[Senate Hearing 109-132]
[From the U.S. Government Publishing Office]
S. Hrg. 109-132
PLANNING FOR AN AGING POPULATION: THE ADMINISTRATION'S RECOMMENDATIONS
FOR THE OLDER AMERICANS ACT REAUTHORIZATION
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON RETIREMENT SECURITY AND AGING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
ON
EXAMINING THE ADMINISTRATION'S RECOMMENDATIONS FOR THE OLDER AMERICANS
ACT REAUTHORIZATION, FOCUSING ON THE NATIONAL FAMILY CAREGIVER SUPPORT
PROGRAM, PRIMARY LONG-TERM CARE ISSUES, AND THE AGING POPULATION AND
WORKFORCE
__________
MAY 17, 2005
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
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21-351 WASHINGTON : 2005
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
MICHAEL B. ENZI, Wyoming, Chairman
JUDD GREGG, New Hampshire EDWARD M. KENNEDY, Massachusetts
BILL FRIST, Tennessee CHRISTOPHER J. DODD, Connecticut
LAMAR ALEXANDER, Tennessee TOM HARKIN, Iowa
RICHARD BURR, North Carolina BARBARA A. MIKULSKI, Maryland
JOHNNY ISAKSON, Georgia JAMES M. JEFFORDS (I), Vermont
MIKE DeWINE, Ohio JEFF BINGAMAN, New Mexico
JOHN ENSIGN, Nevada PATTY MURRAY, Washington
ORRIN G. HATCH, Utah JACK REED, Rhode Island
JEFF SESSIONS, Alabama HILLARY RODHAM CLINTON, New York
PAT ROBERTS, Kansas
Katherine Brunett McGuire, Staff Director
J. Michael Myers, Minority Staff Director and Chief Counsel
______
Subcommittee on Retirement Security and Aging
MIKE DeWINE, Ohio, Chairman
JOHNNY ISAKSON, Georgia BARBARA A. MIKULSKI, Maryland
ORRIN G. HATCH, Utah JAMES M. JEFFORDS (I), Vermont
JEFF SESSIONS, Alabama JEFF BINGAMAN, New Mexico
PAT ROBERTS, Kansas HILLARY RODHAM CLINTON, New York
MICHAEL B. ENZI, Wyoming (ex EDWARD M. KENNEDY, Massachusetts
officio) (ex officio)
Karla L. Carpenter, Staff Director
Ellen-Marie Whelan, Minority Staff Director
(ii)
C O N T E N T S
__________
STATEMENTS
TUESDAY, MAY 17, 2005
Page
DeWine, Mike, Chairman, Subcommittee on Retirement and Aging,
opening statement.............................................. 1
Mikulski, Barbara A., a U.S. Senator from the State of Maryland,
opening statement.............................................. 2
Prepared Statement........................................... 3
Carbonell, Josefina G., Assistant Secretary for Aging, U.S.
Department of Health and Human Services, Washington, D.C....... 5
Prepared Statement........................................... 7
DeRocco, Emily Stover, Assistant Secretary for Employment and
Training, Employment and Training Administration, U.S.
Department of Labor, Washington, D.C........................... 15
Prepared Statement........................................... 17
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Clinton, Hillary Rodham, a U.S. Senator from the State of New
York, prepared statement................................... 35
(iii)
PLANNING FOR AN AGING POPULATION: THE ADMINISTRATION'S RECOMMENDATIONS
FOR THE OLDER AMERICANS ACT REAUTHORIZATION
----------
TUESDAY, MAY 17, 2005
U.S. Senate,
Subcommittee on Retirement Security and Aging, Committee on
Health, Education, Labor, and Pensions,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:10 a.m., in
Room 430, Dirksen Senate Office Building, Hon. Mike DeWine,
chairman of the subcommittee, presiding.
Present: Senators Dewine, Mikulski, and Murray.
Opening Statement of Chairman DeWine
Senator DeWine. Good morning. We welcome all of you this
morning, welcome you to the Subcommittee on Retirement Security
and Aging's first hearing on the reauthorization of the Older
Americans Act.
We thank Senator Mikulski for being here. It is a pleasure
to always work with her. During the reauthorization process in
the year 2000, we were the chair and ranking member, as well,
and I look forward to again working with her on the Older
Americans Act.
Older Americans are an important and rapidly growing
segment of our population. Over 36 million people living in the
United States are over the age of 65, accounting for about 12
percent of the population. The Census Bureau projects that 45
years from now, people 65 and older will number nearly 90
million in the United States and comprise 21 percent of our
population.
Further, we know that 4.6 million people age 65 and older
are still employed. The Older Americans Act is an important
service provider for these Americans. It makes a range of
social services available for our aging population, including
congregate and home-delivered nutrition programs, community
service employment, and services to prevent the abuse, neglect,
and exploitation of older Americans.
As we work toward reauthorization, this subcommittee plans
to hold a series of hearings on the Older Americans Act and
other issues facing older Americans. Reauthorizing the act is a
primary goal of this subcommittee and we look forward to
reviewing and updating the Older Americans Act programs.
We also look forward to the recommendations expected to
come from the White House Conference on Aging, which will take
place later this year. I am sure that they will provide
recommendations that will be both informative and timely for
this reauthorization.
Today's senior population is very different from what it
was in 1965, when the Older Americans Act was created. Our
hearing will begin with an overview of the act, its history,
how it operates today, some of its problems, and some suggested
solutions.
Senator Mikulski?
Opening Statement of Senator Mikulski
Senator Mikulski. Thank you very much, Mr. Chairman. I,
too, am pleased today to initiate the hearing on the
reauthorization of the Older Americans Act. I, too, look
forward to working with you. As I recall, we were the ones that
actually got the job done and got it authorized----
Senator DeWine. I wasn't going to say that, but--
[Laughter.]
Senator Mikulski. [continuing]. And look forward to the
same collegial efforts that are a hallmark of you.
This is the 40th anniversary of the Older Americans Act,
and as we look forward to reauthorizing it, we have got to look
at how we need to not only reauthorize, but how we have to
refresh, reinvigorate, and even reexamine what needs to be
done. I am looking forward to you, and I have several
principles that I hope would guide reauthorization.
No. 1, we do need a national program with national
standards to ensure consistency of the administration, but
allowing for local flexibility--a senior program in a rural
area of Utah is very different than in the bustling metropolis
of the Baltimore metropolitan area. So we want national
standards, but the flexibility to adapt to local needs for both
good delivery of care and for, as well, creativity in the area.
Second, we have to recognize the changing demography, the
growing number of seniors over 85, the baby boomers coming of
age, and the growing number of seniors in minority groups, many
of whom with different language and cultural demands.
Third, we have to look forward to making sure that our
ultimate goal is to make sure that seniors are independent.
And fourth, that we also ensure that State and local
programs have the resources they need in order to do this.
It is vital to continue the core services. I particularly
note that we need to continue the much beloved information and
referral service, probably one of the most important services,
and at the same time the meals, the whole issue of nutrition
programs, whether delivered onsite or offsite, and then the
other issues relating to helping people keep independence, and
also how to protect our seniors against scams. Scams, scams,
scams, scams, and there seems to be no end at how to do that.
And then at the same time, look for independence, not only from
the health standpoint, but also now many people are facing
unexpected layoffs.
Senator DeWine and I represent manufacturing areas. When
this bill was passed 40 years ago, manufacturing was king in
this country. Now it is changing. People have been laid off,
whether it is my steelworker or his tire worker, and yet what
then happens? Do we say goodbye to them or do we find a way for
them? Before, we used to focus on the poor and how to get them
back into the labor market, but now we have to look at the
middle class, as well.
We look forward to your ideas on modernizing the Older
Americans Act in terms of the new demography and the new
demands, and then it comes to the issue of independence. That
is why I look forward to your insights on lessons learned from
the national Caregiver Support program that we created, and
caregiving, as we know, is so important.
We look with such fondness and admiration to First Lady
Nancy Reagan. She has emerged as really kind of the icon of
caregiving. She had the will, she had the love, she had the
affection, and she had the means. Usually, the people we are
talking about have the will, but not the wallet. How can we
help families by giving help to those that practice self-help,
and we look forward to that.
So rather than me talking, we want to hear from you and
then have an ongoing dialogue.
Mr. Chairman, I ask unanimous consent that my full
statement be in the record.
Senator DeWine. It will be made a part of the record, and
as always, Senator, a very good statement. We thank you for
that.
[The prepared statement of Senator Mikulski follows:]
Prepared Statement of Senator Mikulski
Good morning. I'm very pleased to be here this morning as
we meet to discuss ways to improve the Older Americans Act--an
extremely important act that meets the day-to-day needs of
America's seniors. I would like to thank the new chairman,
Senator DeWine, for calling this hearing today.
I am looking forward to reauthorizing the Older Americans
Act. It is an important responsibility that we have to our
Nation's seniors. There are several principles that I believe
must guide reauthorization. First, we must continue and improve
the core services of this act to meet the vital needs of
America's seniors. Secondly, we must modernize the act to meet
the changing needs of America's senior population, including
the growing number of seniors over 85, the impending senior
boom, and the growing number of seniors in minority groups.
Next, we must look for ways to help seniors live more
independent and active lives. Finally, we must give national,
State, and local programs the resources they need to carry out
these vital responsibilities. Let me expand on these
principles.
