[Senate Hearing 112-106]
[From the U.S. Government Publishing Office]
S. Hrg. 112-106
MEALS, RIDES, AND CAREGIVERS: WHAT MAKES THE OLDER AMERICANS ACT SO
VITAL TO AMERICA'S SENIORS
=======================================================================
HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
MAY 26, 2011
__________
Serial No. 112-6
Printed for the use of the Special Committee on Aging
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SPECIAL COMMITTEE ON AGING
HERB KOHL, Wisconsin, Chairman
RON WYDEN, Oregon BOB CORKER, Tennessee
BILL NELSON, Florida SUSAN COLLINS, Maine
BOB CASEY, Pennsylvania ORRIN HATCH, Utah
CLAIRE McCASKILL, Missouri MARK KIRK III, Illnois
SHELDON WHITEHOUSE, Rhode Island JERRY MORAN, Kansas
MARK UDAL, Colorado RONALD H. JOHNSON, Wisconsin
MICHAEL BENNET, Colorado KELLY AYOTTE, New Hampshire
KRISTEN GILLIBRAND, New York RICHARD SHELBY, Alabama
JOE MANCHIN III, West Virginia LINDSEY GRAHAM, South Carolina
RICHARD BLUMENTHAL, Connecticut SAXBY CHAMBLISS, Georgia
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Debra Whitman, Majority Staff Director
Michael Bassett, Ranking Member Staff Director
CONTENTS
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Page
Opening Statement of Senator Herb Kohl........................... 1
Statement of Senator Bob Corker.................................. 2
Statement of Senator Bill Nelson................................. 3
Statement of Senator Mark Udall.................................. 3
Statement of Senator Bob Casey................................... 4
PANEL OF WITNESSES
Statement of Rosalynn Carter, President, Rosalynn Carter
Institute for Caregiving, Americus, GA......................... 5
Statement of Kathy Greenlee, Assistant Secretary, Administration
on Aging, Department of Health and Human Services, Washington,
DC............................................................. 7
Statement of Elizabeth Marshall, OAA Service Recipient, York, PA. 15
Statement of Max Richtman, Chair, Leadership Council of Aging
Organizations, Washington, DC.................................. 17
Statement of Heather Bruemmer, State of Wisconsin Long-Term Care
Ombudsman, Madison, WI......................................... 19
Statement of Timothy Howell, CEO, Senior Citizen Home Assistance
Services, Knoxville, TN........................................ 21
APPENDIX
Witness Statements for the Record:
Rosalynn Carter, President, Rosalynn Carter Institute for
Caregiving, Americus, GA....................................... 32
Kathy Greenlee, Assistant Secretary, Administration on Aging,
Department of Health and Human Services, Washington, DC........ 64
Elizabeth Marshall, OAA Service Recipient, York, PA.............. 71
Max Richtman, Chair, Leadership Council of Aging Organizations,
Washington, DC................................................. 76
Heather Bruemmer, State of Wisconsin Long-Term Care Ombudsman,
Madison, WI.................................................... 98
Timothy Howell, CEO, Senior Citizen Home Assistance Services,
Knoxville, TN.................................................. 103
Responses to Additional Questions for the Record:
Rosalynn Carter, President, Rosalynn Carter Institute for
Caregiving, Americus, GA....................................... 113
Kathy Greenlee, Assistant Secretary, Administration on Aging,
Department of Health and Human Services, Washington, DC........ 115
Max Richtman, Chair, Leadership Council of Aging Organizations,
Washington, DC................................................. 123
Additional Statements Submitted for the Record:
Senator Robert P. Casey, Jr. (D-PA).............................. 125
American Bar Association, Washington, DC......................... 126
Center for Advocacy for the Rights and Interests of the Elderly,
Philadelphia, PA............................................... 131
East Tennessee Area Agency on Aging and Disability............... 145
LeadingAge, Washington, DC....................................... 149
National Association of Senior Legal Hotlines, Austin, TX........ 152
The OASIS Institute, St. Louis, MO............................... 159
MEALS, RIDES, AND CAREGIVERS: WHAT MAKES THE OLDER AMERICANS ACT SO
VITAL TO AMERICA'S SENIORS
----------
THURSDAY, MAY 26, 2011
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 2:03 p.m., in
Room SD-106, Dirksen Senate Office Building, Hon. Herb Kohl,
Chairman of the Committee, presiding.
Present: Senators Kohl [presiding], Nelson, Casey, Udall,
Manchin, and Corker.
OPENING STATEMENT OF SENATOR HERB KOHL, CHAIRMAN
The Chairman. Good afternoon. We'd like to thank all of you
for being with us today.
In 1965, the same year Medicare was created, President
Johnson signed another landmark bill for America's seniors, the
Older Americans Act. Today the programs authorized by the OAA
serve more than 10 million older Americans nationwide and over
386,000 in my State of Wisconsin. They help seniors live
independently in their communities through home care, home-
delivered and group meals, family caregiver support,
transportation, as well as other services.
While the need for such vital OAA services has increased
during these difficult economic times, Federal funding for OAA
programs has not. This year OAA programs were cut by 17 percent
from last year.
Every five years, Congress takes a fresh look at OAA
programs to assess whether they are meeting the needs of the
people they serve. Last September I held a field hearing in
Milwaukee to gather ideas for strengthening and improving OAA
programs. Since then we've incorporated many of the
recommendations we received into priorities, and we will work
with our colleagues to include these priorities in the new
bill.
One of our priorities will address helping the nearly 44
million family members providing care to an older relative by
simply asking them: ``What do you need?'' By permitting States
to assess whether family caregivers need services such as
respite care and counseling, we can delay more costly
institutional placements of frail and disabled seniors.
We also believe we must strengthen 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 settings. We will work to expand the
capacity of the National Ombudsman Resource Center and increase
the ombudsmen's access to resident health care records so they
can be more efficient as well as more effective.
Once again, we'd like to thank you all for being here. We
look forward to your remarks, particularly those who are
testifying, on how we can improve the Older Americans Act.
We turn now to Senator Bob Corker.
STATEMENT OF SENATOR BOB CORKER
Senator Corker. Thank you, Mr. Chairman. As always, thanks
for calling the hearing on the Older Americans Act. We want to
thank the witnesses here today to share your expertise and
experience, and I want to especially thank Rosalynn Carter, our
First Lady, for sharing her experience, and Tim Howell with the
Senior Citizen Home Assistance Services in Knoxville, for
coming to Washington to testify on the good work that they are
doing for seniors of East Tennessee. I look forward to learning
more about Older Americans Act programs today.
When the Older Americans Act was passed in 1965, it was
designed to be the human services support for seniors and
complement the health support offered by the brand-new
Medicare-Medicaid programs. This non-medical support envisioned
by the Older Americans Act was proven to be what seniors need
to stay in their own homes and independent as long as possible.
These services, like home-delivered meals, rides to
appointments and activities, housekeeping and personal care,
case management, caregiver support, and senior centers, are the
first--are the sort of home and community-based services that
seniors and their families across the country rely upon.
In Tennessee Older Americans Act home- and community-based
service programs serve about 159,000 people. Almost 2,000
people are working and learning new skills for future
sustainable employment because of the senior community service
employment program. The service providers in Tennessee work
hard to help seniors maintain dignity and independence with the
latest innovations and programs.
For example, Tennessee has started to get in place aging
and disability resource centers. These centers are to serve as
a single point of entry for all services a senior may be
eligible for. I look forward to reviewing the upcoming
evaluation by the U.S. Administration on Aging of these centers
and to see if any necessary improvements in the information and
referral--in this information and referral innovation.
In 2020--and this is something that I think all of us are
focused on as we look at future budgets--there will be more
than 75 million people over the age of 60 and thereby eligible
for the Older Americans Act programs. With our population
growing older, these programs become more and more important.
But at the same time, we are experiencing a fiscal crisis and
need to seriously review spending on all government programs.
This means that Older Americans Act programs will have to
continue to innovate and increase efficiencies to meet
increasing demand.
I look forward to working with my colleagues and with our
panelists to continue to modernize the Older Americans Act so
that it can be flexible and appropriate to serve the needs of
our Nation's seniors.
Thank you, Mr. Chairman.
The Chairman. Thank you very much, Senator Corker.
Senator Nelson of Florida.
STATEMENT OF SENATOR BILL NELSON
Senator Nelson. Thank you, Mr. Chairman. I want to take
this opportunity to thank you for your long and distinguished
career. This is the first opportunity publicly that I could say
that to you, as we have already discussed privately, because
last week you announced that you are going to retire from
public service. Your 24-year career in the United States Senate
is most distinguished and most appreciated by a lot of folks
who never get a chance to tell you.
Like most citizens of the United States that have a
connection one way or another with Florida, so you do as well.
The Senator's brother is one of our distinguished citizens in
Palm Beach.
I want to, Ms. Carter, thank you for you just keeping on
keeping on. It was a long time ago when you and your husband
were campaigning in the Florida primary in 1976, and you have
been his partner every step of the word in the best sense of
that word, and you continue today rendering service to our
country and to our people. So thank you very much.
