. [Applause.] Prepared Statement of Senator Herb Kohl Hello, everyone. I'd like to thank you for joining us here today. It's so nice to be holding an Aging Committee hearing here in my hometown. In 1965, President Johnson singed into law the Older American's Act which provides the bulk of aging-related programs. Today, it serves over 10 million Americans nationwide, and over 386,000 seniors right here in Wisconsin. The Older Americans Act helps seniors live independently in their communities through home care, home-delivered and group meals, family caregiver support, transportation and other services. Last year, federal funding for OAA programs was $2.3 billion. Every five years, Congress takes a fresh look at OAA programs to assess whether they are meeting the needs of the people they serve. We are here today to listen to your ideas for strengthening and improving OAA programs. As Chair of the Senate Aging Committee, I will work closely with my colleagues to ensure your recommendations play a prominent role in the debate over the future of these programs. As a member of the Senate Appropriations Committee, I have been a strong supporter for adequate funding for OAA programs each year. I have long-championed the National Family Caregiver Support Program, which provides needed assistance and respite services to family members who care for an elderly or disabled relative. I am also a longtime supporter of the Long-Term Care Ombudsman Program, which provides an advocate for elderly and disabled patients to help resolve complaints of abuse and neglect in long-term care. Not surprisingly, the need for such vital OAA programs has increased during these difficult economic times. Over the next year, we will be looking to find the areas in which OAA programs are not meeting the needs of today's seniors so we can fill in those gaps during reauthorization. We are very fortunate to be joined today by U.S. Assistant Secretary for Aging Kathy Greenlee. We are particularly proud to host her here in Wisconsin because our State is a model for OAA programs in many ways, as you will hear from our other witnesses. Thank you again to all of you for being here. I look forward to hearing your input on ways we can improve the Older Americans Act during reauthorization, both for Wisconsin's seniors and seniors nationwide. The Chairman. Our first witness today is Kathy Greenlee. Kathy's the Assistant Secretary for Aging at the United States Department of Health and Human Services. Kathy Greenlee brings over a decade of experience advancing the health and independence of seniors and their families. Prior to becoming the Assistant Secretary, Ms. Greenlee served as Secretary of Aging for the State of Kansas, as well as the Kansas State Long-Term Care Ombudsman. We're very fortunate to have her with us here today, and we would look forward and be delighted, Ms. Greenlee, to receive your testimony. STATEMENT OF KATHY GREENLEE, U.S. ASSISTANT SECRETARY FOR AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Ms. Greenlee. Thank you, Senator. It's a delight to be with you today. I'd like to say hello to all my fine colleagues from Wisconsin who are in the audience with us. It's an honor to be able to testify before the Senate Special Committee on Aging at a field hearing. I would like to be able to briefly discuss what we've been doing at the Administration on Aging to solicit input, and I also look forward to remaining for the whole hearing so I can hear what the members of the other panel and the audience have to say, as well. Senator, your leadership in the field of aging precedes you and is certainly much well known outside of Wisconsin and it's something that I was very well aware of, both as the Kansas Ombudsman and the Kansas Secretary of Aging. So I would like to thank you. You serve in essential positions in Congress the Senate Appropriations Committee, Judiciary Committee, and, of course, as Chair of the Special Committee on Aging. It's critical to have champions for seniors, and I'd like to commend you for what you've been able to do for the seniors of Wisconsin as well as for the seniors of the Nation. This is the first visit I've made as Assistant Secretary to Wisconsin. As a lifelong Kansan, I'll tell you I've spent my tourist dollars here but I've been to Dane County. I've been to Door County. But this is the first chance to come and really talk to you about the needs of Wisconsin seniors and also to commend you on the leadership of your network. As you just mentioned, the Wisconsin model, the Aging and Disability Resource Centers have led the Nation, and I'd like to specifically acknowledge Donna McDowell. Donna is the bureau director of the Wisconsin Aging and Disability Resource Bureau and I know you know of Donna's leadership here. She's also served on her National Association Board and has been a national leader in this work, as well. This is a great place, I think, to be a senior and you're well deserving of these good services. As you just mentioned, the Older Americans Act was passed in 1965, 16 days before Medicare and Medicaid were passed. Those three laws, the Older Americans Act, Medicare and Medicaid, really form the foundation of the programs that we have in this country, along with Social Security, to help seniors maintain their health and dignity as they age. The Older Americans Act, I think, is a quiet member of that team but has been steadily for 45 years assisting seniors in getting nutrition and supportive services so that they can remain independent as they age. I have seen the demographics here, and I've seen the demographics in the Nation. We are becoming an older Nation, as you know, more seniors, more diverse seniors, and one of the highest-growing populations are the seniors that are 85 years and older. We have much to do to be able to provide adequate resources to seniors to support them as they age and allow them and support them in remaining in their homes and communities. We also have much to do together to support family caregivers and I know you will hear from a family caregiver this afternoon. As you know, family caregivers are 80 percent of the long- term care system in this country. Their work is essential and important, not just to their loved ones but to all of us. I think it's also important, before we talk specifically about the Older Americans Act, to acknowledge that this was an historic year for seniors with the passage of the Affordable Care Act and I know of your support for many of the provisions in the Affordable Care Act that address seniors. I think the Affordable Care Act provides this network a tremendous opportunity to showcase what we know best, how to support seniors and their health and their living in the community, and we look forward to finding new ways to work with our partners within the Department of Health and Human Services but also with the Members of Congress on how we can use the Affordable Care Act to its fullest. One piece of that