Core Services
It is vital to continue and improve the core services of
this act. Seniors have come to depend on the information and
referral services, congregate and home-delivered meals,
transportation, home care, and other OAA programs to meet their
daily needs. Take information and referral services. Whether it
is pension counseling or the long-term care ombudsman program--
these are vital to helping seniors navigate the complex
financial and health care systems. Not all seniors have family
and friends that can assist them with complicated decisions,
like choosing a long-term care insurance plan or a nursing
home. These programs put information in terms seniors can
understand. These programs are a safety net for many. Where
else would they get these services?
Modernization
Our senior population is not the same as it was in 1965.
This will be the first time the baby boomers will be eligible
for services under this reauthorization of the Older Americans
Act. That's why we must modernize the OAA to meet the changing
needs and diversity of our seniors. What does this mean? Well,
it means making sure we have programs and services to meet the
needs of the growing population that is 85 or older. It means
making sure that we are sensitive to the needs of minority,
low-income, and hard-to-reach seniors. And it means preparing
for the upcoming senior boom. By 2050 there will be nearly 90
million seniors over age 65, more than twice their number in
2003. We must take advantage of new technology and innovations
like the Internet to reach out to these seniors.
Independence
Seniors today are living longer, healthier lives. We must
do what we can to help them be as independent and active as
possible. The majority senior citizens with chronic conditions
live in the community and has their care provided by spouses,
adult children and other family members. With the
reauthorization of OAA in 2000, we worked hard to create the
National Family Caregiver Support Program. In 2003, this
program provided assistance to nearly 600,000 caregivers.
Services include respite care, caregiver counseling and
training, information about available resources, and assistance
in locating services. These services are invaluable to seniors
and their families. We must ensure that we are doing what we
can to help ALL seniors live healthy, independent lives for as
long as possible.
Resources
Finally, we must provide the resources necessary to meet
these challenges and support our seniors. Too many Older
Americans Act programs have been flat funded for too long. We
must commit ourselves, our dollars, and our programs to meet
the needs of our growing and changing senior population.
I want us to reauthorize this act. This is our
responsibility. We must not abandon it. I look forward to
working with the Administration on Aging and the Department of
Labor to get their input.
I thank you for your testimony and I look forward to
working with you in the coming months to improve the quality of
life for all of America's seniors in 2005 and beyond.
Senator DeWine. Let me introduce our witnesses today.
First, I would like to introduce the Assistant Secretary for
Aging, Josefina Carbonell. She was sworn in as Assistant
Secretary for Aging at the Department of Health and Human
Services on August 8, 2001. In her position at the
Administration on Aging, she advocates for and works on issues
concerning older Americans. The Administration on Aging reaches
into every community by providing services, information, and
referral on adult day care, elder abuse prevention, home-
delivered meals, in-home care, transportation, and caregiver
supports.
Prior to joining the Administration on Aging, Ms. Carbonell
was President and CEO of the largest Hispanic geriatric health
and human services organization in the Nation, Little Havana
Activities and Nutrition Centers in Dade County, Florida. We
welcome you being with us.
Let me also introduce our second witness, Assistant
Secretary Emily DeRocco. Ms. DeRocco was sworn in as the
Assistant Secretary for Employment and Training at the
Department of Labor on August 3, 2001. She is responsible for
managing the over $11 billion budget that funds our Nation's
public workforce investment system, which includes the
Community Service Employment for Older Americans program.
Ms. DeRocco has served in a number of high-level Federal
positions, including serving cabinet officers at the Department
of the Interior and the Department of Energy. She also spent
over 10 years as the Executive Director of the National
Association of State Workforce Agencies. We welcome you, as
well.
Ms. Carbonell, we will start with you.
STATEMENT OF JOSEFINA G. CARBONELL, ASSISTANT SECRETARY FOR
AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES,
WASHINGTON, DC.
Ms. Carbonell. Thank you, Mr. Chairman. Chairman DeWine,
Senator Mikulski, distinguished members of the subcommittee,
thank you for inviting me and Emily DeRocco to discuss the
reauthorization of the Older Americans Act. In the 40th
anniversary year of the Older Americans Act, it is appropriate
to speak of the importance of modernizing this legislation to
meet the needs of the next generation of elderly individuals,
the baby boom generation.
The Older Americans Act has produced a wide variety of
programs to support the long-term care needs of elderly people.
It brought Federal support to Meals on Wheels, making it one of
the most worthwhile volunteer ventures in the history of this
Nation. It brought quality to senior center programs, providing
seniors an opportunity to socialize and to improve their health
status through nutrition, health screening, medication
management, and physical activity programs. More recently, the
Older Americans Act brought recognition and support to family
caregivers, who account for some two-thirds of all of the long-
term care provided to elderly and disabled people across the
United States.
AOA and its network of State and community-based
organizations and volunteers successfully implemented the 2000
reauthorization, including the Caregiver program, through which
States and communities served almost 600,000 caregivers in
fiscal year 2003, far exceeding client projections for the
programs during its early years of implementation.
Since the last reauthorization, we listen regularly to our
customers and those who serve them to ensure that we can move
the Older Americans Act and its programs forward in a way that
will best serve elders, including the baby boom generations,
for years to come.
Perhaps the most significant contribution of the Older
Americans Act over the past 40 years is the emergence of our
long-term care service network, which is the largest provider
of community-based care for the elderly in the United States,
administering $3 to $4 billion each year in community-based
care. Just as the Older Americans Act created this network that
has provided so much in helping people maintain their
independence in the community, the act should now be modernized
to help the network and the country sustain community-based
care.
There are challenges to address with this reauthorization.
The number of Americans is increasing at unprecedented rates,
and those Americans reaching age 65 are living longer. As the
baby boom ages, there will be far more people in need of long-
term care than there are today.
The costs of long-term care are enormous. This year, $129
billion will be spent on older individuals receiving paid care.
Everyone agrees that there are major problems with our approach
to long-term care, with its bias toward institution-based
services, it is out of sync with people's needs and
preferences. It is fragmented, confusing, and inefficient at
times. It is financially unsustainable for individuals, for
families, and our society at large.
Just as the Older Americans Act was the solution for many
significant policy challenges affecting frail elderly people in
the past, the act should be a significant part of the Nation's
solution to the challenges we face now. Consistent with the
mission of the act and the President's new Freedom Initiative,
our strategies for reauthorization of the Older Americans Act
will focus on simple but relevant principles: Consumer
information and consumer choice; support for those at highest
risk of disability and poverty, before they become disabled and
impoverished; providing care to people where they want it; and
the prevention of conditions that cause disability and disease.
We will pursue efficiency and integration in access to
long-term care by those who need it. We will pursue changes
that recognize that we cannot wait until people are old and
frail and poor to begin to address their long-term care needs.
This will require older people to be more engaged in the
planning of their own long-term care and will require them to
take steps to maintain their health and to reduce their risk of
disease, disability, and injury.
We will pursue changes that recognize people's preferences
for long-term care. This means a greater focus on community-
based care and providing choice and control to consumers in the
management of that care.
We will continue to make it easier for consumers to learn
about and access services and supports. We will strengthen our
efforts to give people practical tools based on the best
available science so that they can maintain their health and
independence for as long as possible.
Thank you, Mr. Chairman, for the opportunity to speak to
you today about the reauthorization of the Older Americans Act.
I have tremendous respect for and confidence in the long-term
network that I have spoken about today, and many of which are
present here today. I am proud to have served as a provider and
a leader in this network for more than 30 of the 40 years since
the Older Americans Act was created and I look forward to
working with you on the reauthorization.
Senator DeWine. We appreciate your testimony. Thank you
very much.
[The prepared statement of Ms. Carbonell follows:]
Prepared Statement of Josefina Carbonell
INTRODUCTION
Chairman DeWine, Senator Mikulski, distinguished members of the
committee, thank you for inviting me here today to discuss the
reauthorization of the Older Americans Act.
In the 40th anniversary year of the Older Americans Act, it is
appropriate to speak of the importance of this legislation to elderly
people across the United States, especially those who are disabled and
frail and at risk of institutionalization in nursing homes. The Older
Americans Act has produced a wide array of programs to support the
long-term care needs of elderly people. The act brought Federal support
to meals-on-wheels, making it one of the most significant and
worthwhile volunteer ventures in the history of this Nation. The Older
Americans Act brought consistency and quality to senior center programs
across the country, providing declining seniors an opportunity to
socialize with each other, to improve their nutritional status with
healthy meals, and to see other aspects of their health status
addressed through health screening, medication management, and physical
activity programs. More recently, the Older Americans Act brought
recognition and support to family caregivers, who to this day account
for some two-thirds of all of the long-term care provided to elderly
and disabled people across the United States. In the 2000
reauthorization, the act brought respite services to family caregivers,
as well as information, access assistance, counseling, training and
other supports.
We saw to the successful implementation of the provisions of the
reauthorization of 2000 by focusing closely on the implementation of
the caregiver program, where we brought vision, strategic planning, and
performance accountability to the day to day management of the program.
We also recognized the capacity of the aging network of States, area
agencies, and service providers, which assist frail elderly people with
long-term care services. As a result, we steered our discretionary
innovation resources to pursuing program efficiency in long-term care,
and improving the well being of elderly clients by focusing on
prevention. Finally, we listened regularly to our consumers and those
who serve them to ensure that we can move Older Americans Act programs
forward in a way that will best serve elders, including the baby boom
generation for years to come.