Mr. Chairman, I just wanted to mention that, on this
subject that we are discussing today, that a good example is a
bill that I've had to file. I say had to file because, for
example, in all the good stuff that programs like community
development block grants do, CDBGs, but it has, for example, a
limitation of 15 percent of the funds that can go to feeding
programs for seniors. In one particular case, the City of Miami
wants so desperately to use those, the remaining CDBG funds,
for assistance to seniors in the feeding programs. But they're
limited to 15 percent.
So I filed a bill to raise that a modest amount to 25
percent, that would give the recipients of CDBGs that
flexibility to tailor their particular needs of the community,
in this particular case the needs of senior citizens. I just
wanted to get that out on the record for the committee.
The Chairman. Very good. Thank you, Senator Nelson.
Senator Mark Udall.
STATEMENT OF SENATOR MARK UDALL
Senator Udall. Thank you, Mr. Chairman. Good afternoon to
everybody. I too want to associate myself with Senator Nelson's
remarks about your leadership. I haven't forgiven you yet,
Senator Kohl. I want that to be on the record.
The Chairman. I have your note.
Senator Udall. But I wanted to welcome our panelists. I
unfortunately have to step out. I serve on the Intelligence
Committee, and we're having an important debate on the Patriot
Act and its reauthorization.
But I did want to acknowledge the First Lady. The Udall and
Carter families have been intertwined for many decades and we
have great respect for their commitment to public service, and
it's wonderful to see you here today.
Ms. Greenlee, you were a hit in Pueblo last summer. You
were a real crowd-pleaser. I can't say the same about myself,
but thank you for holding a hearing with us in Pueblo. I know
the chairman and many members of the committee have been
holding hearings all over our great country on the OAA.
We have a real opportunity in my opinion to modernize the
act for a new and unique generation of seniors. I'm a member of
the baby boom cohort. These Americans, my remarks say, which
are my people, are fast approaching Medicare eligibility, and I
think we have different expectations, different experiences,
about how we can make our golden years really meaningful.
So this is an important hearing. Mr. Chairman, I look
forward to working with you to modernize the act in ways that
take advantage of the potential and the contributions that
every American can make regardless of their age. So thank you
again.
The Chairman. Thank you, Senator Udall.
Senator Casey.
STATEMENT OF SENATOR BOB CASEY
Senator Casey. Mr. Chairman, thank you. I'll be brief, and
I'll add a statement to the record. But we want to commend you,
not only for today's hearing, but of course for your great
service to the United States Senate. You've been--you've been a
great leader of this committee, and we'll miss you. We know
you're going to be here for a while yet. We're not saying
goodbye yet, but we want to commend you for that.
To Rosalynn Carter, former First Lady, we're grateful that
you're here and appreciate your important witness on these
issues over many years and your leadership and your testimony
today.
Assistant Secretary Greenlee, we're grateful to have your
testimony today as well.
On the second panel, I'm honored to say as a Pennsylvanian
we have a former Mayor of York, Pennsylvania, Elizabeth
Marshall, who is here. We will say hello to her in a more
personal way a little later, but I am grateful she's here.
Just a couple words about why we're here. This legislation,
of course, the Older Americans Act, has often been described as
the glue that holds a whole series of programs that benefit
older citizens together. I think what brings us into this room
today is not just legislation and policy, but a shared
commitment that we have more work to do as it relates to older
citizens, those who have fought our wars, worked in our
factories, taught our children, built our economy, and gave us
life and love; that we've got an obligation, an enduring,
abiding obligation, to do all we can. And one of the ways to
fulfil that obligation is to make sure that we make the right
choices on legislation and policy, and I'm happy to be part of
this hearing today.
Thank you, Mr. Chairman.
The Chairman. Thank you very much, Senator Casey.
We're honored to have with us today former First Lady
Rosalynn Carter. We're all familiar with Ms. Carter's tireless
advocacy alongside her husband, President Carter, on behalf of
human rights and conflict resolution around the world. She is
also a dedicated advocate for caregivers and mental health
issues here at home.
Mrs. Carter is President of the Rosalynn Carter Institute
for Caregiving at Georgia Southwestern State University, where
she leads the institute's efforts to promote the well-being of
family caregivers throughout our country. She is an inspiration
for many and a legend in her own right.
Next we'll be hearing from Kathy Greenlee, the Assistant
Secretary for Aging at the U.S. Department of Health and Human
Services. Ms. Greenlee has a wealth of experience advancing the
health and the independence of seniors and their families.
Previously Ms. Greenlee served as Secretary for Aging for the
State of Kansas, as well as the Kansas State Long-Term Care
Ombudsman.
We thank you very much for being here, and we'll take your
comments and testimony, Mrs. Carter.
STATEMENT OF ROSALYNN CARTER, PRESIDENT, ROSALYNN CARTER
INSTITUTE FOR CAREGIVING, AMERICUS, GA
Mrs. Carter. I'm very pleased to be here this afternoon to
speak about caregiving, an issue that is very important to me.
It has been part of my life since I was 12 years old and my
father was diagnosed with leukemia at age 44. We lived in a
very small town and all the neighbors rallied around. But I
still vividly remember going to my secret hiding place, the
outdoor privy, if you can believe that, to cry. That's where I
could be alone.
I was the oldest child, and I felt the burden of needing to
help care for my father and my three younger siblings. Yet I
was afraid and didn't always feel like being strong. But my
mother depended on me.
Less than a year after my father died, my mother's mother
died, and my grandfather came to live with us. He was 70 and
lived to be 95. My mother cared for him at home until he died.
I helped as much as I could, but I was married and living away
much of the time. During the last few years of his life he was
bedridden and totally dependent on her, our family members,
neighbors, and friends for all his needs.
My story is not unique, but today the informal support
networks that were so much a part of my life in a small town--
neighbors, extended family, the church--are not there for
millions of Americans. Families are fractured and dispersed.
Women, the traditional caregivers, are now an integral part of
the work force. Advances in medical science mean we are living
much longer, yet resources to enable us to live independently
are sorely lacking.
We face a national crisis in caregiving, especially for our
elderly citizens. Most frail elderly and disabled people live
at home today. About 90 percent of the care they need is
provided by unpaid, informal caregivers, most often family
members, providing tasks that only skilled nurses performed
just a decade ago, and with minimal preparation and training.
Many of these caregivers are frail and elderly themselves
and find the burdens of caregiving overwhelming. Consider these
facts: Older people caring for their spouses have a 63 percent
higher mortality rate than those of similar age without
caregiving responsibilities; the stress of caring for a person
with dementia negatively impacts the caregiver's immune system
for up to 3 years after caregiving ends, making them more
susceptible to all kinds of illnesses; caregivers report
chronic conditions such as heart disease, cancer, and diabetes
at twice the rates of noncaregivers; and up to 50 percent
report struggling with depression. It's even higher when caring
for a loved one with dementia.
While experts estimate the value of care provided by unpaid
informal caregivers to be more than $375 billion annually, many
caregivers have to reduce their working hours or even quit
their jobs, losing health and retirement benefits worth
hundreds of thousands of dollars.
The economic consequences are devastating. Our nation's
family caregivers are enduring both physical and mental
problems and even dying sooner because of the responsibilities
in caring for a loved one.
Mr. Chairman, there are only four kinds of people in the
world: those who have been caregivers, those who currently are
caregivers, those who will be caregivers, and those who will
need caregiving. That's all of us. Caregiving knows no
geographic or political boundaries.
The Rosalynn Carter Institute for Caregiving at Georgia
Southwestern State University near my home town is doing
groundbreaking work to help Americans with their challenging
caregiving responsibilities. In one of our programs, with
support from our corporate partner Johnson and Johnson, we
undertook a national assessment of the state of caregiving in
our country. We discovered innovative programs proven to be
effective, but they were not and are not reaching people in
need.
One of them focuses on the spouses of people with
Alzheimer's disease. It provides concrete advice on how to deal
with difficult behaviors like wandering, repeatedly asking
questions, and agitation. It also focuses on taking care of
oneself and on simple techniques to reduce stress. A woman at
home who's been through our program told me that it changed her
life. She said she was overwhelmed by difficulties and stresses
of assuming care for her mother after her father died
unexpectedly. She now is proud of being able to allow her
mother to stay in her home. Just think what a difference this
kind of program would make in lives of caregivers across this
country.
The RCI, which is what we call the Rosalynn Carter
Institute, has been working in Georgia and in demonstration
sites around the country to introduce these interventions at
the community level. But much more needs to be done.
There must be a fundamental shift in how this nation values
and supports caregivers and caregiving. Last October the
Rosalynn Carter Institute released a very important report,
``Averting the Caregiving Crisis: Why We Must Act Now.'' This
report is the result of 3 years of intensive study which
involved hundreds of experts. I urge each of you to read it
carefully, for it contains a blueprint for a national
initiative to support family caregivers.
Its recommendations include: better assessments of
caregiver health; increased use of evidence-based interventions
in communities across the country; and greater flexibility in
both public and private insurance programs to provide training
and support for family caregivers. Its most important
recommendation, however, is a call for leadership. We propose a
National Quality Caregiving Task Force in the President's
office, with shared leadership between the Secretary of Health
and Human Services and the Secretary of Veterans Affairs. We
have the knowledge base to solve the caregiver crisis, and we
are already spending billions of dollars which can be used much
more effectively.