that's so important is the Elder Justice Act. It passed after 10 years, and we're very, very pleased. [Applause.] The Elder Justice Act is critical. What I began doing on my own journey with regard to reauthorization was hold a series of reauthorization listening sessions. I had a full day hearing in Dallas, one in Alexandria, VA, and one in San Francisco in March. I had testimony from over 300 individuals at those three hearings. In addition, I did a webinar with Jane Oates, who's the Assistant Secretary for Employment and Training at the Department of Labor, to talk specifically about the Senior Community Services Employment Program, Title V, of the Older Americans Act. We also took input on our website and encouraged community organizations to hold gatherings so that they could provide us their information about the reauthorization and there are many things that we know by having these national hearings and some of the concepts are overarching and not specific to a specific title. The single point of entry for individuals seeking services is critical, and something that you know very well. Person- centered care and self-directed care are universal concepts that need to continue to be embodied with the Act. States and local organizations have talked about the need for flexibility and being able to tailor the services to the unique needs of an individual. That flexibility has been a hallmark of this Act, so we can provide specific services to a specific individual and their family and that continues to be something that's very much embraced, as well as the integration of medical services with human services, so that we can look to find the best of science to help integrate into the best of social services, and then, of course, the workforce. I mean, all of us know that even though family caregivers are 80 percent of the long-term care, we need increasing numbers of workforce to help with geriatrics, everything from geriatricians to direct care workers, and that certainly was a common theme as I took testimony. With regard to the specifics on the Older Americans Act, the comments were grouped into a couple of categories, one having to do with the structure and the other having to do with service and delivery. I'll just run through some of these, and I could talk about each of these topics at length and I know I don't have time to do that. The original Declaration of Objectives in the Act is still valid, that the guiding principles of helping to create a society that enhances the lives of older individuals is still critical. The role of advocacy is also something that needs to be supported and embraced up and down the network, starting from my role as Assistant Secretary to the grassroots individuals, to really advocate on behalf of seniors. I heard a lot of people talk about one of the best things about the Older Americans Act is the requirement that individuals advocate on behalf of seniors. The importance of home- and community-based services. All of the programs that we have within Title III, which is where we have supportive services and nutrition funding, were universally supported in the testimony that I have received, as well as, as I said, the Aging and Disability Resource Centers and flexibility. We also, in the last few years at the Administration on Aging, have been focusing more on health promotion and evidence-based health programs. That concept has been embraced by this national network. We want to have good science behind the health services that we provide to seniors and their supporters. Of course, support for caregivers. There are caregiving relationships of all kinds and what we need, I think, is to be responsive to the needs of caregivers and see that families come in different kinds. We have family members caring for each other. We have friends caring for people. We have grandparents raising grandchildren, that caregiving is critical. I certainly don't need to point out to this audience that the issues of the rural nature of this country in many States comes up and when I hear from my friends further to the West and the North Central Plains, they even talk to me about what it's like to live on the frontier, that there are people who are aging in rural America who have quite a distance to travel to receive services. It's also been presented to me the need to continue to be innovative. We've always funded through Title IV of the Older Americans Act innovation and training, and I've met many people who got into this work because we were able to support them through the Older Americans Act, as well as I mentioned the need to collaborate with the Department of Labor on community services and supporting seniors who need job support and the ability to give back through community services. Title VI of the law, and I am trying to describe these to the audience by description, not just title, but Title VI of the law is specific for tribal organizations. Our relationship at the Federal level is directly with the sovereign organizations of the Tribes and we fund those programs directly instead of funding them through the State. We hear a lot of support for continued consolidation and flexibility among the Tribes and even though we've been talking about reauthorization, not appropriations, I do want to share the incredible comments that I received about the lack of resources in Indian Country, that the Tribes really do as much as they can with very few resources, and we understand the need to be innovative and creative as we partner with them. Then last but certainly not least but only finally because it's Title VII is the Elder Rights, Elder Justice, the work with the Ombudsman Program, and the elder hotlines. I think one of the interesting puzzles for us moving forward is to figure out how best to use the Elder Justice Act that's just passed, the Affordable Care Act and Title VII of the Older Americans Act so they fit hand in glove and strengthen each other as we move forward. Our opportunity internally with reauthorization has just started. I've been working with people in the Office of The Secretary to work within the Administration, so I can't tell you specifically what we will do or present, but want to confirm to you that we've been listening and this is a tremendously good law. I encourage people to pay attention to the needs of seniors. I applaud you for what you've been doing and really want to recognize, Senator, your leadership and your concern about the reauthorization. Thank you very much. [Applause.] [The prepared statement of Secretary Greenlee follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] The Chairman. Thank you very much. Thank you very much, Secretary Greenlee, for your testimony. We're looking forward to working with you to reauthorize the OAA. I'd like to ask you has the Administration set any priorities for Older Americans Act reauthorization and what do you view as some of the critical improvements that need to be made for the future of