OLDER AMERICANS ACT ACCOMPLISHMENTS SINCE REAUTHORIZATION IN 2000
The National Family Caregiver Support Program
The single most important new provision of the 2000
reauthorization, and most significant accomplishment of AoA and the
aging network since 2000, is the implementation of the National Family
Caregiver Support Program. In the first 2 full years of the program's
implementation, over 12 million people received information about the
program, and many of these individuals have sought assistance through
the aging network. At the time of the 2000 reauthorization, State and
area agencies were projected to serve 250,000 caregivers with respite,
access, counseling, training, or other forms of service. However, the
number of caregivers served surpassed the projections so that States
and area agencies provided access assistance services alone to almost
600,000 caregivers, and also provided respite, counseling, training,
and other forms of support in 2003.
Soon after its initial implementation, the National Family
Caregiver Support Program became a highly visible program that
responded to the diversity of caregiver needs. At the same time, it
forged connections to the home and community-based services (HCBS)
system in each State. With AoA's emphasis on performance accountability
and management, it became evident that resources provided under the
caregiver program would not be the sole source of support for
caregivers, but that Older Americans Act services provided to elderly
people would also ease caregiver burden and help them care longer for
the elderly they served.
AoA provided flexibility in program structure and operations that
has allowed States to focus on such issues as developing new
infrastructures for caregiver support; reorganizing State aging
networks to be better able to integrate the NFCSP; and developing
partnerships with entities not traditionally part of the State's aging
network. As a result of this flexibility, States have reported a number
of efforts focused on integrating the NFCSP into the existing HCBS
infrastructure. Some approaches involved blending the NFCSP with other
existing services, while others incorporated the program in a way that
allowed it to stand on its own as a unique program yet still connected
to the broader array of HCBS.
Ohio, for example, has approached integrating the FCSP by
broadening its State care coordination policy to include many of Ohio's
Federal and state-funded programs for older adults and caregivers. This
new framework fosters awareness of the similarities among programs and
draws attention to the under-served and unidentified caregivers in
other programs. As the FCSP becomes integrated into the continuum of
care already in place, a more seamless approach to service provision
will result.
Minnesota has utilized the development of the NFCSP to encourage
AAAs, counties, providers and community organizations to examine other
programs (Medicaid waiver, State respite programs, community service
grants) to ensure that the NFCSP and HCBS programs offer a
complementary array of services.
Georgia, in collaboration with the Rosalynn Carter Institute for
Human Development (RCI), has utilized demonstration grants available
through the NFCSP to expand a collaborative network of professional and
family caregiver groups known as Care-Nets. Composed of educational
institutions, businesses, and family caregivers, Care-Nets develop
service and educational programs to meet the needs of caregivers,
oversee research conducted by RCI, and provide recognition and support
for caregivers.
Pennsylvania saw the NFCSP as a vehicle for expanding the scope of
the existing state-funded caregiver support program and maximizing
opportunities to get consumers into, and help them to navigate through,
the long-term care system.
Coordination of the FCSP and other HCBS programs has been a key to
assuring access and reaching caregivers, as was developing partnerships
with business, religious, ethnic, social service and community
organizations. States reported similar ways of ensuring that their
FCSPs are accessible to anyone seeking information and services,
including:
Alabama's ``care coordinators'' have taken a grassroots approach to
doing outreach. Because a majority of the care coordinators have some
direct experience with caregiving (either in the past or currently),
they are able to understand caregivers' needs and use their personal
experiences with caregiving as a tool for outreach and education.
Alabama, California, Delaware, and Massachusetts have all utilized
the concept of a ``mobile van tour'' to reach remote, hard-to-access
areas of their States where caregivers have little opportunity to
receive information, or because of the remote location, have difficulty
getting to a central point such as a service center to obtain
information and service.
Maryland has adopted a proactive strategy of reaching out to
caregivers early, before they are in crisis. To achieve this, printed
materials (e.g., bookmarks) have been printed and disseminated broadly
to promote the program to a wide group of prospective consumers of
caregiver services.
AoA commissioned the Family Caregiver Alliance to further document
and summarize the States' efforts in implementing the caregiver program
and to assess the States' performance in implementing the program. One
interesting finding was that the vast majority (78 percent) of adults
in the United States who receive long-term care at home, are cared for
exclusively from unpaid family and friends. Other findings included the
following: (1) More than one in three (36 percent) States began
providing support to caregivers of older people for the first time as a
result of the implementation of the NFCSP; (2) All States now provide
some explicit caregiver support services as a result of the NFCSP; (3)
The NFCSP is emerging as a key program in the States for enhancing the
scope of services to caregivers and as fuel for innovation; (4) The
NFCSP seems to be speeding the adoption of consumer direction in family
caregiving programs; (5) Respite care is the service category most
commonly offered to caregivers and is available in all 50 States and
DC; and (6) State legislatures, recognizing family caregivers' roles,
are enacting laws to fund caregiver support services, expand family and
medical leave, and include family caregiving in State long-term care
efforts.
Throughout the Nation, States and communities committed the
necessary resources, attention and commitment to the implementation of
the National Family Caregiver Support Program that allowed the program
to achieve the early results AoA sought for the program. States and
communities served far more caregivers than early projections indicated
would be served; and from the beginning, States and communities
provided the full range of services to caregivers, such as respite,
access, counseling, training and supplemental services. This
accomplishment demonstrated the capacity, organization and skill of the
aging network of Federal, State and community entities to implement a
major new program to serve the long-term care needs of elderly people
and their caregivers in a short period of time.
Accomplishments in Strategic Management of Network Capacity
The reauthorization of the Older Americans Act in 2000 allowed the
aging network to expand the reach and scope of support to the elderly.
The act also fostered a more strategic approach to program management,
whereby the activities and initiatives AoA undertakes are determined by
their ability to produce the goals AoA established for the program. For
example, AoA's initiatives to integrate long-term care in communities
are designed to improve the efficiency of the program. States and
communities are responding to these initiatives, and have increased the
number of elders served per million dollars of AoA funding by over 10
percent by 2003. AoA's emphasis on improving the health and nutritional
status of elders through its meals programs and health promotion and
disease prevention initiatives are expected to help Older Americans Act
clients remain in the community. The fact that 86 percent of caregivers
surveyed by AoA report that Older Americans Act services help them care
longer for the elderly than they could without the services, indicates
that States and communities are succeeding in maintaining the
independence of vulnerable elderly clients. Since the reauthorization
of the Older Americans Act in 2000, AoA has employed a mission-driven
strategic plan and performance outcome measures to demonstrate the
effectiveness of its network of State and local entities, and we will
continue to use these tools to pursue additional program improvements.
AoA program activities have a common purpose that reflects the
primary legislative intent of the Older Americans Act: to make
community-based services available to elders who are at risk of losing
their independence, to prevent disease and disability through
community-based activities, and to support the efforts of family
caregivers. This fundamental purpose is accompanied by the following
four strategic priorities: (1) Make it easier for older people to
access an integrated array of health and social supports; (2) Help
older people stay active and healthy; (3) Support families in their
efforts to care for their loved ones at home and in the community; and
(4) Ensure the rights of older people.
This new focus on strategic management was accompanied by a strong
commitment to measuring performance outcomes, which in turn required
immediate improvements in the data AoA used to measure performance.
With the cooperation of State and area agencies on aging, AoA has
achieved two significant improvements related to performance outcome
data. The first was to improve the quality and to reduce the time lag
in making program data available to support budget and other management
decisions. Since 2000, AoA has reduced the time lag from 28 months to
11 months for the last budget cycle. AoA also instituted annual
performance outcome measure surveys to obtain and use data reported by
elderly individuals and caregivers about outcomes such as the
usefulness and effects of Older Americans Act services and also about
their satisfaction with the services they received.
This effort has resulted in comprehensive performance measures that
have led to a new understanding of the nature and effects of Older
Americans Act programs and the entities across the Nation which
administer services through these programs. We now measure the
efficiency of Older Americans Act programs, and have documented
significant efficiency improvements, noting again for our core programs
an increase of 10 percent in the number of clients served per million
dollars of AoA funding since 2001. We now measure our ability to target
services to the most vulnerable of elderly individuals, noting again
for our core programs that States and communities have increased the
number of severely disabled clients who received selected in-home
services by 15 percent over the fiscal year 2003 base level for this
measure. We now measure how consumers assess our core programs, noting
that the percentage of caregivers who report that our services
definitely help them provide care longer has increased to 68 percent,
and that 82 percent of clients receiving transportation services rated
the services as very good to excellent.
Our commitment to performance measures has guided and contributed
significantly to: (1) our budget requests and initiatives over the past
3 years, which document how demonstration initiatives can contribute to
improved performance in core programs; (2) our establishment of
comprehensive performance partnerships with the Centers for Medicare
and Medicaid Services (CMS) and other HHS partners, which have allowed
us to expand our demonstration initiatives beyond what AoA could
support on its own; and (3) our proposals for the reauthorization of
the Older Americans Act, which focus on modernizing the act to better
empower community-based organizations and consumers to contribute even
more to helping elderly individuals retain their health, independence
and dignity in the community.
Learning What Needs To Be Done in This Reauthorization
The upcoming reauthorization of the Older Americans Act provides an
opportunity to build on the work of the current Older Americans Act. To
guide us in identifying areas where the Older Americans Act can be
improved, AoA has again used strategic management and performance
results. Our commitment to improve the efficiency of our programs
causes us to pursue greater integration of community-based long-term
care services through the reauthorization of the act. The lack of
integration, which is often characterized by duplicative, uncoordinated
programs and systems in the community, causes inefficiency in the
delivery of long-term care in the community. Likewise, our commitment
to help elderly individuals maintain their health and independence in
the community, causes us to pursue through this reauthorization the
expansion of the use of evidence-based health promotion and disease
prevention programs and practices that delay and prevent the chronic
conditions that are known to result in disability among the elderly.