These are challenging times for our country, with extreme
pressure on federal, state, and local resources. Families and
communities are struggling to cope. Yet if we fail to act now,
the consequences for those in need of care will be increased
rates of institutionalization, higher risk of abuse and
neglect, unnecessary isolation, and perhaps even premature
death. For family caregivers it will mean much greater burden,
increased risk of physical or mental health problems, and more
financial hardships. For our already overtaxed health care
system, it would be impossible to find the work force to
deliver high-quality institutionalized care.
The overall impact would be an unprecedented burden. In
human terms, it will lead to unparalleled suffering for
millions of older Americans and their family caregivers. We
cannot let this happen.
Thank you for the opportunity to speak with you about this
most significant national issue. Mr. Kohl, thank you.
[The prepared statement of Rosalynn Carter appears in the
Appendix on page 32.]
The Chairman. Thank you very much, Mrs. Carter.
We'll hear from Ms. Greenlee.
STATEMENT OF KATHY GREENLEE, ASSISTANT SECRETARY,
ADMINISTRATION ON AGING, DEPARTMENT OF HEALTH AND HUMAN
SERVICES, WASHINGTON, DC
Ms. Greenlee. Thank you. Senator Kohl, it's good to see you
again. Senator Corker. Members of the Special Committee on
Aging: Thank you for the opportunity today to talk about the
reauthorization of the Older Americans Act. In preparation for
this process, at the Administration on Aging we went through
the most extensive outreach effort in the history of the agency
to seek input from all across the country, from family
caregivers, seniors, and other individuals providing support.
We have a lot of information that we have gathered about the
value of these programs and look forward to continuing to work
with this committee as we take up the challenge of
reauthorization.
Senator Kohl, I would like to join your colleagues in
commending you in your service on behalf of older Americans. I
think I have mentioned to you before I first heard of you from
our mutual friend George Petrosky, the former Wisconsin long-
term care ombudsman. Not only have you been instrumental in
helping seniors; you have paid particular attention to those
seniors in nursing homes in this country. And many of us--I
think I can speak on behalf of the whole aging network--have
valued your contributions and will miss your leadership. So
thank you for your service.
It's also wonderful to appear today with Mrs. Carter, a
tremendous honor to be here. I met Mrs. Carter last fall when I
traveled to Americus to the Rosalynn Carter Institute to talk
specifically about what we need to do to continue to advance
the cause and the supports for caregivers. She had released her
report about that same time.
Mrs. Carter is a leader in the field of caregiving. The
work that they're doing at the institute is innovative. The
leadership she is asking for she is herself providing. I also
want to acknowledge her work in the field of mental health, not
something we will spend as much time on at this hearing. But
Mrs. Carter's work in mental health is really important for
individuals dealing with mental health and their family
members.
So I applaud your work, Mrs. Carter. It's an honor to be
here.
As you know and mentioned, I was the Secretary of Aging in
the State of Kansas. I have served now for 2 years as the U.S.
Assistant Secretary for Aging, and in both of those capacities
I have listened to and spoken to thousands of individuals and
families in a variety of settings. And I have seen first-hand
how the Older Americans Act reflects the values that we have in
this country: supporting independence, helping people maintain
their health and well-being so they are better able to live
with dignity, protecting the most vulnerable among us, and
providing basic respite care and other supports for families so
that they are better able to take care of loved ones in their
homes and their communities for as long as possible. This is
what Americans of all ages overwhelmingly tell us they prefer,
to age at home in their communities.
One of the real strengths of the Older Americans Act is
that it doesn't matter if an individual lives in a rural area,
a frontier area, or an urban center. The programs and the
community-based supports are flexible enough to meet the needs
of individuals in all of these diverse communities and
settings.
Over the past year alone, nearly 11 million older Americans
and their family caregivers have been supported through the
Older Americans Act comprehensive community-based system. These
services, as you mentioned, Senator Kohl, complement medical
and health care systems. They help to prevent hospital
readmissions. They provide transportation to doctor's
appointments and support some of life's most basic functions,
such as bathing or having a home-delivered meal.
This assistance is especially critical for nearly 3 million
seniors who receive intensive in-home services, half a million
of whom would otherwise qualify for nursing home admission.
For more than a year, as I have mentioned, we have received
reports from more than 60 reauthorization listening sessions
around the country, and have received on-line input from a
variety of sectors, individuals, and organizations and their
caregivers. This input represents the interests of thousands of
individuals with regard to the Older Americans Act's services.
During this process we heard an overriding issue that Mrs.
Carter has already spoken to today, and which was also advanced
through the Vice President's Middle Class Task Force, and that
is the issue with regard to families. Families are doing the
best that they can, but they're struggling between balancing
the demands of work, child care, and elder care. Families tell
us that they need some basic assistance in supporting their
care for their loved ones.
During our process of soliciting input, we heard that the
Older Americans Act is working and it needs to continue to be
flexible. We also heard two particular themes that I want to
suggest in terms of further conversation. One suggestion or
recommendation that we have heard is that we continue to
improve the program outcomes by embedding evidence-based
interventions and disease prevention programs, encouraging
comprehensive person-centered approaches, providing flexibility
to respond to local nutrition needs, and increasing efforts to
fight fraud and abuse.
Second, we need to remove barriers and enhance access,
extending caregiver supports to parents who care for their
adult children with disabilities, providing ombudsman services
to all residents of nursing facilities, not just seniors, and
using aging and disability resource centers as single access
points to provide information regarding public and private
resources for long-term supports and services.
Let me give you three brief examples we would like to
discuss as we continue our work: One, we should ensure that we
utilize the best evidence-based interventions for helping older
individuals manage chronic disease. These have been effective
in helping people adopt healthy lifestyles, improve their
health status, and reduce their use of hospitals and emergency
room visits.
We want to improve the Senior Community Services Employment
Program by integrating it with other senior programs. As you
know, the President has recommended in 2012 through this budget
process that we transfer the older workers program from the
Department of Labor to the Administration on Aging.
We would also like to continue to combat fraud and abuse of
both Medicare and Medicaid by permanently establishing the
authority for the operation of the senior Medicare patrol
program as a basic component of the Older Americans Act, so we
can continue to use retired volunteers to help us detect and
deter fraud in the area of Medicare and Medicaid.
The Older Americans Act has historically enjoyed widespread
bipartisan support. Based in part on this extensive public
input, we believe that reauthorization can strengthen the Older
Americans Act and put it on solid footing to meet the
challenges of a growing population of seniors, while continuing
to carry out the critical mission of helping elderly
individuals maintain their health and independence in their
homes and communities.
Thank you again, Senator Kohl and Senator Corker, for your
leadership. I look forward to working with you and the rest of
your committee. Thank you.
The Chairman. Thank you very much, Ms. Greenlee.
[The prepared statement of Kathy Greenlee appears in the
Appendix on page 64.]
We'll now commence questioning. We'll start with Senator
Corker.
Senator Corker. Thank you, Mr. Chairman. I'll be brief.
Again, thank you both for your testimony. Mrs. Carter, I
notice the chairman said you were a legend in your own right.
Certainly not in relation to anybody up on this panel, we serve
with a lot of folks here that are a legend in their own mind.
[Laughter.]
Senator Corker [continuing]. So we thank you so much for
having earned that and certainly bringing such focus on this
issue. But thank you very much for your testimony.
I have a few organizational issues to ask Ms. Greenlee
about. I know the President's budget this year transfers some
additional responsibilities into your agency, the Title VSenior
Community Services Employment Program, the State Health
Insurance Assistance Program, the CLASS Act. I know you were
talking about some of the flexibilities and other kind of
things that need to happen within your organization. Is that
going to, in your opinion, distract at all from your ability to
efficiently carry out the other responsibilities of the
organization?
Ms. Greenlee. No, Senator Corker. The agency has a 45-year
history and experience in providing community supports to
individuals. One of those components is the economic security
of seniors, and we have a variety of programs that have worked
on pension counseling, benefits outreach. Bringing the older
workers program to AOA will help strengthen our mission, not
detract from it. It is the only one of the Older Americans Act
programs that we do not administer.
The senior health insurance assistance programs are
primarily delivered at the local level through our area
agencies on aging. And the reason for the CLASS Act, the
underlying need for the CLASS Act, is to provide a different
type of option for individuals to maintain their independence
in the community. We feel like we have a wealth of knowledge to
support these other programs and can make them all work to help
individuals, people with disabilities, and seniors remain
independent.
Senator Corker. I know that Secretary Sebelius has
mentioned that the CLASS Act is an unsustainable program unless
numbers of changes are made. I know that you are probably
closest to it since, as you mentioned, you're going to be
involved in implementing it. Are there things that you are
already looking at, major structural changes to actually cause
the CLASS Act to be sustainable? I know there are people on
both sides of the aisle who have a lot of concerns about that.