OAA? Ms. Greenlee. Senator, it's easier for me at this point because I'm still working internally with regard to what we will present, rather than giving you specifics but to identify opportunities. I think it's clear in looking at the mission of the Administration on Aging, the mission of the Older Americans Act, and many of the components of the Affordable Care Act health reform--that we as a Nation have embraced community living and community services, and that there are many things that we can do and need to do moving forward to look at community services across populations, so that we can meet the cultural needs of people who have diverse backgrounds, that we can work with seniors as well as people with disabilities. A common platform for all of us moving forward as an aging and diverse Nation is community care and community support. The Older Americans Act will always be a piece of this but will never and was not intended to be a huge, huge component but a supportive and critical part. So I think, looking forward, that the opportunities and the innovation are looking at what we can do to make sure that each of these amplifies the other and that we can support seniors living in their homes and independently. I believe that that's what seniors and their families want. I also believe personally that we will always have a need for skilled long-term care in some setting that's in a congregate setting, such as skilled nursing homes. So while nursing home residents are 3 percent of the population, they are some of the most vulnerable, and while we talk about community services, we must always remember that people who lived as long as they could at home but needed care in a different setting. The Chairman. In terms of access and affordability, how much more or less difficult is it to provide services in urban areas versus out in the country? Ms. Greenlee. I don't mean to be glib, but it depends on if you're talking to a rural or urban provider. That's serious because the rural providers, and I know this coming from a rural State, will talk about the tremendous cost of time and distance, that delivering a meal 50 miles away, a hundred miles away is expensive. Our urban counterparts, our urban providers will also talk about the difficulty of density, of having a great number of people to serve and transportation, I think, is the underlying concern for both, that we have many people, seniors aging in rural counties, without access to transportation, but we also have transportation problems in cities and the chore is to figure out how best to use transportation resources, regardless of where someone lives, to get them the services that they ask for. The Chairman. As we all know, funding for the current OAA programs is already stretched very thin. Some programs have more applicants than we are able to serve. While we hope to expand OAA in many areas, it seems to me we also need to consider where we can consolidate in order not to have runaway costs. Do you have some ideas on that? Ms. Greenlee. The guidance I would give at this point, Senator, is flexibility, that is the beauty of the law, and to the degree that we at the Federal level can support the States and the area agencies in being able to be flexible with their services and creative with their services. This is a grassroots network that we built and supported and the most effective use of resources are on the ground where a local provider can assess what other kinds of supports and systems are in place for an individual and provide the most cost-effective and efficient programs possible. So I think continuing to support the grassroots network is the solution. The Chairman. Last year, as you know, Federal funding for OAA was $2.3 billion and as we look forward to reauthorization, I would suppose you're very much aware and cognizant and sensitive to the need to provide the same level and quality of services while still not stretching that budget unnecessarily. You're very much mindful of that, I'm certain? Ms. Greenlee. One of the best conversations I've had recently in Washington is with the individual who heads the CMS Office, Centers for Medicare and Medicaid Services, for Innovation Programs. I think the future going forward will require us to better figure out how much we should invest in medical services and how much we should invest in social services, so that they complement each other, rather than expecting each to grow independently of the other. I think there are some opportunities moving forward to use the best practices of this network to be able to demonstrate that if we provide home services and meals, we can show demonstrated cost savings to both Medicare and Medicaid with fewer hospital visits and fewer emergency room visits. We need the time and the opportunity to look for those best practices and be able to highlight the network and from that we will have the experience that we need to go more global or at least on a national scale. I think we have to look at these together. The Chairman. How has your experience in the State of Kansas enabled you to hit the ground running? Ms. Greenlee. Yes, it's been very helpful to have been in a State and had the unique position of having a variety of jobs that are very important now from being the ombudsman to also running a Medicaid agency and being familiar with nursing homes. I feel like I've had the wonderful opportunity to see services on the full range from when seniors first starting needing help to when they're in a supported dementia unit in a skilled nursing facility. I've seen all of the services and the underlying goal, I think, for everything that we do is supporting the health of seniors. I had one of those epiphany moments in a nursing home in Abilene, KS a couple of years ago, when I realized that all residents are in the nursing home for one reason they lost their health, and so we must support health, support community services and make sure that we have quality nursing home care when it's needed. The Chairman. That's very good, Ms. Greenlee. We very much appreciate your taking the time and showing the interest to come here to Wisconsin to provide your testimony and we're looking forward to working very closely with you over the coming year as we've indicated here today we reauthorize the OAA Act. We've received many testimonies for the record that we would like to have a chance to review with you and request that you consider them as the Administration goes about reauthorizing the program. We very much appreciate your willingness not only to be here today but to stay for the duration of this hearing so that you can hear what is offered from the great State of Wisconsin to you to consider as you go about your responsibilities. Thank you so much for being here, Kathy Greenlee. Ms. Greenlee. Thank you, Senator. Thank you very much. [Applause.] The Chairman. All right. We turn now to our second panel. The first witness on the second panel will be Kay Brown. She's