Another significant source of information, which has guided AoA's
activities over the past few years, is the numerous, grassroots
conversations we had with the elderly people and caregivers we serve
and with those in the States and communities who serve them. The
listening sessions we have conducted around the Nation have presented
us with a distinct opportunity to better serve our consumers and to
more effectively implement our services in rural, urban, and suburban
areas by listening to the concerns and challenges faced by older
Americans and their caregivers. We have worked to ensure that we hear
the voices of all of our consumers--including States, area agencies on
aging, tribal organizations, service providers, volunteers, older
persons and their caregivers, as well as, representatives of Federal,
State and local policymakers and the media. Nearly half of the comments
received addressed ideas for future amendments to the act, and those
ideas focused primarily on allowing greater flexibility in implementing
the Older Americans Act, allowing greater integration of long-term care
programs and funding streams to create a more seamless program of
services for elderly people and caregivers.
Principles To Be Achieved With This Reauthorization
Perhaps the most significant contribution of the Older Americans
Act over the past 40 years is the emergence of a long-term care service
network, which is the largest provider of community-based long-term
care for the elderly in the United States. The State and area agencies
on aging, and the service providers that comprise this network have
grown to be the most significant source of community-based care under
the major national programs serving the elderly, including Medicaid
waiver programs. In addition to administering our Older Americans Act
investment in long-term care, and related State and community-funded
programs, this community-based long-term care network now administers
and manages almost two-thirds of this Nation's Medicaid investment in
community-based long-term care for the elderly and disabled. Just as
the Older Americans Act created this network that has provided so much
in helping elderly people maintain their independence in the community,
the act should now be modernized to help this network and the country
adapt to the challenges of sustaining community-based long-term care.
Demographic Issues
Many important changes are taking place in the elderly population,
which are creating new challenges and opportunities for our society,
families and individual citizens. The number of older Americans is
increasing at unprecedented rates, and those Americans reaching age 65
are living longer than ever before. Among those over the age of 85, the
proportion of people who are impaired and require long-term care is
about 55 percent. While the precise number of people who will need
long-term care in the future could be affected by numerous variables,
including possible declines in rates of impairment, the expected
increase in the number of seniors as the baby boomers age is so great
that most experts agree that there will be far more people in need of
long term care in the future than there are today. By 2050, when all of
the baby boomers will be age 85 and older, there will be over 86
million people age 65+ living in the United States, compared to 35
million today.
Primary Long-Term Care Issues
Three major issues in particular must be addressed in the
modernization of the Older Americans Act: (1) the growing demand for
long-term care; (2) the future public and private costs of long-term
care; and (3) the systemic problems inherent in our current approach to
financing and delivering long-term care services and supports.
Demand: The shift in our Nation's demography that I cited above
will have profound implications for every aspect of our society, and
particularly for the future of long-term care. The projected
demographic changes that are influencing the demand for long-term care
will also affect how this care is provided. Families are expected to be
smaller in the future than they are today, and if current trends
continue, a greater proportion of women may be in the labor force. Both
shrinking family size and increasing workforce participation by women
could make informal care less available (women currently provide the
majority of such care) and thus lead to a greater potential reliance on
care from other sources. In addition, ethnic and racial minorities age
65 and over will grow faster than other segments of the population. By
2050, the African-American proportion of the elderly population will
increase by more than half--from 8.2 to 12.0 percent--and the
proportion of Hispanics among the elderly will almost triple from 6 to
16 percent. The issue of growing demand is directly linked with the
baby boom generation. As the baby boom generation ages, the demand for
long-term care services is certain to increase.
Cost: Even before the aging of the baby boom generation, the costs
of long-term care are enormous. This year, $129 billion will be spent
on older individuals receiving paid care--or approximately $15,000 per
impaired senior. The major sources of financing are: Medicaid (39
percent); individual and private out-of-pocket expenses (36 percent);
and Medicare (20 percent) which pays for some skilled nursing facility
and skilled home health care.
It is important to note that another significant source of care is
donated or non-paid care provided by families, friends and neighbors.
Over 95 percent of all chronically disabled elders living in the
community receive at least some unpaid family care, and two-thirds rely
exclusively on such help. The dollar value of informal care is
estimated to be $257 billion per year. As the population ages and
fiscal pressures on State budgets increase, it becomes increasingly
important to find more effective ways to finance and deliver long-term
care.
System Problems: While views may vary on exactly what we should do
to prepare for the baby boom, everyone agrees that there are major
problems with our current approach to long-term care, and our system of
care needs fundamental reform. It is out of sync with people's needs
and preferences. It is fragmented, confusing and inefficient. And it is
financially unsustainable for individuals, families and our society at
large.
Studies consistently show that seniors have an overwhelming
preference to receive support at home. One recent study reports that 81
percent of persons over age 50 would prefer to avoid nursing home care
even if they needed 24-hour care. Another study reports that 30 percent
of older people would rather die than move to an institutional setting.
While nursing home care is a critically important component of our
support system, most experts agree we need to provide more
opportunities for home and community-based services.
Another major problem with our current system is that it is
fragmented, terribly confusing to consumers, and inefficient. Most
people are simply unaware of their potential need for long-term care
and their financial exposure to costs. Research shows that most
Americans still equate long-term care with nursing homes and that many
believe that Medicare pays for long-term care. When older people or
their family members do seek out information or care, they face a
complex, and often mind-boggling, maze of publicly supported and
private options, administered by a wide variety of providers operating
under different, sometimes conflicting--and often duplicative--rules
and regulations. Consumers consistently report experiencing serious
difficulty and frustration in trying to learn about and access
available options. Compounding this situation is the fact that most
individuals face difficult long-term care decisions amidst a crisis,
such as an unexpected hospital admission (65 percent of nursing home
admissions are directly from hospitals), or the collapse in a fragile
unpaid caregiver support network. Under these circumstances, families
have little time to explore the many options that might be available,
and this often results in a nursing home admission or the unnecessary
use of very expensive home health care.
Emerging Solutions
Just as the Older Americans Act has been the solution for so many
significant policy challenges affecting frail elderly people in the
past, and the caregiver program in particular in the recent past, we
believe the act is a very significant part of the Nation's solution to
the emerging long-term care financing challenges that we face now. And
this solution will build on policies that the President and the
Secretary of HHS have already instituted.
As evidenced by the New Freedom Initiative, the Administration is
committed to creating a system of care that reflects the needs and
preferences of Americans of all ages with disabilities, and the values
of choice, control and independence. Since 2001, the Department of
Health and Human Services, with the support of Congress, has provided
the States and communities with a variety of new tools to help them
advance the goals and values embedded in the New Freedom Initiative.
These tools have included Medicaid demonstrations, including ``Money
Follows the Person'' to fully fund 1 year of the cost of helping
Medicaid nursing home residents return to the community; implementation
of the National Family Caregiver Support Program; replication of the
successful Cash and Counseling model; the Aging and Disability Resource
Center Initiative; and the Own Your Future Campaign.
It is noteworthy that many of these tools also support the
integration of people with disabilities into the workforce. As more
people continue working past the nominal retirement age of 65, the
provision of supports and accommodations will enable some individuals
with disabilities to extend their employability well into their senior
years. For seniors with disabilities, income from employment or self-
employment will help improve their self-confidence and productivity as
well as extend their independence and integration into their
communities.
Several of the Administration's long-term care initiatives address
the needs of the entire population. There are three strategies that are
particularly relevant: empowering consumers to make informed decisions;
targeting limited public resources to help high-risk individuals to
stay out of nursing homes; and promoting the use of programs that can
help older people reduce their risk of disease, disability and injury.
Empowering Consumers
Helping all individuals to make informed choices--including choices
about their financing and care options--can enhance people's ability to
stay at home and improve the quality of their lives. Increased
awareness and use of two private financing options in particular would
go a long way toward advancing these goals: private long-term care
insurance and home equity programs. Both instruments are relatively new
products and currently underutilized. Only about 4 percent of Americans
aged 45 and older with incomes of at least $20,000 currently have long-
term care insurance. In addition to giving people greater control over
their future, long-term care insurance can reduce both Medicaid and
Medicare costs.
One of the paradoxes of our current long-term care system is that
impaired, older Americans are struggling to live at home at a time when
they own more than $2 trillion in untapped housing equity. Over half of
the net worth of seniors is currently illiquid in their homes and other
real estate. Home equity instruments such as reverse mortgages enable
older people to tap into the equity in their homes. It is estimated
that 45 percent of households at financial risk for ``spending-down''
to Medicaid could take advantage of a reverse mortgage to help them pay
for long-term care. On average, affected households could expect to get
$62,800 from a reverse mortgage.
The Administration has launched two interrelated, complementary
initiatives to empower people to make informed decisions about their
financing and care options. One initiative, the Own Your Future
Campaign was launched this past year to encourage more people to plan
ahead for their long-term care. The project is a joint effort of the
Administration on Aging, the Assistant Secretary for Planning and
Evaluation (ASPE), the Centers for Medicare and Medicaid (CMS), the
National Governors Association, and the National Conference of State
Legislators. It is currently being piloted in five States (Arkansas,
Idaho, Nevada, New Jersey, and Virginia), and involves the targeted
mailing of HHS materials and a letter from the Governor of each State
to every household headed by an individual between the ages of 50 and
70.