Ms. Greenlee. Senator, as you have referenced, I was
designated officially in January as the administrator of the
CLASS program at the Administration on Aging. The Secretary and
I have both had opportunity to testify, most specifically on
the House side, and committed ourselves and our efforts to the
financial solvency of this program.
We both agree that there are reforms that need to be made
to the program in order to sustain the program and make it
financially sound for 75 years, as required by the law. We will
this fall issue preliminary regulations with regard to the
program and at that time be able to provide more information
about the kinds of things that we need to do through a
regulatory process to strengthen the program.
There are things that we were looking at, considered by the
Senate before the bill was passed, that we will return to first
as we find ways to support the program for its financial
solvency.
Senator Corker. As you go about looking at implementing it,
I know there has to be some investments made, if you will,
through your organization to begin that implementation. How are
we accounting for that? Is that something that goes into the
actual cost of the CLASS Act itself or is that something--how
is that being accounted for?
Ms. Greenlee. Senator, as you know, the Department of
Health and Human Services was given money to implement the
Affordable Care Act. It is from those funds that we have
currently been paying for our operational costs. We have made
sure that we can identify all the staff who are working on the
CLASS program full time and those of us who split our time
between CLASS and the Administration on Aging's traditional
work, so that we can fairly account for the work that we're
doing. I believe we're adequately handling the accounting that
needs to be done.
Senator Corker. I know there's going to be a tremendous
amount of focus on Medicare and its sustainability over the
course of this summer. My hope is that we will in a bipartisan
way figure out a way to make it solvent. We all know it's going
to be insolvent as is. The trustees are stating by the year
2024.
As you move ahead with the CLASS Act, I think people
believe it's already at that stage as it's been set up, and I
do hope you'll let us know of some of the major frailties that
exist there and continue to keep us apprised of that.
We thank you for your service, and I look forward to having
several questions for the second panel.
Thank you, Mr. Chairman.
Ms. Greenlee. Thank you, Senator.
The Chairman. Thank you, Senator Corker.
Senator Casey.
Senator Casey. Thank you, Mr. Chairman.
I want to thank you both for your testimony and the
personal witness that you bring to these issues.
I wanted to start with our former First Lady, Mrs. Carter,
on a question that relates to the specialized training that is
often needed in these circumstances. I have been over many
years as a State public official for a decade and now in my
fifth year in the Senate overwhelmed by the kind of care that's
delivered by direct care workers, how strong they are, how
dedicated they are, willing to do backbreaking and sometimes
impossible, seemingly impossible work on behalf of those who
need that care and on behalf of their families.
But I wanted to ask you about it. I noted in your testimony
on the four recommendations that you made, as well as Assistant
Secretary Greenlee, about evidence-based programs. I wanted to
get your sense of that, based upon your experience, as to
evidence-based programs on this question of specialized
training and preparing folks for doing that difficult work.
What can you tell us about that in your experience?
Mrs. Carter. Well, we've been working with evidence-based
programs for a good while now at the Rosalynn Carter Institute.
One that we are working on--we're doing six in all--with
Johnson and Johnson. Johnson and Johnson has been great,
because they were the first ones that did clinical trials in
nursing homes working with those who were suffering from mental
disorders. So they've been very good to us.
But we have six programs and a couple of them are
Alzheimer's. We are actually doing an Alzheimer's one at home.
We train people to go into the homes. They don't have to come
in. When we were trying to get them to come to the Institute
for training they didn't want to. Caregivers don't want to come
in, and they don't want to admit they're caregivers. So many of
them don't want to admit they have to have help; it's just
their job to do what they should do for a family member.
But we send them into the houses. When they find out that
this person can come to the house, they welcome them. So we go
I think 6 weeks, go in a couple times a week. And it's just
made--we have found that it increases the time people can stay
at home without being institutionalized. The depression is
lifted to a certain degree, and it just--it's working.
We're also trying this in other places around the country.
But we're working with three different ones now, and we're kind
of comparing them to see which is best for Alzheimer's. We've
done one with cancer. And we've had--at the Rosalynn Carter
Institute, we had everybody that we knew of, I think, in the
United States who was working on evidence-based programs. I
think we had one person from Ireland that came to that meeting.
We have had great reports, and actually it just helps the
caregiver so much when the program works. It's cost-effective
because they don't have to try things and try things. They just
know what works, and if they will follow the guidelines of the
program it can help.
So we just need evidence-based programs in the whole
country. It's going to be a long time before we get there. But
we're really working and doing research right now on those
programs in many parts of the country.
Senator Casey. I thank you for that. I know that part of
what we're trying to do is to not only improve care and provide
the kind of highest level of care we can, but also to provide
options for the work force. Sometimes I guess they're described
as career ladders, ways for people to move up if they're at
entry level, in an entry level position.
So I think that evidence-based, evidence-based research and
the care that can come from that is going to be critically
important.
I know I've got about 20 seconds, but, Assistant Secretary
Greenlee, anything that you wanted to add on this question of
training or the evidence-based methods?
Ms. Greenlee. This will state the obvious. It's such a
broad topic that it will take many different Federal
organizations working together. We have a community living
initiative within HHS that looks at issues with regard to
people with disabilities, as well as seniors. Senator Corker
mentioned the CLASS Act. This was identified even in the law of
the CLASS Act, how will we support the public programs that we
will have in the future, such as the CLASS Act; the Medicaid
and Medicare programs; the programs that we have under the
Older Americans Act; and disability programs, with a paid work
force that allows them to have meaningful career ladders, as
well as a skill set necessary to serve an increasingly aging
population. It will take both a paid and unpaid workforce to
provide the care that's needed in this country.
Senator Casey. Thank you very much.
The Chairman. Thank you, Senator Casey.
Senator Manchin.
Senator Manchin. Thank you, Mr. Chairman, and thank both of
you for being here and we appreciate it very much. The State of
West Virginia appreciates the work that you have done and also
the assistance that we get in the Older Americans Act and what
it's done for our State.
As you know, we have the second most aged State in the
Nation per population and probably one of the most rural
States. So it's quite costly for us to give the services that
are needed. But we've expanded those, and I think the word that
you mentioned earlier was ``flexibility.'' I can't explain
enough how much flexibility that we need in some of these
States so that the money is not sliced to where transportation
is one, meals on wheels is another.
The formula that's used for small States and rural States
such as myself, and there's more populated States--and I know
that the funding mechanism is based on population. It should be
based on the services that are given, if you could just
consider that. We serve an awful lot of people in West Virginia
and our funding is much lower, but we're feeding many, many,
many more than other States that might not have the need as we
have.
With that, I think you might be aware of some of the
programs we've expanded, the FAIR programs and the Lighthouse
programs. We did some things and during the most difficult
recession times we expanded programs because it was a priority
of ours to allow our seniors to live in dignity in their own
homes, with a little bit of assistance.
Need-based is a big thing in West Virginia because we have
a lot of seniors who want to be able to contribute and pay
their way or pay part of their way if they can. So we try to
develop flexible plans to where they felt like they were still
contributing, but yet they just couldn't find the service
anywhere. A lot of times if you're on a certain cuff and you
get--if you're not within certain guidelines as far as income,
the service is not even offered. I think that's something that
should be considered, too, because it's not for a lack of need.
They just can't find anyone else to provide those services, and
they're willing to pay. So we hope those flexibilities are
taken into consideration.
But in transportation, that's the one that we're having
some concerns about. I don't know if--I support the OAA lock,
stock, and barrel. So tell me what you think you can do to help
us help ourselves more?
Ms. Greenlee. Senator, we have transportation support that
we can provide through the Older Americans Act. Transportation
is such a huge issue that I don't think there's a way to
completely address transportation needs with such a program of
this size. We need to talk to other partners at the Federal
level and at the State and community level to figure out what
is the best way to provide transportation services.
I think one of the best things that we can do--and for this
answer I'm actually relying on my Kansas experience--is to make
sure that we remove any barriers, so that if we provided
support for, say, a van at any level with government funds, we
use it to the best ability in serving all populations.
So I think we need to be innovative, work with our
transportation partners, and figure out how we can make sure
that we're not in the way of what needs to happen in the
community to get the job done.
Senator Manchin. What recommendation do you have--I know,
Mrs. Carter, from your experience. What recommendation would
either one of you have, how we can be more efficient with the
dollars we have? As you know, the budget constraints are going
to be tough on all of us. But by setting the priorities we can
make sure that the dollars we have are in place, but yet they
go further. And we're all growing older and in need of the
services, I'm sure.
But is there anything that we can do that would give you
the efficiencies or help you have more efficiencies? Have we
tied your hands in any way, Mrs. Carter?
Mrs. Carter. One of the greatest helps would be to have
data so we could know how to allocate the resources. One of the
recommendations that our study has made is that we use the
Behavior Risk Factor Surveillance System that the Centers for
Disease Control has developed. They have developed a caregiving
module. If we could use that in the states in the OAA, it
wouldn't cost very much, because the question is not--it's not
on the survey--all surveys--and you have to ask for it.
So we checked to see--Georgia doesn't have it in their
survey. So we checked to see how much it would cost, and it
would cost just $21,000 a year to get that data in Georgia, and
that would be so helpful in cutting costs.