the Director of the Education Workforce Income Security Team at the U.S. Government Accountability Office, which is GAO. There, she focuses on improving government performance and delivering benefits and services to low-income as well as vulnerable populations. After her, we'll be hearing from Dorothy Williams. She's a family caregiver from Wauwatosa, who cares for her 101-year-old mother, who has dementia. Dorothy will describe her experiences with the respite services she has received through the Family Caregiver Support Program. After Dorothy, we will be hearing from Stephanie Sue Stein, who is the Director of the Milwaukee County Department on Aging. Ms. Stein administers Older Americans Act programs through the Milwaukee County Aging Resource Center. She's on the Board of the Wisconsin Geriatric Education Center. She's also a member of the State of Wisconsin Long-Term Care Council. Finally, we'll be hearing from Heather Bruemmer. She's the Executive Director and State Ombudsman for the Wisconsin Board on Aging and Long-Term Care where she oversees the Long-Term Care Ombudsman Volunteer Program. She also chairs the state's Long-Term Care Council and she actively serves on the Coalition of Wisconsin's Aging Group Advisory Council. We thank you all for being here today and we'll start out with Kay Brown. STATEMENT OF KAY BROWN, DIRECTOR, EDUCATION WORKFORCE INCOME SECURITY TEAM, U.S. GOVERNMENT ACCOUNTABILITY OFFICE Ms. Brown. Senator Kohl, I'm pleased to be here today to discuss our ongoing work on services provided through Title III of the Older Americans Act. My remarks are based on preliminary results from our national survey of local area agencies on aging and our site visits to four States. This work is part of a larger study that we are conducting for you. Today, I will discuss two topics: what we have learned about requests for Title III services and how agencies have coped with these requests. First, regarding requested services, local agencies responding to our survey told us that for seniors, home- delivered meals and transportation were requested most frequently. For caregivers, respite care was in highest demand. In fact, for all three of these services, a number of agencies, close to one in four, told us they cannot meet all of the requests. In addition, state and local officials said the number of requests are increasing. Given these circumstances, local agencies sometimes must make difficult decisions about which applicants to serve and how much service to provide. Many agencies told us how they reach out to those groups targeted under the law, such as low- income or minority individuals. Further, most agencies reported conducting at least some screening to assess applicants' need for services, like home- delivered meals or respite care. On the other hand, most local agencies did not screen for congregate meals or transportation services. In addition to these known service needs, an unknown number of seniors who may need services do not request them. In our final report due out next year, we hope to estimate the number of individuals at high risk of needing services, such as transportation and home-based care. Moving on to my second issue, how agencies have coped with these increasing requests, particularly in the current economic environment. As we know, agencies providing services under the Older Americans Act rely on multiple funding sources. Many reported overall decreases in funding from Fiscal Year 2009 to 2010. Forty-four of 64 survey respondents said state funding, which is the second largest source of funding for these programs nationally, has decreased. Funds from local government, voluntary client contributions, and private sources have also fallen. So how did local agencies respond? First, as in prior years, many responded to changes in demand by transferring funds among programs, most often from congregate meals to home- delivered meals or support services, and some ended up having to reduce services due to funding cuts. Twelve of 64 reduced support services and 12 reduced nutrition services. However, more States found ways to maintain levels. Some took steps to reduce administrative costs by, for example, stretching meal services supplies, limiting raises for employees, or leaving vacant positions unfilled. State officials in Wisconsin told us that, due to state budget cuts, the agency was unable to fill vacant positions and had cut planning, administration, and monitoring activities in order to avoid cutting services. Others we visited responded to limited funding and growing service requests by providing service to all who requested it but in smaller doses, such as fewer transit rides or fewer respite care hours. The additional $97 million from the Recovery Act specifically designated for home-based and congregate meals helped some local agencies to temporarily fill gaps in their nutrition services budget. Many expanded existing programs, though, and some created new programs. Ultimately, the majority of these agencies expressed concern about how expenses now covered by the Recovery Act will be met when the funding ends at the end of this year. In conclusion, Title III provides invaluable supports for older Americans. The need for these services will only increase over time as the number of people aged 60 and older continues to grow. Further, the current fiscal stress and looming deficits may continue to strain program resources. As a result, it will be increasingly important for home- and community-based services networks to make sure they're focusing on those in greatest need. This concludes my prepared statement. Thank you. [The prepared statement of Ms. Brown follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] The Chairman. Thank you very much, Kay. Now we'll speak to Dorothy Williams. We'd love to hear your testimony. STATEMENT OF DOROTHY WILLIAMS, FAMILY CAREGIVER, WAUWATOSA, WI Ms. Williams. Hi. I'm Dottie Williams, and I represent a family caregiver. I take care of my 101-year-old mom in our home, and I do this 24/7, 52 weeks of the year. Two years ago, my mom broke her hip and when she was being discharged from a rehab facility, I was asked to meet with a Milwaukee social worker to see if they could help me and I didn't think it was any help because my mom had a tiny sum of money saved for one year of nursing home in case something catastrophic happened and we couldn't care for her anymore in our home. Lo and behold, this wonderful social worker told me that there was a fund through a national funding but it wasn't for my mom. It was respite care for me, and it wasn't based on income, it was based on need. I was really blown away. In fact, I probably started to cry. Anyway, I was accepted in the program and she said it was for respite. So I hadn't really thought about respite. I had been told about respite, but I thought I was strong. I was fine. I didn't need it. But here was this respite given to me and I started using it. I worked