The Aging and Disability Resource Center (ADRC) Program, which was
launched in 2003 by the Administration on Aging and the Centers for
Medicare and Medicaid Services, is also designed to help people plan
ahead for their long-term care, as well as address the immediate
problems consumers face when they try to learn about and access needed
care. This program provides competitive grants to States to assist them
in developing and implementing coordinated access to information,
individualized advice to consumers on their options, and streamlined
eligibility determination for programs. The long-range vision is to
have ADRCs serving as ``visible and trusted'' places at the community
level nationwide where people of any age or income can go to get
information on all available options. The program also reduces
government fragmentation, duplication, and inefficiencies.
The Administration on Aging is also actively partnering with CMS to
ensure that all older Americans take full advantage of the new
prescription drug coverage available under the Medicare Modernization
Act. This past year, we collaborated with CMS to inform seniors about
the Medicare Drug Discount Card options and the transitional assistance
program for low-income seniors. This AoA/CMS partnership provided
almost $5 million in support to help community-based organizations
assist low-income, limited-English speaking populations learn about and
enroll in the transitional program. This year, we are working to help
seniors to learn about and enroll in the Part D Program, including the
low-income subsidy being made available through SSA. We have dedicated
staff full-time to this effort in both our headquarters and regional
offices, and have assigned them to work on various CMS and SSA teams to
oversee this national outreach and enrollment effort. AoA's goal is to
enlist the active support of at least 10,000 of our community-based
aging services provider organizations in helping older people learn
about and take full advantage of the new coverage.
AoA is uniquely suited to add value to this partnership because it
is inherent in our mission to provide access to information, resources,
and services for older Americans. Our service providers can reach the
homebound through home care and meals-on-wheels services. They can
educate and advise senior beneficiaries who gather at senior centers
and congregate programs. They can reach out to caregivers, who are
known to help their frail family members make exactly the types of
decisions that are needed for the drug benefit program. AoA's
community-based organizations are experienced providers of services to
the poor, minorities, and those in rural areas. The network will
service as it does in communities across this country as the tool to
inform, educate and enroll. AoA's activities will be focused on getting
information and support to these community organizations to ensure that
they can and will participate in the education and enrollment of
elderly people.
Targeting High-Risk Individuals
Another strategy is targeting limited amounts of public resources
under capped appropriations to help individuals who are at high risk of
nursing home placement to remain at home for as long as possible. These
individuals are usually in a situation where they have neither the time
nor the ability to do anything but use their liquid assets. The
research shows that effectively targeting individuals who, without some
form of help would have gone into a nursing home, is key to saving
public dollars. Every day you help an individual stay out of a nursing
home, you are helping them use their own personal and financial
resources on less expensive forms of care for a longer period of time.
Seven States have implemented programs, all administered by their
State aging offices in coordination with their regular Older Americans
Act programs, and these are targeted explicitly at people who are at
risk of nursing home placement. These States include Minnesota,
Nebraska, New Jersey, New York, Rhode Island, Utah, and Wisconsin.
Building Prevention Into Long-Term Care
Most long-term care needs emerge from chronic diseases and other
conditions, such as arthritis, diabetes, heart or lung disease, stroke
and dementia, as well as from injuries suffered as a result of a fall
or other accident. We now know these conditions and their effects can
be mitigated, even for people who are very old, through lifestyle
changes and disease management programs. Yet, our formal system of
long-term care--like our acute care system--still emphasizes medical
services over prevention. While changes are occurring in Medicare to
give more emphasis to prevention and chronic care management, much more
can be done through our public health and social service programs.
There is a growing body of scientific research, being generated by
the National Institutes of Health, the Centers for Disease Control and
Prevention, and the Agency for Healthcare Research and Quality and
others, documenting evidence-based programs that have proven effective
in reducing the risk of disease, disability and injury among the
elderly. Deploying these programs at the community level through
venues, like senior centers and congregate meal programs, that can
reach large numbers of older people when the opportunities for
prevention are optimal (i.e., long before they become seriously
disabled and/or spend down to Medicaid) can improve the quality of life
and reduce health care costs.
One example is the Chronic Disease Self-Management Program (CDSMP),
a model developed at Stanford University. This program is a 6-week
workshop designed to empower people with various chronic diseases to
take control of their health. The program has been shown to
significantly improve participant health status and reduces the use of
hospital care and physician services. Another example is a program
developed at Yale University to prevent falls--a leading cause of
serious injury and death among the elderly--and a major contributor to
health costs. The Yale program uses a multifaceted approach to help
older individuals cope with key risk factors. Participants are trained
to improve balance, gait and posture, better manage their medication,
and to remove home hazards. The program significantly reduces the
incidence of falls among participants.
In an effort to begin bringing these types of programs ``up to
scale'' nationwide, the Administration on Aging launched an Evidence-
Based Prevention Program in 2003 in partnership with NIA, CDC, AHRQ,
CMS and the John A. Hartford, Robert Wood Johnson, and several smaller
foundations. The program is designed to demonstrate the efficacy of
implementing evidence-based models at the community level through aging
service provider organizations such as senior centers, nutrition
programs, faith-based organizations, and senior housing projects. A
dozen local projects are being funded for a 3-year period. They focus
on disease self-management, fall prevention, nutrition, physical
activity, medication management, and depression. Each project is being
evaluated to ensure that they maintain fidelity with the original
research design and outcomes.
The employment of strategies such as these provide us a basis for
hope that we can sustain our national support for the long-term care
needs of the Nation, even with the aging of the baby boom generation.
The strategies focus on several principles that are simple but
relevant: consumer information and choice; support for those at high-
risk of disability and poverty before they are disabled and poor;
prevention of conditions that cause disability and disease.
Reauthorization: The Opportunity for Policy Changes in Long-Term Care
The 2005 reauthorization of the Older Americans Act provides a
unique and timely vehicle for accelerating the long-term care policy
development that is needed to fully prepare the United States for the
aging of the baby boom and the emergence of long-term living as a
common experience of life. The Older Americans Act was passed in 1965
to promote the dignity and independence of older Americans and to help
society prepare for an aging population. It was designed to complement
two other programs enacted that year: Medicare and Medicaid. Congress
charted out a vision in the OAA for a nationwide network of public and
private agencies organized around the common purpose of promoting the
development of a comprehensive and coordinated system of care designed
to help older people live at home for as long as possible and avoid
unnecessary placement in nursing homes.
The system envisioned in the OAA has become a consumer-driven,
locally designed service program, supported by multiple funding
streams, and capable of reaching people with low-cost social
interventions long before they needed intensive services so that
preventive opportunities could be optimized. The system was to be
available to people of all income levels, and service resources were to
be targeted at those most in need, especially low-income minority,
isolated and limited-English speaking populations. Early
reauthorizations of the Older Americans Act created area agencies on
aging and fostered the principle of local flexibility and the use of a
``bottom-up'' planning process to ensure that OAA programs would
reflect local needs and conditions. Over the last 4 decades, the
Administration on Aging has guided the development of the national
aging services network that today consists of 56 State units on aging,
655 area agencies on aging, almost 250 Tribal organizations, 29,000
community-based provider organizations, over 500,000 volunteers, and a
wide variety of national non-profit organizations. This nationwide
infrastructure currently provides a wide array of home and community-
based services to over 8 million elderly individuals each year, which
is 17 percent of all people aged 60 and older, including 3 million
individuals who require intensive services and meet the functional
requirements for nursing home care. It also provides direct services to
over 600,000 informal caregivers each year, who are struggling to keep
their loved ones at home.
Many States have looked to their aging services networks to lead
the development of their long-term care systems, including States that
have created the most balanced and cost-efficient systems of care such
as Oregon, Washington and Vermont. The OAA network is one of the
largest providers of home and community-based care. It manages between
$3 and $4 billion each year in public and private resources. All State
units on aging have been given responsibility to administer State
revenue programs; over 30 State units administer Medicaid Waiver
Programs and State Health Insurance Counseling Programs; over 25 States
have expanded the authority of the State aging units to serve younger
populations with disabilities; and 22 States have authorized their
State units to administer the Aging and Disability Resource Center
program.
In short, the network created by the Older Americans Act and led by
the Administration on Aging is positioned to help ensure the
modernization of long-term care under the Older Americans Act. The
network has experience in serving all populations. It has experience in
serving the older population and those that are not elderly. It has
served the caregivers of the elderly and disabled, and has reached out
to these varied service populations with models of integration that can
simplify access to services and provide choice to consumers. Community-
based organizations across the Nation have emerged as leaders in
bringing evidence-based health promotion and disease prevention
practices to the elderly in senior centers and in their homes.
The single most important goal of the Older Americans Act
reauthorization should be to strengthen the act so it can play a more
central role in helping our Nation prepare for the baby boom and long-
term living. Consistent with act's mission and the President's New
Freedom Initiative, the reauthorization should reflect the values of
consumer choice, control and independence, and the principle of
providing care to people where they want it.
With the reauthorization of the Older Americans Act, AoA and HHS
will propose forms of modernization along the lines that I have
addressed here. We will pursue changes that will improve the efficiency
and effectiveness of the largest long-term care provider network in the
country. Prominent among those changes will be the integration of long-
term care and efficiency in access to care by those who need it. We
will pursue changes that recognize that we cannot wait until people are
old and frail and poor to begin to address their long-term care needs.