Ms. Greenlee. For about a decade now, the Administration on
Aging has been focused on evidence-based practices. We do this
a lot in the field of Alzheimer's support for individuals and
their family members, the evidence-based practices that I
mention in my testimony.
Those of us who work in the social services arena
understand that science is not just for people who are in the
laboratory, that good evidence, good outcomes in science is a
critical part of delivering quality and effective social
service programs. That's why we're suggesting that we continue
to work in this effort with real regard to the health programs
in the Older Americans Act, to make sure that we've got good
outcomes.
I agree with Mrs. Carter about the global issue of data.
Our ability to continue to research our programs makes the case
with regard to their effectiveness. Their ability to provide
cost savings to other programs such as Medicare and Medicaid is
also a critical component of this conversation as we figure
out, as we go forward, how to balance the supports that are
needed with the increasing pressures of more seniors and the
struggling budgets at the Federal and State level.
Senator Manchin. I'll wait until my second round. Thank you
very much, both of you.
The Chairman. Thank you very much, Senator Manchin, and
we'd like to thank you both profusely for being here today. You
have made tremendous contributions today, as you have in the
past, and again we appreciate your being here. Thank you so
much.
Ms. Greenlee. Thank you, Senators.
The Chairman. We'll turn now to the second panel, if you'll
step up to the table, please. First we'll be hearing from
Elizabeth Marshall, a recipient of home-delivered meals. Ms.
Marshall was elected as the first female Mayor of York,
Pennsylvania, in 1977. She also served as a member of the York
City Council.
Next we'll be hearing from Max Richtman, who serves as
Chairman of the Leadership Council of Aging Organizations, a
coalition of 66 national aging organizations. Mr. Richtman is a
former staff director at this committee and is currently the
Acting CEO of the National Committee to Preserve Social
Security and Medicare. Welcome.
Next we'll be hearing from Heather Bruemmer, who is the
Executive Director and State Ombudsman for the Wisconsin Board
on Aging and Long-Term Care. She also chairs the State's Long-
Term Care Council and serves on the Coalition of Wisconsin
Aging Groups' Advisory Council.
Senator Corker has a witness from Tennessee.
Senator Corker. Yes, sir. I'd like to introduce Timothy
Howell, who is the Chief Executive Officer of the Senior
Citizen Home Assistance Services, a nonprofit that provides in-
home caregiving in East Tennessee. SCHAS aims to improve the
lives of seniors and persons with disabilities while
maintaining their independence and dignity. Mr. Howell has
worked for SCHAS for 10 years, has been the CEO since 2008.
As CEO, Mr. Howell oversaw the completion of Renaissance
Towers, an assisted living community targeted to low-income
seniors who wish to pay for their own care. He's President of
the Tennessee Association of Homemaker Services Providers, a
member of the National Council on Aging, and the Downtown
Rotary.
Thank you for traveling all the way from East Tennessee to
be here.
The Chairman. Thank you.
We'll hear now from Mrs. Marshall.
STATEMENT OF ELIZABETH MARSHALL, OAA SERVICE RECIPIENT, YORK,
PA
Ms. Marshall. Thank you very much.
This is addressed to you, Chairman Kohl, and to Senator
Casey and other members of the committee. Thank you for
inviting me to testify before you today. I am pleased to be
able to share with you my thoughts on the Older Americans Act.
Throughout my life I have always strived to be an independent
woman. Born in 1918, I'm a child of the Great Depression and
have continued to live by the values of economy, thrift, and
self-reliance that I learned during my formative years.
My husband Howard and I married after he returned from
serving overseas. We moved to York, Pennsylvania, in 1948 and
we bought our first and only home there in 1954. This is the
same house I live in today. Our two sons still live near me,
and my daughter resides in New Hampshire.
An old song by Joseph Burke called ``A Little Bit
Independent'' is my theme song, if you will: ``A little bit
independent in your walk, a little bit independent in your
style.'' I have worked throughout my life to be an independent
woman, to find my strengths and use them, whether in service to
my family, community, or country.
In the early 1960s I increasingly became involved in the
York community, which was undergoing a turbulent time, and
eventually in 1971 I was elected the first member of city
council and later served--oh, I'm sorry. It led to my election
to York City Council in 1971, and then I was elected as the
first female Mayor of York in 1977. I later served as Deputy
Comptroller for the City of York. So I know something about
government and the challenging choices faced by decisionmakers
as to the best use of taxpayer dollars.
After my public service career, I worked as a real estate
agent for 18 years. I retired just 11 years ago at 81 years of
age. I have been on my own now for 10 years since my husband
passed away in 2001.
Many of us in our neighborhood are long-time residents. Our
tight-knit community is essentially aging in place and helping
each other remain in our homes for as long as possible. I am
proud to still be an independent woman. I want to be able to
stay in my home, near my family and neighbors.
I am grateful that the York County Area Agency on Aging is
there for me and for thousands of other seniors in my
community. I have a care manager at the Area Agency on Aging.
She was able to connect me to the home-delivered meals program
and if I need additional support, services, or even just
information, she will be ready to assist me and my family.
Three times a week a volunteer from the local senior center
delivers both hot and cold meals to me in my home. I appreciate
the meals service, and it's also nice to have a friendly
visitor check in to make sure I'm safe and doing well.
I understand that the home-delivered meals service is
funded in part through the Older Americans Act. The act allows
the coordination and provision of many other in-home and
community programs. There's even a part of the act focused on
family caregivers, to help them help us.
And we can't forget our senior centers, which are more
important than ever to help older adults stay connected to
their community. Many recipients of services are like me; they
just need one or two little bits of help. Others may need more
services. But the act allows seniors to receive just what they
want to stay healthy. Even if you need a high level of support,
receiving this care in your home is still more affordable for
you and the taxpayers than care in a nursing home.
As our leaders struggle to balance the budget and reduce
the deficit, the cost savings that Older Americans Act programs
generate are even more critical.
My story--my story is not necessarily a unique one. My
peers and I have served our families, communities, and country
for many years, and with the right balance of help we can
continue to remain contributing members of our society and
maintain our health, independence, and dignity for as long as
possible. I'm glad to be able to continue living in my home of
57 years, where I can still be, quote, ``a little bit
independent in my walk.''
The Older Americans Act allows you to retain your dignity,
health, and independence with just a little bit of support. I
urge this committee and your colleagues in the Senate and House
to understand how vital these little bits of support are to
millions of older Americans determined to age in place. We need
to reauthorize the Older Americans Act in a timely and
bipartisan fashion and prepare our country for the wave of baby
boomers standing behind my generation.
Thank you, Senator Kohl and members of the Aging Committee,
for inviting me to share my thoughts about the Older Americans
Act with you here today.
[The prepared statement of Elizabeth Marshall appears in
the Appendix on page 71.]
The Chairman. Thank you, Mrs. Marshall. That was a
beautiful statement.
Ms. Marshall. I'm sorry, I didn't hear that.
The Chairman. That was a beautiful statement. Thank you so
much.
Ms. Marshall. Oh, thank you.
The Chairman. Mr. Richtman.
STATEMENT OF MAX RICHTMAN, CHAIR, LEADERSHIP COUNCIL OF AGING
ORGANIZATIONS, WASHINGTON, DC
Mr. Richtman. Mr. Chairman, members of the committee: First
of all, let me say to Mrs. Marshall: You're a tough act to
follow, but I'll do my best.
On behalf of the Leadership Council of Aging Organizations,
I'm honored to testify before the Special Committee on Aging
about the LCAO Older Americans Act reauthorization consensus
document. LCAO is a 66-member coalition of diverse national
nonprofit organizations dedicated to preserving and
strengthening the well-being of America's older population.
Historically, LCAO has played a significant leadership role in
past reauthorizations of the Older Americans Act.
In preparation for this year's reauthorization, we've
worked for over 6 months to develop the consensus document that
we have submitted to the committee. Under the leadership of the
LCAO community services committee, individual organizations
presented their ideas and suggestions for improving the Older
Americans Act. These ideas were incorporated into the consensus
document, which was enthusiastically endorsed by the full LCAO
at our April 6th meeting.
The LCAO Older Americans Act reauthorization document
contains 98 recommendations. They do a number of things. They
reinforce key existing priorities in the current statute and
seek to address challenges and opportunities brought about by
the exponential growth of our older population. We agree that
the Older Americans Act continues to work very well for older
adults across the country. The act's core mission,
infrastructure, and programs remain relevant, effective, and
very much relied upon by older adults and caregivers.
The problem we face, of course, is insufficient funding,
which makes it difficult for the aging network to carry out
Older Americans Act priorities as established by Congress in
past reauthorizations. There simply is not enough money for all
the needs that exist.
On that note, I'd like to thank you, on behalf of our
organization, Mr. Chairman, for your request to the General
Accounting Office to examine the true magnitude of this unmet
need. We also acknowledge that the Older Americans Act, like
other statutes, is a dynamic document that can and must change
to address emerging needs and embrace new innovations.