through an agency and I started having dates with my husband. I started to reconnect with friends. I saw my doctor, and I realized I had become this dried-out sponge that wasn't a very nice person. If you've taken care of anybody with dementia or anybody with disability, you realize you have to be happy, can never lose your temper, can't pout or throw a temper tantrum. You have to always be pleasant and cheerful and positive, and I realized I hadn't been that person and the respite care really rejuvenated me, filled me up again, and helped me be a better caregiver. So I realized, you know, you hear the phrases about wanting something or is it about needing something. I realized that respite care for a caregiver is a need. It isn't a want. Then, last, I would just urge you to please renew the OAA Act. It funds this National Family Caregiver Program that I receive funds from. I would love it if there was a way to expand it for more families or other needs or even lengthen it. This is a short-term program. It isn't a long-term program. Wisconsin, fortunately, has some other programs in place to help people, such as my mom and myself, and I just want to again thank you for this wonderful gift that was given me. Thank you. [The prepared statement of Ms. Williams follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] The Chairman. Thank you very much, Dorothy. [Applause.] The Chairman. Stephanie, we'd love to hear from you. Pull the microphone up as close as you can. STATEMENT OF STEPHANIE STEIN, DIRECTOR, MILWAUKEE COUNTY DEPARTMENT ON AGING Ms. Stein. OK. Senator Kohl, thank you so much for having this field hearing here. I know that your heart is with the people of Wisconsin and the people of Milwaukee and our heart is with you and we are so appreciative of your efforts in the Senate around elder rights and justice and pension rights and nursing home safety, but, most of all, for 90,000 people in Wisconsin, let me thank you for senior care and what you did for these citizens. [Applause.] It's also a wonderful opportunity to meet and hear Secretary Greenlee. We now know that the Administration on Aging is in very good hands and that is a relief. Thank you so much for being here. [Applause.] As Congress moves to reauthorize the Older Americans Act, please keep in mind that the Older Americans Act programs are truly the fundamental national underpinnings of home- and community-based care. In Milwaukee County, Wilson Park, where we are today, hosts one of our 30 congregate meal sites where every day thousands of people get a good meal and friendship and have some fun. Every day in Milwaukee County, because of the Older Americans Act, we deliver 850 home-delivered meals to homebound seniors. Every day, hundreds of people receive rides because of the Older Americans Act to see their doctor, to go shopping, or to come to a nutrition program and get out of the house. Dozens of people, like Dottie, receive care through the National Family Caregivers Support Program, so that caregivers can continue on with the difficult and blessed job of caring for the people that they love. The last reauthorization was pretty special to Wisconsin because it began to replicate aging and disability resource centers which we are so proud started in this State and are still very supportive. [Applause.] The Act also expanded nursing home diversion, a big thing close to our hearts, and helped us offer more wellness and prevention services to help people stay out of institutions. I hope, as you leave, you'll look at our fitness center here where older people for free get a personal trainer and get to work out and get strong and stay as strong as they can possibly be. So the programs in the Older Americans Act are very important, they are very appreciated, and they are very under- funded. So any money, extra money that can be appropriated for the title, Senator Kohl, will be greatly appreciated in Wisconsin. However, the Older Americans Act is more than programs. The Act is based on the principles of the full participation of our Nation's older Americans in all aspects of our complex society and in order to support those principles, it created very important structures: the Administration on Aging, our State Aging Unit, and Area Agencies on Aging throughout the United States to help carry out the Act. As an area agency on aging, the Milwaukee County Department on Aging has had great success because the Older Americans Act orders that we lead, we listen, and that we advocate. As an area agency on aging, we lead collaborations to find lasting solutions for issues in our community. Our collaborations have resulted in onsite services and supports in public housing and low-income housing, a mature worker center where older people seeking employment can go to one place and help them in their job search run by the Interfaith Program for Older Adults, a Robert Wood Johnson Foundation grant, which allowed us to transform seven neighborhoods into caring, connected, elder-friendly communities, an economic security initiative led by Family Service, our Intergenerational Council and our Wellness Council, and many, many other initiatives. The Older Americans Act requires that we listen to older adults. They are to be our advisors. In this community, older adults lead our work through our Commission on Aging, our advisory councils, our nutrition council, our neighborhood teams, and all of our trained senior statesmen in this community. Older people contribute to every aspect of the work of our area agency. Now, I could recognize dozens of people in this room but I really want to thank the current Chair of our Commission on Aging Barbara Bechtel. [Applause.] Our Chair Emeritus of the Milwaukee County Commission on Aging, Commissioner Gwen Jackson. [Applause.] They keep me very busy, Senator. Finally and most important, the Act requires us to be effective, visible advocates. In Wisconsin, we have helped advocate for a real affordable drug program, Senior Care, an end to waiting lists for home- and community-based care, Family Care, a strong Ombudsman Program, and a well-funded Benefit Specialist Program to help others. On August 24, our Commission on Aging and Advisory Council held a public working session on reauthorization of the Older Americans Act so we could submit recommendations to you and the Administration on Aging and all of our recommendations are attached to my written testimony, but our highest priorities turned out to be continued support and the growth of wellness and prevention and not just for older people but for their caregivers, too. A national transportation initiative as a new part of this Act because, as Secretary Greenlee testified, transportation is an underlying issue no matter where you live in this country. [Applause.] The formalization of aging and disability resource centers everywhere in the United States, so that everyone has the opportunities we have in Wisconsin and, most important, a way to fund