This will require that those who are not old should plan for their own
long-term care. It will require the elderly who are not poor to make
creative use of their existing resources to finance and support their
care, with limited government assistance, to prevent poverty and the
loss of independence. We will pursue changes that recognize the
preferences of people for long-term care, which means a greater focus
on community-based care and providing choice and control to consumers
in the management of that care.
Thank you, Mr. Chairman, for the opportunity to speak to you today
about the reauthorization of the Older Americans Act. I have tremendous
respect for and confidence in the long-term network I have spoken about
today. I am proud to have served as a community-based provider and a
leader in this network for more than 30 of the 40 years that have
passed since the Older Americans Act created it.
Senator DeWine. Ms. DeRocco?
STATEMENT OF EMILY STOVER DEROCCO, ASSISTANT SECRETARY FOR
EMPLOYMENT AND TRAINING, EMPLOYMENT AND TRAINING
ADMINISTRATION, U.S. DEPARTMENT OF LABOR, WASHINGTON, DC.
Ms. DeRocco. Thank you, Mr. Chairman, Senator Mikulski. I
am delighted to join my distinguished colleague here to talk
about the reauthorization of the Older Americans Act.
As you have cited, the U.S. economy is entering a period of
dramatic demographic changes as our population ages. The
changing demographics of the labor force in combination with
the ever-increasing skill needs of employers have made it more
critical than ever before that every available worker,
including older Americans, be able to join or remain in the
workforce.
Yet we know older workers face significant challenges to
full participation in our workforce. Employment barriers
include difficulties keeping pace with changing skill
requirements and technology, the lack of opportunities for
skills training and professional development, some
misperceptions among some employers about the abilities of
older workers, the lack of flexible work schedules and certain
financial disincentives to working that may encourage early
retirement.
We know many older workers want to remain in the workforce
and many need to continue working for financial reasons, and
there is a resource available to help. Currently, our Nation's
taxpayers invest about $15 billion a year in the workforce
investment system, and this system, as you know, includes the
Senior Community Service Employment program and we have an
important role to play in helping older workers obtain the
necessary skills and access the opportunities that will enable
them to continue working.
At the Department of Labor, we are taking steps to enhance
the effectiveness of this system to serve workers, and my
testimony describes our Older Worker Task Force, our protocol
for serving older workers, and other initiatives that I hope
you will read in the written testimony.
But I would like to turn now specifically to the Senior
Community Service Employment program, which, as you know, is
the Workforce Investment program targeted exclusively to low-
income seniors. We currently have 69 SCSEP grantees, including
13 national grantees and 56 units of State and Territorial
governments that assist in the operation of this program
throughout the Nation.
In 2000, Congress enacted the Amendments to the Older
Americans Act, including our SCSEP program, and the Department
of Labor subsequently issued regulations implementing your
changes. The program has clearly evolved from being focused
largely on community services to a program that increasingly
emphasizes the achievement of economic self-sufficiency and
independence through unsubsidized employment.
In 2002, the Department conducted the first open national
competition for the SCSEP grants. Our purposes were to ensure
that the best providers working with this population had an
opportunity to compete and be selected to provide services, as
well as to infuse new and innovative service delivery methods
and ideas into the program and improve our efficiency and our
services so more seniors could be served.
We also are implementing the rigorous performance measures
that the Congress called for in your amendments in 2000.
Beginning July 1, 2005, our grantees will be held accountable
for achieving specific performance outcomes related to
placement in unsubsidized employment, retention, earnings
increases, and customer satisfaction.
In view of the increasing importance of older workers in
our economy, it is fortuitous that reauthorization of the
Workforce Investment Act and the Older Americans Act are before
the Congress this year. We have worked to closely link these
two systems and believe that that ought to be an additional
part of our goal in reauthorization of Title V of the Older
Americans Act.
I would like to just articulate five principles that we
believe ought to be considered in that reauthorization. First,
in order to help meet employers' demands for skilled workers,
we need to attract additional older workers at all income
levels to our labor force, encourage others to remain in the
workforce, and offer opportunities for older workers to update
their skills. SCSEP and the Workforce Investment System are
each avenues to do this and we will be recommending specific
improvements in both to do it more effectively.
Second, we must make the One-Stop Career Center system more
responsive to the specialized needs of older individuals
seeking to work or upgrade their skills. Specifically, we need
to better integrate services for older workers into that One-
Stop Ccareer Center system in order to truly provide universal
service and assist more older workers, regardless of income, to
gain skills which are in demand.
Third, we need to tailor SCSEP services to meet the needs
of individual older workers by providing a range of training
experiences, including on-the-job and classroom training or
retraining, depending upon the individual's background and
experience.
Fourth, we must target our SCSEP resources to effectively
serve those older workers in need of work experience, including
low-income older workers who lack basic skills or who are
unable to obtain private sector employment immediately.
And finally, we need to streamline the SCSEP program to
make it easier to administer in order to improve program
performance, serve more participants, and get return on the
investment for the Federal taxpayers' dollars. We will have
specific proposals to address each of these issues and to
improve program accountability and administration.
Mr. Chairman, Senator Mikulski, we look forward to working
with you, this subcommittee, and your House counterparts on
reauthorizing the Older Americans Act.
Senator DeWine. Great. Good testimony. Thank you very much.
[The prepared statement of Ms. DeRocco follows:]
Prepared Statement of Emily Stover DeRocco
Mr. Chairman and members of the subcommittee, I am pleased to have
the opportunity to testify before you today with my distinguished
colleague, Josefina Carbonell, Assistant Secretary for the
Administration on Aging, to discuss the reauthorization of the Older
Americans Act (OAA). For over 35 years, the Department of Labor has
administered the Senior Community Service Employment Program (SCSEP),
authorized by Title V of the Older Americans Act.
Before discussing what we believe to be the important principles to
consider in reauthorizing title V, I would like to say a few words
about America's aging population and workforce and provide context on
where SCSEP fits in the broader workforce investment system.
The Aging Population and Workforce
As you know, the U.S. economy is entering a period of dramatic
demographic change as our population ages. According to the Department
of Labor's Bureau of Labor Statistics, by 2030, as the baby boom
generation ages, 24.2 percent of the civilian noninstitutional
population, or about 66.2 million Americans, will be 65 or older,
compared to just 15.6 percent in 2000. Further, as a result of lower
birth rates in recent years, combined with the aging and retirement of
the baby boom generation, the American workforce is growing more
slowly.
The changing demographics of the labor force, in combination with
the ever-increasing skill demands of employers, have made it more
critical that every available worker, including older Americans, be
able to join or remain in the workforce to enable the continued
competitiveness of American businesses in the 21st Century.
Barriers to Employment Faced by Older Workers
Yet, older workers face significant challenges to full
participation in our workforce. Employment barriers include
difficulties keeping pace with changing skill requirements and
technology, the lack of opportunities for skills training and
professional development, misperceptions among some employers about the
abilities of older workers, the lack of flexible work schedules, and
certain financial disincentives to working that may encourage early
retirement. Many older workers want to remain in the workforce and many
need to continue working for financial reasons.
There is a resource available to help: currently, our Nation's
taxpayers invest about $15 billion in the workforce investment system.
The workforce investment system, which includes SCSEP, has an important
role to play in helping some older workers to obtain the necessary
skills and access to opportunities that will enable them to continue
working.
Response by the Department of Labor to an Aging Population
Our workforce investment system has an important role to play as
well for employers who need a skilled workforce in order to grow and be
competitive. If we are to meet the rapidly-changing skills demands of
business and address potential labor shortages, we will need to help
employers seek out untapped labor pools, like older workers. Some
employers already recognize the value that older workers bring to the
workplace: they know that older workers are a human capital asset;
bring responsibility, loyalty, dedication, experience and skills to the
workplace; and serve as effective mentors to younger employees.
Still, more needs to be done to provide job training opportunities
for mature workers and better connections to older workers for
employers looking to hire.
At the Department of Labor we are taking steps to enhance the
effectiveness of the workforce investment system to serve older
workers, and we are pursuing new strategies and special initiatives to
link mature workers to employers.
Older Worker Projects and Initiatives
Older Worker Task Force
In November 2004, the Employment and Training Administration
convened an interagency taskforce comprised of representatives from the
Office of the Assistant Secretary for Policy, the Bureau of Labor
Statistics, the Employee Benefits Security Administration, and the
Bureau of International Labor Affairs to focus on the older worker
population. Its charge is to develop a comprehensive policy and
investment strategy designed to address the key issues related to the
participation of older workers in the labor market.
Three objectives have been identified for the taskforce:
1. Identifying and filling knowledge gaps that currently exist
regarding older workers' employment opportunities.
2. Strengthening the capacity of the workforce investment system to
provide comprehensive, integrated employment and training services to
older workers.
3. Identifying and addressing the barriers to employment faced by
older workers in order to improve employment outcomes for this
population.
The taskforce's recommendations are under review, and I look
forward to working with our public and private partners to move the
recommendations from ideas into reality.
Protocol for Serving Older Workers
In January 2005, the Department of Labor released a written
``Protocol for Serving Older Workers'' to the over 1,900 comprehensive
One-Stop Career Centers of the workforce investment system. The goal of
this protocol is to enhance the services provided to older workers, and
to promote the One-Stop Career Center system's adoption of innovative
strategies for tapping into this labor pool.
We know the workforce investment system must do a better job
serving a larger number of older workers and we must forge new
partnerships with business and industry and organizations representing
the interests of mature workers to ensure successful placement of older
workers in jobs.