It's notable that the Older Americans Act is up for
reauthorization the same year that the first of the baby
boomers turn 65. Not only are the numbers of older adults
increasing at a historic rate, but this population is becoming
much more diverse. Additionally, as older Americans live longer
they face growing health and economic challenges. All of these
issues are converging to place tremendous strain on the aging
network, a network that is already overburdened, but eager to
expand capacity and enhance planning to meet the demands and
opportunities presented by our aging population.
Particularly in times of fiscal restraint, times such as
now, we acknowledge that improvements can be made in the
efficiency and effectiveness of the Older Americans Act in its
delivery of core services and how it interacts and coordinates
with other Federal programs that serve older adults. There are
recommendations throughout the document we presented that call
for improved coordination of services and identification and
dissemination of best practices that already occur in local
communities in order to strengthen the aging network
nationwide.
LCAO also believes it is crucial to strengthen evaluation,
research, and demonstration of aging services. This will not
only empower the aging network to continue implementing best
practices but will also state with authority the degree to
which the Older Americans Act provides a cost-effective way for
older adults to remain in their own homes with health and
economic security.
The Older Americans Act programs, such as in-home
assistance, home-delivered and congregate meals, and respite
for family caregivers, benefit individuals and their families.
They also save Federal and State government resources from
being spent on otherwise unnecessary care in hospitals and
nursing homes.
On behalf of LCAO, I applaud this committee for its
leadership in calling attention to the upcoming Older Americans
Act reauthorization. We urge Congress to continue the long
tradition of bipartisan and timely reauthorization of this
important statute while providing the funding needed for Older
Americans Act programs to keep older Americans independent and
productive.
Thank you again for the opportunity to testify today on
behalf of the 66 members of the LCAO, and I welcome your
questions and comments. Thank you.
[The prepared statement of Max Richtman appears in the
Appendix on page 76.]
The Chairman. Thank you, Mr. Richtman.
Heather Bruemmer.
STATEMENT OF HEATHER BRUEMMER, STATE OF WISCONSIN LONG-TERM
CARE OMBUDSMAN, MADISON, WI
Ms. Bruemmer. Chairman Kohl, Ranking Member Corker, and
members of the committee: Thank you so much for this
opportunity to testify today. I'm the State Long-Term Care
Ombudsman of Wisconsin and also represent the National
Association of State Long-Term Care Ombudsman Programs, better
known as NASOP.
It is a privilege and honor to be here on behalf of the
ombudsman advocates who work daily tirelessly to assure the
rights and well-being of hundreds of thousands of vulnerable
residents living in long-term care settings throughout the
Nation. The significance of this effort to reauthorize the
Older Americans Act cannot be overestimated. It is a primary
duty of this Nation to protect our most vulnerable individuals
and to preserve their pride and dignity.
Everyone has a history, a story. We all create memories. So
it's our responsibility to assure that all members of our
rapidly aging population have the proper access to services
that will respect their right to be who they are and who
they've been.
The Older Americans Act provides critically needed home-
and community-based services that allow older adults to remain
for as long as possible in the community with needed support.
Since 1978, the ombudsman program has been a core component of
the Older Americans Act. It is the only program in that act
that specifically serves consumers provided by residential care
facilities.
I think that we all appreciate and value the importance of
living in our own home. We heard from Elizabeth today it's very
special, and as a result there has been a remarkable growth in
the amount of home- and community-based services available for
seniors in Wisconsin. In November of 2008 we had a significant
trend happen. We have more assisted living beds in the State of
Wisconsin than we do nursing home beds.
Wisconsin was one of the original pilot States when the
long-term care ombudsman was first created by Congress, and our
State has continuously relied and improved the advocacy
resources available to aging consumers. The Board on Aging
formed in 1981. We had five ombudsman. Today we have 15
outstanding regional ombudsman and over 100 volunteers serving
95,000 clients in nursing homes and assisted living facilities,
and we also provide services through the Medicaid waiver
programs.
Nationally, ombudsman visited 79 percent of all nursing
homes on a quarterly basis last year, yet only 46 percent of
assisted living facilities and similar homes. Throughout the
country, it has become increasingly more difficult for
ombudsman to participate in visits for assisted living. The
inability of Congress to provide sufficient funding is
certainly not the result of trying by the champions of the
long-term care ombudsman program, such as yourself, Chairman
Kohl, and the members of this committee. Each year the program
resolves hundreds and thousands of complaints and,
interestingly, 77 percent of these complaints are resolved to
the satisfaction or partially resolved to the client's needs.
We spend time in nursing homes. If we are able to address
the needs of people living in assisted living with the same
intensity as we do the concerns in nursing homes, our numbers
would be astronomical.
The long-term care program offers significant protections
to residents. The complexity and diversity of consumers today
who live in these facilities is growing. We have falls, medical
mismanagement, medication errors, pressure ulcers, and abuse
situations, and unfortunately they are on the rise. We spend a
tremendous amount of time investigating these incidents and
also provide education and guidance to facility staff to help
prevent reoccurrences of these problems.
Unfortunately, we are still confronted with the reality of
inadequate resources, but we keep moving forward and protecting
our most vulnerable.
Resident and family councils are vehicles by which open
communications are really important in order to deliver
excellent quality of life and care. When considering this
reauthorization, it is important with this requirement to
maintain resident and family involvement with the assistance of
the ombudsman program.
Access to confidential information for ombudsman is
critically important. We are recommending that this
reauthorization ensure the private and unimpeded access by
individuals to ombudsman service in a confidential setting,
that it is not compromised. The sections of this act relating
to the process of and limitations and disclosure of client
information needs clarification and emphasis. It is important
that the text of the Older Americans Act clarifies that the
privacy provisions of the Health Insurance Portability and
Accountability Act, better known as HIPPA, do not impede the
access to resident health records by the ombudsman and
representatives of the program.
The Administration on Aging had declared in a memo that the
ombudsman program representatives are performing a health care
oversight function and they are not impacted by the HIPPA
privacy rules. Throughout the country we have more and more
people that can't speak for themselves and who have no legally
authorized representative to speak on their behalf. It's really
our duty, and we recommend that we add language to this act to
encourage States to intensify their efforts to educate the
public on the value and importance of completing documents to
establish a trustee relationship.
The Board on Aging and NASOP also support the
recommendation to amend Title 2 to provide a base appropriation
beginning at $1 million to the National Ombudsman Resource
Center. It has proven to be a valuable site for ombudsman
programs to obtain training resources and technical assistance.
It would be extremely helpful to expand the center's training
capacity and ability to work with State regulators to improve
the investigative process used to deal with resident
complaints.
The Older Americans Act gives us a strong foundation and
reauthorization gives us a window of opportunity to build an
even more robust demonstration of the Nation's concern for our
well-being of our elders. It is extremely important that
Congress and the aging network come together to strengthen our
long-term care ombudsman programs to provide a safe and home-
like environment.
On behalf of Wisconsin's long-term care ombudsman program
and NASOP as advocates for the Nation's most vulnerable
facility residents and consumers of long-term care, I thank
you, Senator Kohl, Ranking Member Corker, and the members of
the committee for allowing me to share our thoughts on the
reauthorization. Thank you.
[The prepared statement of Heather Bruemmer appears in the
Appendix on page 98.]
The Chairman. Thank you very much, Ms. Bruemmer.
Mr. Howell.
STATEMENT OF TIMOTHY HOWELL, CEO, SENIOR CITIZEN HOME
ASSISTANCE SERVICES, KNOXVILLE, TN
Mr. Howell. Thank you, Senators on the Special Committee on
Aging, for allowing me to address you today. As the CEO of
Senior Citizens Home Assistance Services that provides
homemaker and personal care to 20 counties in East Tennessee, I
see elders and people with disabilities every day that come to
me with different situations. Although their stories are
different, their goal is the same: to maintain their dignity.
Their health may be fading and all their mental status
diminishing, but they are still human beings, and their dignity
should not be diminished over time.
Senior Citizens Home Assistance Services was formed in 1970
with a grant from the Older Americans Act as a study to see if
people could use homemaker services to stay in their homes.
Since then we have been on the battle of the forefront of
maintaining dignity for our elders.
The majority of the work that we do is through our
homemaker and personal care services. We screen, hire, and
train caregivers to travel to the home and provide light
housekeeping, laundry, shopping, companionship, transportation,
and personal care like bathing, feeding, toileting, and
grooming. This year we will help over 2,500 people with over
300,000 hours of one on one care to stay in their home.
The good news of this story is that the agency receives
funding from many different sources. We have a full fee private
pay system so those that can afford to pay for the services
can, and then we also receive money from Federal, State,
Veterans Administration programs. But I think one of the best
things that we have and something that we could have helped
Senator Manchin with with his question is that we have a
sliding scale fee for people that do not qualify for those
government programs, but also may not have the ability to pay
the full fee. We have a sliding scale fee because we are able
to have fundraisers and we get United Way funding. So if
somebody comes to us that does not have--that has a gross
income that keeps them from the government programs, then we
are still able to help them even though they may have expenses
such as a home mortgage or medicines or things like that. So we
are still able to help them with a sliding scale fee, and they
can pay us like $7 an hour, $9 an hour, or $11 an hour, and so
they can still get the help that they need to stay in their
homes.