advocacy. We would like the Administration and Congress to consider creating state protection and advocacy agencies for aging in every State modeled on the disability protection and advocacy agencies that are so, so successful in this State and the rest of the country because it is through advocacy that the other systems get changed and we get to make better use of that very small Older Americans Act money. Finally, I'd have three personal things I'd like to ask, Senator. One is that we need a national effort to rebuild and modernize outdated non-appropriate nursing homes in this country. [Applause.] We need a national effort to bring older adults into the technology revolution, so that when three-quarters of our citizens are walking around with buttons in their ears and pushing screens, older people will have some idea of what's going on in those devices. [Applause.] I would like us to work on a national agreement about what assisted living really means, what it really offers, so consumers know what to expect when it comes to this huge industry that is very different that calls itself assisted living. [Applause.] Everywhere in the United States there are great expectations about the reauthorization of the Act and I know that with your help, many of those expectations can be realized. Thank you so much, Senator Kohl. [Applause.] [The prepared statement of Ms. Stein follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] The Chairman. Thank you very much, Stephanie, and now we'll hear from Heather Bruemmer. STATEMENT OF HEATHER BRUEMMER, EXECUTIVE DIRECTOR AND STATE OMBUDSMAN, WISCONSIN BOARD ON AGING AND LONG-TERM CARE Ms. Bruemmer. Thank you so much, Senator Kohl. It truly is an honor to be here. Thank you so much for the opportunity to testify on the reauthorization of the Older Americans Act. I also want to recognize Assistant Secretary Kathy Greenlee for her strong advocacy for the older adults. Senator Kohl, I know Stephanie made a list of all of the great successes you've had, but one that I really want to recognize and thank you for is the criminal background checks. Thank you so much. That's just so important---- [Applause.] For our vulnerable individuals residing. Since 1978, the Ombudsman Program has been a core program of the Older Americans Act. It's the only program in the Act that specifically serves consumers of services provided by residential care facilities. It provides critically needed home- and community-based services that delay institutionalization. In November 2008, we had a very significant thing happen here in Wisconsin where we now have more assisted living beds than we do nursing home beds, and I only see in the future that this trend will continue. We all appreciate and value the importance of living in one's own home and as a result there's been a remarkable growth here in the State of Wisconsin of home- and community-based services available for our seniors. However, there are some elders who benefit from living in assisted living and nursing homes because they're unable to safely live in their own homes. Wisconsin was one of the first States to pilot the Long- Term Care Ombudsman Program which was created by Congress and our State has continuously relied and improved resources available to our senior services. In 1981, the legislature created the Board on Aging and Long-Term Care and our program continues to grow. We provide advocacy services for nursing homes, assisted living, such as residential care apartment complexes, community-based residential facilities, adult family homes, and persons who reside in their own homes receiving Medicaid Waiver Program dollars. As long-term care services and supports have grown in scope and complexity, Federal support for the Long-Term Care Ombudsman Program has not always grown with them. While the mandate to serve residents in assisted living was added to our mission in 1981, there is no new fiscal authorization for this function. Ombudsmen visited about 79 percent of all nursing homes on a quarterly basis last year. Only 46 percent of all board and care assisted living received quarterly visits. Very significant, and I would say here in Wisconsin we would agree with that. Throughout the country, it has been increasingly difficult for ombudsman programs to serve residents in assisted living. So it's very important, I think, for everyone to know that it is not--the lack of sufficient funding is certainly not for the lack of trying by you, Senator Kohl. You've been a great champion and great support for the Ombudsman Program. Each year the Long-Term Care Ombudsman Program resolves hundreds and thousands of complaints made on behalf of aging consumers nationwide. Seventy-seven percent of these complaints are partially resolved which is pretty significant. We know that the complaints coming in truly are of great concern. The majority of ombudsmen spend time in skilled nursing facilities, so it's important to know what is happening in our Wisconsin assisted living facilities here. We believe that people have complaints and concerns. However, we can't confirm that with any degree of certainty due to our inability to visit those facilities. We offer significant consumer protections to residents. I think what we've noted in the last years, complexity and diversity of consumers who live in assisted living facilities continues to grow as well as in nursing homes. Significant concerns, such as falls, medication errors, pressure ulcers, and abuse situations, are on the rise here in the State. We spend a tremendous amount of time investigating those complaints, but, most importantly, we also try to provide education and guidance to facility managers and staff to help prevent these reoccurrences. We also spend time educating and empowering facility leadership, individuals and families in providing care that is consumer-centered. You know, our seniors are our greatest gift and they're full of wisdom and full of life experiences. So it's important to know who is that individual that we're serving, what is their life history, and really make sure that they have meaning and full relationships with their caregivers. Every senior deserves the best quality life and care. I would like to propose the following modifications to the Older Americans Act. The section of the Act relating to the process of and limitations on disclosure of client information needs clarification and emphasis. The current language needs to be emphasized to make clear to facilities that it is this right guaranteed to individuals is of the utmost importance to meeting the goals of the Act. Ombudsmen throughout the country report having contact with more and more individuals who cannot speak for themselves and have no legally authorized representative to speak on their behalf and those are our most vulnerable people who we really need to advocate for and protect. We ask that the provisions in Title VII be amended to add language that states to intensify the