Now I would like to turn to the Senior Community Service Employment
Program (SCSEP), a workforce investment program targeted exclusively to
low-income seniors.
Title V--The Senior Community Service Employment Program
SCSEP serves persons 55 years of age or older whose family incomes
are no more than 125 percent of the Federal poverty level. Participants
are placed in a part-time community service assignment in a local non-
profit agency so that they can gain on-the-job experience, and prepare
for unsubsidized employment.
The fiscal year 2005 appropriation for SCSEP is $436,678,400. This
funding will support over 61,050 SCSEP positions, and will result in
approximately 91,500 people participating during Program Year 2005
(July 1, 2005-June 30, 2006).
There are currently 69 SCSEP grantees, including 13 national
grantees (12 national non-profit organizations and one Federal public
agency), and 56 units of State and territorial governments. The 13
national grantees are:
the AARP Foundation;
Asociacion Nacional Pro Personas Mayores (ANPPM);
Easter Seals, Inc.;
Experience Works, Inc.;
Mature Services, Inc.;
National Able Network;
National Asian Pacific Center on Aging (NAPCA);
National Caucus and Center on Black Aged, Inc. (NCBA);
National Council on the Aging, Inc. (NCOA;
National Indian Council on Aging (NICOA);
Senior Service America, Inc.;
SER-Jobs for Progress National, Inc.; and
The United States Forest Service.
Program participants receive training and work experience in a wide
variety of occupations, including nurse's aides, teacher aides,
librarians, gardeners, clerical workers, and day care assistants at
non-profit 501(c)(3) organizations and public agencies. Program
participants also work in the health care industry, such as in
hospitals, as well as in recreation parks and forests, education,
housing and home rehabilitation, senior centers, and nutrition
programs. They are paid the highest applicable minimum wage, be it
Federal, State or local, or the prevailing rate of pay for persons
employed in similar public occupations by the same employer.
The typical SCSEP participant is a woman with a high school
education in her mid-sixties. At the end of Program Year 2003 (June 30,
2004), 73 percent of the participants were women, 44.3 percent were
minority, 81.5 percent were age 60 or older, 8.7 percent were age 75 or
older, and 70.8 percent had a high school education or less.
SCSEP can make a difference for these individuals. A recent article
on the SCSEP Web site featured the successful placement of an Ohio
woman laid off from her 5-year secretarial job at a local hospital. She
came to SCSEP for help, was found to be SCSEP-eligible and placed in a
community service assignment in the grantee's resource room. In that
capacity, she helped to provide services to other older workers as she
pursued her own job search. Initially reluctant, she agreed to
participate in the grantee's WIA-funded Job Club, refreshing her
interviewing and job-seeking skills, and benefiting from shared
information on job openings. As a result of a Job Club lead and these
services, she is now employed at a mass transit company as the
Administrative Assistant to the Executive Director--a challenging and
interesting position. The SCSEP gave this participant an opportunity to
earn money and engage in meaningful work while she gained the self-
confidence to engage in a successful job search.
SCSEP Reforms
In 2000, the Congress enacted Amendments to the OAA, including the
SCSEP program. The Department of Labor subsequently issued implementing
regulations. As a result, there are a number of changes that have been
made to SCSEP since 1999 when the last reauthorization hearings were
held.
The program has evolved from being focused largely on community
services to a program that increasingly emphasizes the achievement of
economic self-sufficiency through unsubsidized employment. While the
statutory goal for private-sector placement is a minimum of 20 percent,
our grantees place approximately 35 percent of participants in
unsubsidized employment each year. Our goal is to increase this
percentage. In fact, some of our best-performing grantees place from
50-75 percent of their participants each year. A community service
assignment is the first stop in the SCSEP program, not the last
station.
Currently, we estimate that SCSEP serves less than \1/2\ percent of
the eligible population--and, as we are all aware, the baby boomer
aging cohort continues to grow. Therefore, achieving unsubsidized
placements for employment-ready participants enables grantees to serve
more eligible applicants. The new regulations tighten income
eligibility guidelines to ensure that the statutory mandate to serve
our neediest seniors is met. Further, the Amendments and the
implementing Final Rule also require that grantees apply certain
priorities and preferences in recruiting and selecting eligible
individuals for SCSEP to serve those individuals with multiple barriers
to employment.
In 2002-03, the Department conducted the first open national
competition for the national SCSEP grants. The Department made this
decision to ensure that the best providers were selected, as well as to
infuse the program with new and innovative ideas to improve its
efficiency so more seniors could be served. Over 60 organizations
applied and 13 organizations were awarded national grants--9 incumbents
and 4 new grantees. The Department ensured a smooth transition through
a variety of mechanisms, including: (1) permitting voluntary slot
swaps; (2) providing additional resources to avoid potential layoffs of
program participants due to over-enrollment; (3) convening a PY 2003
Orientation and Training Conference for all national grantees; (4)
establishing an internal Transition Management Group; (5) instituting
weekly conference calls between the Department and the national
grantees; and (6) using the Department's Toll-Free Help Line to respond
to questions about the transition.
The coordination roles and responsibilities between SCSEP grantees
as One-Stop partner programs and the One-Stop Career Center system have
now been clarified and strengthened. The Department has been committed
to helping this system forge relationships that leverage resources to
serve more older individuals.
Beginning July 1, 2005, SCSEP grantees will be held accountable for
achieving specific performance measures relating to placements in
unsubsidized employment, retention, earnings increase, and customer
satisfaction. This means that the Department will have specific outcome
data to show the Congress about the value-added we provide to older
individuals.
Administrative procedures have also been strengthened. Grantees
must now meet fiscal accountability provisions such as assuring there
is no fraud and abuse in the grantee organization or failure to repay
debts, similar to those required under the Workforce Investment Act.
The State Plan is now known as the State Senior Employment Services
Coordination Plan, reflecting the new emphasis on collaboration and
partnership. In order to improve the ability of States to coordinate
services, grantees must arrange for the participation of a broad array
of stakeholders in the development of an annual plan to ensure an
equitable distribution of projects within the State.
Section 502(e) of the 2000 Amendments is now a separate employer-
based subsidized training program. These projects utilize innovative
strategies and new work modes, such as flex-time, flex-place, and job
sharing, to provide SCSEP participants with second career training and
to prepare them for placements with private sector employers in high-
growth industries. This program was designed to enhance the employer
connections of the SCSEP grantees and increase placements of
participants in jobs.
To support these legislative and regulatory changes, the Department
has undertaken a number of initiatives. We are working with the
business community--especially in high-growth sectors such as health
care, retail, information technology and hospitality--to promote the
benefits of hiring older workers. We are also providing technical
assistance to our grantees to help them recruit participants who meet
the new eligibility criteria. Finally, we have developed outreach
materials to inform both employers and potential participants about
opportunities to hire SCSEP participants, and will be mounting a high-
profile celebration of the 40th anniversary of the program during Older
Workers Week, September 18-24.
Principles for SCSEP Reauthorization
In view of the increasing importance of older workers in our
economy, it is fortuitous that the reauthorization of both the Older
Americans Act and the Workforce Investment Act are before the Congress
this year. As you know, SCSEP is closely linked to the Workforce
Investment System. It is a required partner in the WIA One-Stop
delivery system. Additional provisions in both WIA and title V link the
two programs together. After considering our experience administering
the program and input we have received from our grantees through
``SCSEP Reauthorization Town Hall Forums'' that we held earlier this
month, we propose five principles for title V reauthorization, which
view SCSEP within the larger framework of the Workforce Investment
System.
First, we need to help meet employers' demands for skilled workers
by attracting additional older workers into the labor force,
encouraging others to remain in the workforce, and by offering
opportunities for older workers to update their skills. SCSEP and WIA
are each avenues to do this, and we will be recommending specific
improvements to both programs to do it more effectively.
Second, we must make the One-Stop Career Center system more
responsive to the specialized needs of older individuals seeking to
work or upgrade their skills. Specifically, we need to better integrate
services for older workers into the One-Stop Career Center system, in
order to provide truly universal service and assist more older workers,
regardless of income, to gain skills in demand. One-Stop Career Centers
should be a primary destination for older workers seeking to work or
upgrade their skills. An ideal One-Stop Career Center would have a
resource room with a wide variety of worker information and might offer
older workers information on job search and placement assistance,
training and supportive services, starting a business, and
volunteering, as well as retirement planning. It also would help older
workers find opportunities for job sharing, part-time employment, and
other work modes for older workers who want to or need to continue
working, perhaps in second careers, but possibly not full-time, or who
simply seek to ease into retirement.
SCSEP serves the low-income segment of the older worker population,
and SCSEP grantees, often the experts on serving older workers in the
One-Stop Career Centers, must be integrally involved in this effort to
integrate services for all older workers into the One-Stop Career
Center system. They cannot do it alone, however. The larger WIA system
must do a better job of serving older workers in general and it must
serve more of them in order to meet employers' demand for skilled
workers. The Protocol for Serving Older Workers was a step in this
direction.
Third, we need to tailor SCSEP services to meet the needs of
individual older workers by providing a range of training experiences,
including on-the-job and classroom training or re-training, depending
on the individual's background and experience. This range of training
options will allow us to better address individual needs and prepare
low-income older workers at varying skill levels for private sector
employment.
Fourth, we must target SCSEP resources to effectively serve those
older workers in need of work experience, including low-income older
workers who lack basic skills or are unable to obtain private sector
employment immediately. As I noted earlier, SCSEP currently serves only
a small percentage of the eligible population. This principle therefore
fits hand-in-glove with our second principle: as we target resources to
meet the needs of the low-income senior population, we must ensure that
other older workers can access appropriate and effective services
through WIA.