Partnerships are key, we have found, in the battle to
provide dignity. We get cleaning supplies donated to us from a
local office company so that--for those that cannot afford to
purchase them, and we also receive nonperishable foods from
Second Harvest, which is another 501[c][3] in our county, and
that allows us to give food to those that may not have the
ability or the money to pay for their bills at the end of the
month, and we can still get them food.
So if you're looking for employment opportunities--and I
understand, Mr. Kohl, that you might be since you're retiring--
we can hire you; we can train you to be a caregiver. In fact,
our oldest caregiver was born in 1921. She is 90 years old and
she brings an aspect to caregiving that a person my age cannot
do. She is unique with her companionship. She works about 20
hours a week, and she's able to talk to people and relate to
them while she's cleaning their homes and helping them stay in
their homes. So even on your worst days, she can give you a
smile that can brighten up your life.
In fact, over 50 percent of our 310 employees are older
than 50. We have a great caregiver training program that our RN
and nurse trainer uses to teach people to be a caregiver.
Even with all our programs to keep people in their homes,
we realize that the cost does become expensive at times as
their need increases. This is why we built Renaissance Terrace,
a 48-unit assisted living facility that charges $2200 per month
for all the services of an assisted living facility in the
State of Tennessee. We are able to keep the monthly fee low
because we receive Federal, State, and local government funding
from Knox County and from the City of Knoxville, as well as
private donors and foundations to construct the building. With
the construction cost funded, we only have to charge enough to
pay for the operating costs, such as payroll and supplies.
The people that live in our facility are able to pay for
their help, or the VA may help, or in some cases family members
may help pay for the fee. The important fact is that I am not
here asking you for more money to pay for my assisted living
for the residents of Renaissance Terrace. Through combining
your one-time investment with other partners, we developed a
program that can sustain itself, sustain itself through the
residents paying for their care.
I want to thank you for taking this challenge of providing
care to the elders and persons with disabilities while keeping
their dignity intact. I encourage you to look for solutions
that can maintain and support themselves with an investment
from you, but I realize that this will not always be the
situation.
Again, I thank you for allowing me to be here, and I will
answer any questions that you may have.
[The prepared statement of Timothy Howell appears in the
Appendix on page 103.]
The Chairman. Thank you, Mr. Howell.
I'd like to ask you, Mrs. Marshall. Your home-delivered
meals, how important is that in your day and in your week? What
would you do if you didn't have the home-delivered meals
system?
Ms. Marshall. Well, it's hard to know, because I have been
able through my whole life to be independent. My son is worried
about the fact that I'm alone a lot of the time and he thought
that there should be somebody looking in on me every day. So I
ordered the meals on wheels. I get it Monday, Wednesday, and
Friday, and there's always someone there in case I should fall
or some accident of that sort.
So that takes care of 3 days a week, and it also helps me
as far as shopping and cooking for myself. The various foods
that I get are well-balanced and healthy. They sometimes need
seasoning or fixing up a little bit before you put them in the
micro. But it's a very well-balanced, healthy diet, really, and
I'm very grateful for it.
On Tuesday and Thursday I'm on my own, and Saturday and
Sunday. But I have been very grateful for the fact that I have
wonderful sons handy to me and a daughter in New Hampshire who
has been a boon to me. I'm very grateful for the help of my
children. It may be a burden on them. I'm sure in many ways it
is. But I don't hear about it.
The Chairman. How often do you talk to your daughter in New
Hampshire?
Ms. Marshall. Well, I really grew up in two communities. I
had a grandmother in New Hampshire who had a stroke in her 60s
and she lived--she could not speak very well, but she lived at
home. And my mother went up to New Hampshire in June every year
after school was done and took care of her or helped take care
of her, because she was in a wheelchair and completely unable
to do anything for herself.
In fact, I never really got to know her because she
wouldn't talk very much. She would say ``How be ya?'' and that
was about it. But she was very much beloved by her family, and
I have many pictures of her in the wheelchair surrounded by
family members.
There wasn't such a thing as meals on wheels at that time.
Generally, there were people, and in New Hampshire many country
people, because this was in the White Mountains, a village in
the White Mountains. So we really had two residences growing
up. It was a wonderful, wonderful experience.
The Chairman. Good.
To the other members of the panel, what is your principal
recommendation to us as we go about reauthorizing OAA? Mr.
Richtman, would you like to give us your opinion?
Mr. Richtman. Well, I think, as I mentioned in the
testimony, we feel it is very important that the committee take
into account ways to improve coordination of services, to
identify the best practices, things that work in local
communities, and make sure that all of the agencies involved
have the resources to replicate these best practices around the
country.
If I could, Mr. Chairman, to follow up on the question you
asked about home-delivered meals, and I hope this isn't
presumptuous, but I could give this as a recommendation. You
mentioned that I was staff director of this committee in the
1980s and I was involved in previous reauthorizations. There
was a member of this committee who was, shall we say, cynical
about the Older Americans Act activities, and one of the
nutrition service providers from that Senator's State arranged
to take that member of the Senate to deliver meals on a truck.
The reaction that the Senator had when he met people who had no
other way to get a hot meal or have any interaction with
anybody turned him around, and he became a strong advocate for
the program.
So I would recommend some first-hand experience by members
of the committee with some of these programs.
The Chairman. That's very good.
Mrs. Bruemmer.
Ms. Bruemmer. Thank you. I think it's really important that
our vulnerable residents in long-term care facilities have
access to our ombudsman services, which I addressed in my
testimony. We have so many people who are living in long-term
care facilities that don't have family, and it's important that
the ombudsman, who is their advocate, be able to express their
best interests.
Secondly, I think we all know--and you recently had a
wonderful hearing on elder abuse. It is occurring in our world,
unfortunately, and it's our duty to protect our most vulnerable
people that we serve. So it would be wonderful if we could get
additional supports and funding to provide training and
prevention.
You know, we talk about prevention frequently, and it
really does make a considerable difference if we can educate
people on how to prevent. We provide prevention services in
nursing homes and assisted living to staff, and it really has a
positive impact for the people that they serve. And also
supporting the National Ombudsman Resource Center, which is
such a tremendous support to all the States in the Nation and
really benefits our wonderful residents that we serve.
Thank you.
The Chairman. Thank you, Ms. Bruemmer.
Mr. Howell, what's your principal recommendation?
Mr. Howell. I would suggest looking for partnerships and
funding opportunities that could be a one-time investment for
the government, and then maybe those programs could sustain
themselves over time through private pay.
Then also I'd like to say that through the single point of
entry system we need more case management from the providers at
the time that the help is being asked for. People go through
many questions to get into the enrollment process, at least I
know in the State of Tennessee they do, and they get asked
those questions several different times. So I think we need a
system to where once you are asked those questions once it is
shared among the service providers and the case managers and
the MCOs, so that you don't have to keep going back and asking
that elderly person again and again and again, now, what is
your income, what is the help that you need, and so forth.
Because I know we are going to go out and do an intake and
we're looking for things like, does that person have a pet,
because I don't need to send somebody as a caregiver into a
home that has cat allergies when that person has a cat. Or if
they smoke I don't need to send somebody in that home that has
asthma.
So if we don't know those things up front, we're already
setting ourselves up for disaster in helping that person stay
in their home when we don't get all the information that we
need.
So those are my two recommendations, just shared
information among everyone and look for partnerships so that
programs can sustain themselves over time.
The Chairman. Thank you very much, Mr. Howell.
Senator Corker.
Senator Corker. Thank you, Mr. Chairman.
Ms. Marshall, thank you so much for being here. You
mentioned you hope you weren't a burden for your children or
grandchildren. I know that's not the case. I'm sure you're a
blessing, and there's probably a whole line of people in your
community willing to adopt you if they ever felt that was the
case. We thank you very much for being here and putting a face
on an issue that all of us care about. So thank you very much.
Mr. Richtman, I know as director of the National Committee
to Preserve Social Security and Medicare you've been very
critical of some legislation I've offered to get spending back
to historic norms over the next decade. I understand that, and
that's the world we live in today.
Also, it seems you've been very resistant to changes to
Medicare that might make it sustainable. There are a lot of
people in this town that know Medicare is going to be insolvent
or bankrupt in the year 2024. There's no getting around that.
CBO even says by 2020. I'm wondering if you have put forth your
own innovations or changes to cause Medicare to be solvent and
to cause it to be there for seniors down the road?
Mr. Richtman. Well, of course this isn't the subject of
this hearing, but I will respond. I think the legislation
you're talking about is the bill you authored with Senator
McCaskill; is that correct?
Senator Corker. That's correct, yes.
Mr. Richtman. The concern we have is we feel that some of
the process that legislation deals with will lead to dramatic
cuts in the programs we advocate for, and will do so in a way
that--a more indirect way that maybe politically is easier, but
nevertheless the impact would be the same.
On Medicare, you're right, opposed to the bill that was
defeated yesterday in the Senate. It had passed the House. We
feel that Chairman Ryan's proposal to deal with Medicare in
effect eliminates the program, turns it into something entirely
different.
Senator Corker. That really wasn't what I asked, and I
understand that and I've read some of the things you've said
about that. But my question is have you offered your own
solution, since putting our head in the sand would mean that
future wonderful people like Mrs. Marshall would not be able to
benefit from the program.