training and efforts, to educate the public how important it is to complete the documents necessary to have a trusted, and I can't emphasize that enough, a trusted surrogacy relationship with the personal advocate. We spend so much time here in Wisconsin with individuals that have no family, that really depend on our advocacy services. We support the recommendation which would amend Title II of the Act to propose a base appropriation for our National Ombudsman Resource Center. It has proven to be a valuable site for ombudsmen programs throughout the Nation for training, resources, and technical assistance, despite inadequate funding throughout its history. This, along with the addition of Becky Kurtz as the Director of Long-Term Care Ombudsman Program, will well serve the needs of ombudsman programs nationwide. We wish to thank Assistant Secretary Greenlee for her foresight in creating this position. Wisconsin has such a unique ombudsman program. We're very fortunate with the support of you, Senator Kohl, in Wisconsin. Not every State has that support. So thank you. The Older Americans Act gives us a strong foundation and reauthorization gives us this wonderful window of opportunity to build an even more stronger foundation. It is extremely important that Congress and the aging network come together to strengthen our Long-Term Care Ombudsman Programs to provide a safe, home-like environment and protect those members of our aging society who are receiving services and residential care. As one who speaks for Wisconsin's many vulnerable facility residents and consumers of long-term care, I want to thank you once again, Senator Kohl, for allowing me to share with you the thoughts about the reauthorization of the Older Americans Act. Thank you very much. [Applause.] [The prepared statement of Ms. Bruemmer follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] The Chairman. Thank you. Stephanie, you spoke about or referred to inappropriate outdated nursing homes as an issue that needs to be dealt with. Would you tell us a little bit more about your thoughts on that issue? Ms. Stein. I sure will, Senator Kohl. I think that people realize that nursing homes happened as a result of Medicaid, a payment source, and some Federal money that helped people build and at that time, people thought that people who lived in nursing homes had to be treated in a medical model. So there are long corridors and nurses stations and two and three people in a room. It is not the way that any of us want to live the rest of our lives. [Applause.] I don't believe that the nursing home industry really wants to continue serving people that way, but there is no way for them to access capital, especially nursing homes who serve people on Medicaid. You know, there are some great experiments going on in this country through the Pioneers of Nursing Home Care, but they are primarily folks who are developing new models and new systems for people with a lot of resources who can afford to privately pay for them the rest of their lives. Most older people enter nursing homes on private pay and then go on Medicaid because their money is all gone and Medicaid payments are simply not enough for nursing home operators to have the capital to build facilities so that people can get care in a dignified, home-like, personalized way, and I think, you know, the Older Americans Act is about home- and community-based care. We're about home-and community-based care, but it is a national shame that we walk into these places and we give them lots of citations and we expect them to get better and they are in facilities that are simply not appropriate for people to live in. [Applause.] The Chairman. Are you suggesting that we have way too many facilities that should not be operating anymore? Ms. Stein. Oh, there are many facilities that shouldn't be operating anymore, Senator, but often poor people and people who are going to become poor have no other choices but to enter those facilities. The Chairman. Thank you. Now to each member of the panel, as we all know, we have a very important person with us here today who will be central to the reauthorization of the OAA in terms of specifics and advocacy ideas that she will take and this is your chance to zero in on maybe one thing that you want her to remember. She's not going to take six or eight ideas from each of us but she will take one idea that you want her to remember as she goes about her job over these next several months and into next year. So I'll give you each an opportunity to speak with her courteously but sternly. Who would like to advocate first for something you really feel strongly about in the reauthorization? Go ahead, Stephanie. Ms. Stein. Secretary Greenlee, I was so happy when you sat up here and said that everywhere you go in this country people tell you don't lose the advocacy in the Older Americans Act, but it's more than not losing it. We are required to be advocates but there is no money to be advocates and there is no checking up if people are advocates, no requirements, and I really think that the disability community has had for a long time a model of advocacy through their protection and advocacy agencies and wouldn't it be wonderful if we could replicate those agencies for aging in every State and then we'd know there would be advocates that we would work with that could organize the entire State, could change systems, and work on behalf of other people. So in this State, advocacy has changed almost everything that we've done and I'd sure like that to happen everywhere. [Applause.] The Chairman. Go ahead, Heather. Ms. Bruemmer. Thank you very much. I think the message I'd like to share is with elder abuse protections. I think it's so vital. I oftentimes find, especially within the Ombudsman Program, that we're reactive rather than proactive. If we had the resources to go out and train and provide the adequate information and tools for individuals to help protect themselves and have the right advocacy services, it would be tremendous. It's so important. The vulnerability and as we know through the demographics, it's just--Wisconsin is an aging state and we need to be proactive with the appropriate resources, being able to get into facilities timely and being able to get into people's homes to make sure that they are protected and well cared for. The Chairman. Thank you. [Applause.] Dottie, would you like to say something to Kathy? Ms. Brown. Actually, I would like to make a request that when we finish our two jobs that we have ongoing right now, the one I mentioned that is on studying the unmet need for services and also we have a job that we're doing for the Senator on elder abuse and a better understanding of the nature and extent of elder abuse and what kinds of things the government can do to help at the local level. So my request would be that when we finish those reports, we talk again. The Chairman. Thank you very much, Kay. [Applause.] Dottie, say a few words to Kathy. Ms. Williams. I feel that these experts have said many of the things that I've been thinking about, but I do appreciate what Kathy Greenlee said about the funding for rural needs. I'm not an expert on any of this, but it would be nice if there was a way to network between agencies, you know. Some counties run out of funds, some counties don't use all their funds, and if there was a way to have a more equitable networking so that counties could help each other care for the seniors that are in their counties. That's all I have to say. Thank you. The Chairman. That's very good. [Applause.] Dottie, I'd like to ask you whether those people who are anticipating or just getting into the caregiving program that you're involved in need to get some training and introduction before they're involved? Could that be very important? Ms. Williams. I guess I learned on the fly. I mean, I'm just my mother's daughter. I guess I was pretty ignorant. I didn't ask a lot of questions and probably I should have talked to the Director of Aging earlier and that was my fault. I think if I had accessed more departments, I would have had more knowledge and when I was receiving help, it was sort of in a transition period when Milwaukee County was having Interfaith take over some of these responsibilities. So it was kind of a learning experience, both with Milwaukee County as well as Interfaith, and so everybody was kind of learning at the same time, but having been involved with Interfaith now, there are a lot of resources available and I feel very confident in contacting Interfaith and Pat Bruce, who is very helpful in helping me, and I think they would help you with training if you needed it. I have not found in my situation that I needed particularly professional training because in my situation, dealing with my mother who has dementia, it's a very gradual process and so you're kind of learning along with that person. The Chairman. Good. Well, we want to thank you all on this panel. You're clearly and obviously people with great expertise and knowledge and experience and good judgment. We couldn't have found four better people to come and represent the issues and I'm sure that Kathy feels that she's fortunate to have heard from you today. So we thank you for coming. [Applause.] Thank you so much and maybe we'd like Kathy to come and sit before us once more and make some final judgments and opinions. Ms. Greenlee. Thank you, Senator. I'd like to join you in thanking the panel members for providing their insights and what is sometimes both passionate and very personal information. I have a quick announcement and then if I could make some general comments. One of the things that we do at the Administration on Aging is administer lifespan respite grants. The program that we've talked about today, the Family Caregiver Program, has been around for 10 years at the Administration on Aging, but a year ago we began administering grants called Lifespan Respite because, as I mentioned and as you know, caregiving really spans the lifespan. For the second year we've had $2.5 million to administer, and I announced this morning 12 additional grants. We had 12 last year, 12 this year, and we were pleased to announce this morning that Wisconsin has received one of these lifespan respite grants. So I just wanted to say congratulations to you all. [Applause.] Yes, go team or something. The purpose of the grants is coordination. Unlike the Family Caregiver Program where it's specific to an individual, we understand that there are respite programs that need better coordination, more information, a comprehensive need for volunteers, and the lifespan respite grants are meant to help a State coordinate their respite services and so they can be as good quality and grow as they can. So I'm very proud of you and congratulations to Wisconsin for that grant. Then just a couple of comments. Just in reflection, I said I listened to 310 people and you really got to the ground in four. So I was impressed that you go to the same place I did in terms of hearing from the network. The project in front of us, as you know, is to reauthorize the law and you and I certainly know what that task involves and for the audience, when you reauthorize a law, you look at the law and say, well, is it written the way we want it or should we write it a different way? It's about what's written in the law. I have heard a lot of opinion about things that could be written differently and will work with the Administration on whether we should change the law. With regard to the Older Americans Act, it's almost impossible to talk about the law and not talk about the funding, but the reauthorization is about the law. Appropriations is about the funding, and this comes up time and time again and you heard it certainly in the GAO report, that there's tremendous need for these services and they provide tremendous value. Right now in front of Congress, the President has recommended for the Administration on Aging a 10 percent increase in Older Americans Act funds. He recommended $102.5 million increase for our programs. That money was characterized overall as a family caregiver or caregiver initiative. That money would allow us through OAA to support direct caregiver services, direct care recipient services, and would double the lifespan respite grants that I just mentioned. I have been meeting with Members of Congress and their staff and will do everything I can to support the President's request for increased funding for the Older Americans Act. I very much appreciate being able to come to talk to you about both the authority and the law and the appropriations that go with it and look forward to seeing you again either in Wisconsin or certainly in Washington. Thank you very much. [Applause.] The Chairman. Thank you. Thank you very much, Kathy, and all of our witnesses and ladies and gentlemen, for being here today. I think the purpose of the hearing was to be sure that Washington, through Kathy Greenlee, got a very strong opinion from experienced people here in the great State of Wisconsin about the things we can do to strengthen services to older Americans and the people on the panel acquitted themselves and brought that information, that experience, I think, to this hearing very, very well. I'm sure Kathy feels that she's more than gotten back knowledge here which she put in by way of coming here and you're coming here in such huge numbers to represent the issue and to impress upon us how much you care about services to older Americans, I think, has made a very strong impression on her. I assure you it's made a very strong impression on me. So we thank you deeply for giving us your time today and we hope to return to you by way of good valuable service all that you've brought to us by your presence. Thank you so much. [Applause.] [The committee adjourned at 2:07 p.m.] A P P E N D I X ---------- [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]