Mr. Richtman. I was going to get around to that. We
supported the Affordable Care Act, which has some very
significant improvements in Medicare, and----
Senator Corker. Even with the Affordable Care Act, it's
insolvent in the year 2024. So I'm trying to ask----
Mr. Richtman. Well, you know, were it not for the
Affordable Care Act, the Medicare program would be insolvent
much earlier than 2025, which is the date that the trustees
have issued. It's true that the date of insolvency went back 4
or 5 years from previous----
Senator Corker. Closer to today.
Mr. Richtman. Closer to today. Now, a lot of that has to do
with the recession, less revenue coming into the program.
Senator Corker. Mr. Richtman, are you going to answer my
question?
Mr. Richtman. I'm trying to, Senator.
Senator Corker. Well, I wish you'd just get--have you
offered solutions to the program? I haven't heard any. Instead
of sandbagging people that are, have you offered solutions?
Mr. Richtman. Our solution, which I was trying to explain,
included the Affordable Care Act. That is a very positive
improvement of Medicare; added 12 years--I'd say that's a
pretty good solution--added 12 years to the solvency of the
program, added benefits for seniors that they did not have
before, such as preventive care without any out-of-pocket
costs. So I offer that as a solution. I think it's becoming
more and more popular.
Senator Corker. It's very disappointing that someone in
your position would stonewall a situation so important as this.
Let me ask you this. Chairman Kohl and I have both been
very fortunate in life, he far more than me, but we both have.
Mr. Richtman. Me too.
Senator Corker. Would you agree that it would be an
appropriate thing for folks like Mr. Kohl and myself to have
minimal, if almost no, benefit, where, in other words, Medicare
would be more based on ability to pay, where we would have to
pay far more for the benefits of Medicare than someone else who
might not have been as fortunate? Would you agree that that
would be at least a portion of a solution, even though that
would not solve it? Would that be something that your
organization would support?
Mr. Richtman. No, we would not--you're talking about, I
assume, means testing.
Senator Corker. That's exactly right.
Mr. Richtman. We are opposed to means testing both Medicare
and Social Security, and I'll tell you why. These programs, all
the polling shows that they are tremendously popular, because
they're insurance programs. People pay into them while they're
working, and they receive the benefits. Means testing these
programs turns these programs into welfare. That's what welfare
is, a means-tested program.
I've said this at many events that I participated in. If
you ask a group of seniors, how many of you are on Social
Security, how many of you are on Medicare, and usually at my
meetings they all are. And you say, how many of you are ashamed
to be on these programs, nobody is. But if you ask them, would
you be proud to be on welfare, they wouldn't. And I think
turning these programs into welfare programs, which is what
means testing does, puts them in a whole different category,
and the support, tremendous majority support for these
programs, would dissipate.
So we're opposed to that.
Senator Corker. Well, portions of Medicare already are
means-tested. What I hear you saying is you're more interested
in generational theft than you are in----
Mr. Richtman. That's really not fair, Senator. Most of the
surveys we've done--in fact, we just did one with Celinda
Lake--our members, who are almost all on the program, they are
just as concerned that these programs be there for their
children and their grandchildren. And I feel that we reflect
that, and really, I take issue with the charge that we're
interested in that kind of generational warfare.
Senator Corker. Well, I'm very disappointed that you've
offered no real solutions. But I look forward to talking with
you in another venue with that.
Mr. Howell, thank you so much for traveling up here. I
notice that, on the other hand, your organization does have a
sliding scale ability to pay, and you've found that to be
something that's very useful. I wonder if you might describe
that in a little bit more detail?
Mr. Howell. I'd be glad to. When our board set up the
nonprofit in 1970 they wanted to be able to help everyone that
came for assistance to the agency. So the sliding scale fee was
one good way to do that. I think we have found many benefits
from that, and one of them being if we are going to United Way
and asking them for funds and let's say they appropriate to us
in Knox County somewhere around $120,000 and then we provide
help to a person over here and they are able to pay $7 an hour
and that help costs us somewhere around $18, $19 an hour, then
we really only have to come up with about another $11 per hour
to get that funding.
So what that does is that allows that money to be stretched
out further and to help more people. So we don't usually have a
waiting list for services, so if someone calls me I can usually
get the help out to them as quickly as they need it. I think
that telephone call is important because it's saying, I've
given up my ability to do something in my life and so now I
need help; will you come do that? So we don't have to put them
on a waiting list to do so. We can be there and help them.
I also think in a lot of ways it makes us more accountable
because those people are paying for that service. So even--and
that sliding scale fee has increased over time. But even if
they're paying $7 an hour, to a person that is in their 80s or
in their 90s that's a lot of money to something that they
consider to be a maid service come in and helping them clean or
getting them transportation or helping them go grocery
shopping, getting their medicines, and so forth.
So that is a lot of money to them, and I think some of our
proudest moments are when we get a check issued to us from
someone and it's for $28, and that's basically 4 hours of
service, but on the bottom of it it says ``Thank you,'' because
how many people write ``Thank you'' on the bottom of their
checks when they pay their bills? They do that because they
know we are keeping them in their homes with some help. Just a
little bit of help will keep them there.
So I think the sliding scale fee has been a great system
for the people that we serve.
Senator Corker. Thank you. And has there been any stigma
attached to that, as Mr. Richtman just alluded to?
Mr. Howell. In the services that we provide, no, sir, I
don't know of any stigma attached to that. We do help people
that qualify for the government programs and they're in those
and the government is paying for them, and we also help people
that have the ability to pay the full fee. So our caregiver may
go into the home of a very wealthy person one day and then be
in the home of a poor person the next day. We train them to
treat them with the same dignity across the board and with the
same help when they go in that home and provide that service to
them.
Senator Corker. Well, listen; thank you very much for being
here, and I look forward to the rest of your testimony.
Thank you.
The Chairman. Thank you very much, Senator Corker.
Senator Casey.
Senator Casey. Thank you, Mr. Chairman.
What I'll do, for the record, is to submit questions for
Mr. Howell, Ms. Bruemmer, and Max Richtman because I have a
constituent on the left there, the Mayor, former Mayor of York,
and I wanted to speak directly to her for a couple of minutes.
You three don't mind, I don't think, but I'm grateful. I
appreciate all of your testimony and the work that you do. I've
known Max Richtman a long time, and I appreciate his advocacy
for many years on behalf of older citizens.
But I did want to direct my maybe just a comment or two,
Mayor. First of all, once a mayor always a mayor, and we
appreciate your public service to the city of York. Being a
Mayor, being a member of City Council at any time, is a
difficult job, and we appreciate what you did and what you
continue to do for the community in York, and for your
testimony today.
I was struck by some, a couple of lines in your testimony
which in some ways really summarized or encapsulated what we're
talking about today, the Older Americans Act. I was looking at
your testimony, the last page of your testimony, when you say,
and I'm quoting: ``Many recipients of services are like me.
They just need one or two little bits of help.'' A pretty good
summary of what a lot of people need, and sometimes it varies.
Then you go on to say, and I'm quoting again just a line or
two beyond that, quote: ``The act is flexible that way and
allows the senior to customize their care plan to just what
they need to stay healthy,'' unquote.
We can often talk and talk in this town describing
legislation paragraph after paragraph. Rarely do we have a
witness who's able to sum it up very directly and with the
personal experience that you have brought to this. You've been
able to, through your testimony today and I know in other ways,
bring to life and be--in a sense, bear witness to the benefits
of these services. And we're greatly, greatly appreciative of
that, because you didn't have to do that. You could have just
lived with the benefit of these services, but to travel here
and to bring your story and your witness to this is very, very
important, and we're truly grateful.
I know that the whole audience fell in love with you today.
I don't think anyone who knows you is surprised by that. But we
especially appreciate your testimony and your public service.
I guess the last thing I'd say is, again quoting you, you
say a paragraph later, quote: ``The beauty of the Older
Americans Act is that it allows you to retain your dignity,
health, and independence,'' unquote. You have defined
``independence,'' and we're grateful that you're willing to
share your story with us today. And if I can think of an
intelligent question I'll write it down and send it to you, but
I think the answer to most of our questions is through your
testimony and through your personal witness.
Thank you very much.
Ms. Marshall. Thank you so much.
The Chairman. Thank you, Senator Casey.
I have also one last question for you, Mrs. Marshall. Might
you consider making a comeback in politics and running for
Mayor?
[Laughter.]
Ms. Marshall. Well, I have been active in the grassroots, a
grassroots group, and I helped to rejuvenate the Democratic
Party because I'm a Roosevelt Democrat. I have always felt that
when people needed help they should have some programs that
help them, and it just shouldn't be such a matter of who has
wealth and who hasn't. Human life is precious.
The Chairman. Thank you.
Well, we thank all of you for being here today. This has
been very important to us as we continue with the
reauthorization of OAA. You have made an effort to be here
today and it's important and you've made a big contribution.
Thank you so much.
Thank you all for being here.
[Whereupon, at 3:38 p.m., the hearing was adjourned.]
APPENDIX