Finally, we need to streamline the SCSEP program to make it easier
to administer, in order to improve program performance, serve more
participants, and get return on investment for the Federal taxpayers'
dollar. Some of the features and provisions of SCSEP have been in place
for many decades and no longer make sense in view of the changing
economy, increased longevity, and the current geographic distribution
of the target population. We will have specific proposals to address
these issues, as well as to improve program accountability and
administration.
Mr. Chairman and members of this subcommittee, I look forward to
working with you and your House counterparts on reauthorizing the Older
Americans Act. Working together, I am hopeful that we can obtain
enactment of this important legislation later this year. I also look
forward to working with you on the reauthorization of the Workforce
Investment Act.
Mr. Chairman, this concludes my prepared statement. At this time I
would be pleased to answer any questions that you or other subcommittee
members may have.
Senator DeWine. Let me ask both of you when you believe
that we will have specific legislative recommendations on
reauthorization from you all.
Ms. Carbonell. Our proposals are currently being vetted by
the administration and we hope shortly. We don't know the exact
time frame, but----
Senator DeWine. You don't know what ``shortly'' means yet?
Ms. Carbonell. We have been working on this for quite a
long time and getting input from the field and from our
providers in the aging network. The proposal is being fine-
tuned right now by the administration and we hope to be able to
come with the overall white paper on the principles of the
reauthorization and look forward to working with you,
hopefully--I don't want to say a time frame, but I hope that in
the next month, we should be able to do that.
Senator DeWine. Good. Obviously, the sooner the better. We
appreciate that very much and look forward to working with you.
Ms. Carbonell, you talked in your--and 5 minutes is always
a tough time frame to say anything, certainly Senators can't do
it in 5 minutes. I don't know how we expect you to do it in 5
minutes. But you talked about the need to keep people in their
own homes, the need to provide services in their own homes. I
wonder if you could reflect a little bit more in detail about
the Older Americans Act and as we move toward reauthorization
how that pertains to what we will be doing. I mean, it affects
so much of what the States are doing with health care, so much
of what we are looking at at the Federal level, so much in the
jurisdiction of the Finance Committee, for example, but I
wonder if you could reflect on what we are doing with the Older
Americans Act.
Ms. Carbonell. Well, one of the first things that I did
when I came into office was go out back into the community to
talk to caregivers, to talk to seniors, to talk to our aging
services providers, to see which way we could not only
implement the amendments and the changes and the strengthening
of the Act of 2000, but most importantly, how we could move the
act and the services within it, modernize them and improve the
efficiency to better serve the people.
One of the continuing comments that have circulated in
almost all venues, whether you talk to, most importantly, the
seniors, older Americans, their caregivers, is they want to
have a choice to stay at home as long as possible and to live
as independently, quality of life as long as possible.
So that means that that served as the core value that when
we develop our strategic vision, our strategic plan, as we
implemented the changes of 2000, as we move the act forward, to
make sure that we looked at the consumer and their wish to
remain at home as the central focus of what we did throughout
the entire network.
And then the implementation of the new Family Caregiver
program gave us the ability to not only continue to expand the
services to seniors across this country, but to serve a
different kind of client that gave us the complete picture on
the kinds of challenges that caregivers, mostly women, working
women in families that have both children and older adults, are
facing in caring for their loved ones.
So being able to assist them and support them with services
and information and giving them availability and brokering
those resources to those caregivers and to the older Americans
gave us, again, another opportunity to expand and build upon
the core programs of the Older Americans Act, under supporting
services, nutrition services, elder abuse prevention, and
Native American programs, to build upon additional services to
maintain people at home.
Again, the ability and the fragmentation of some of the
services, having been on the other side of this table and
having been a provider for over 30 years, we knew how difficult
it was sometimes to try to really meet the needs of the entire
consumer when someone showed up at your doorstep needing help.
And it was the fragmentation of services with different funding
sources and different requirements which made it very difficult
to try to serve the whole person and their needs.
So we know that home- and community-based care is the
number one priority. They want to remain at home. They want to
age in place. They want to be able to receive services at home,
to maintain independence, to have the ability, for those that
are able and capable of working, to have the ability to
maintain active and independent, to have the ability to
volunteer and to be engaged in their community. So that is one
of the most important principles that was implemented in the
strategic vision and, of course, in the implementation of all
the amendments of the Older Americans Act.
The other very important factor is that throughout the 40
years, we have built one of the most impressive community-based
care systems that is locally based, locally managed, from the
local community up to the Federal level, by States and local
communities developing their own priorities based on their own
community needs, and we have built the largest--we are the
largest provider of home- and community-based care in our
country. We also manage about two-thirds of the Medicaid waiver
programs in States throughout this country.
So we know that we are in the right position to modernize
the act and to bring it to the next level to address not only
the current challenges of people living longer, needing more
forms of support, but also the ability of the act to maintain
independence and to reach younger folks, people, by serving
people 60-plus.
Senator DeWine. Very good. Thank you.
Senator Mikulski?
Senator Mikulski. Thank you very much, both of you, for
very dynamic presentations. Ms. Carbonell is someone whose
social work background and Master's degree--actually, my first
job out of graduate school was working in a rural and poverty
program getting ready for this bill. So it is great to talk to
somebody who likes to go into the street in the community to
know what is up.
Let me go right to the questions about keeping people in
their home. In 1965, we designed this. We were a booming
economy. There was a smaller proportion of elderly. And we were
focusing more on loneliness and isolation and so on.
Now, how would you see the top three things you would like
to focus on if we were just starting this program now? How
would you--what here would you keep as core, or what would you
change, or what would you add, or what would you subtract?
Ms. Carbonell. I think that the principles that the
administration is looking at and the Administration on Aging
definitely have been working on is we have built the system and
we have a core set of programs that have been very effective in
keeping people out of homes. Particularly, we are serving 8.2
million persons under the Older Americans Act, 3 million of
which received intensive services at home. These 3 million
actually would qualify for a nursing home right now because
they have more than three ADLs and they would qualify right now
for institutional care should they wish to seek that choice.
That means that we are being very successful in keeping people
at home.
So what we are looking at, and I think the basic principles
is that we built upon the core programs and the strengths----
Senator Mikulski. Let me go through this list. No. 1, would
you keep information and referral?
Ms. Carbonell. Information and referral has been proven to
be one of the most important services for older Americans and
caregivers across this country.
Senator Mikulski. Second, would you keep the nutrition
programs, Meals on Wheels and congregate meals?
Ms. Carbonell. Nutrition programs have been extremely
effective in keeping people healthy, particularly because we
are targeting those at most risk, with high nutritional risk
factors and other nutrition intervention services that help
people remain healthy and are part of the overall prevention
and wellness programs of the success of the programs.
Senator Mikulski. Senator DeWine said we are going to be
holding other hearings on the Meals on Wheels and the Eating
Together programs. That is the term we use for congregate meals
in Maryland. Do you face challenges, for example, the decline
of the number of volunteers? Gosh, skyrocketing gas prices when
many of the volunteers are elderly themselves. Are there
challenges in maintaining the Meals on Wheels program as we
know it?
Ms. Carbonell. Well, the Meals on Wheels program, again, is
one of the most successful, and the recruitment of volunteers,
again, in that area, is extremely high. You know that overall
in the Older Americans Act, we have over 500,000 volunteers
that provide services directly. A large portion of them are in
the Meals on Wheels program. So the continuous building upon
the ability of the act that we have already the authority, to
build upon the act, to recruit more volunteers, to engage more
people in meaningful activities of volunteering, in programs
such as these and with other programs in the community, is
going to be a critical point of--will continue to be a critical
point of our programs.
Senator Mikulski. So that would be also part of the ``must
do.'' Now, one of the things that we added was the National
Family Caregiver Support program, and it is something I am very
keenly interested in. It, of course, goes to the independence
principle that we both--we all endorse.
What have we learned from the National Caregiver Support
program so far? What aspects have been successful? What can we
do to improve the program? Do you see holes or gaps in the
program?
Ms. Carbonell. Well, first of all, the National Family
Caregiver, like I expressed before, has given us the
opportunity to serve a whole array of providers. They are
helping us provide the care that is being given to older
Americans and disabled Americans across this country. So
Caregiver is a critically important program and it is a core
program that we have embedded into the Older Americans Act rest
of the program.
Senator Mikulski. But what about it was successful?
Ms. Carbonell. It has been extremely successful not only in
reaching----
Senator Mikulski. But what aspects of it?
Ms. Carbonell. All of the aspects. I think that the
Congressional vision to identify the key importance of
information and assistance as one of the most important
services that caregivers need in their search for being able to
care for their loved ones better and quality of care and
accessing resources. So information and assistance has been a
critical service area, and in that area, we have been able to
serve 12 million caregivers so far. We are very proud of that.
Senator Mikulski. That is great.
Ms. Carbonell. So we know that information assistance, like
you mentioned, Senator Mikulski, is a very, very important
service, whether it is given through the Caregiver program, but
we are looking at the Caregiver program as an integral
component of the overall core programs of the Older Americans
Act.
Senator Mikulski. Absolutely. Have you found gaps in the
program or areas that need greater support, either financial,
the supplemental services in particular, or the caregiver----
Ms. Carbonell. We have been able to----
Senator Mikulski. I note your comments on transportation
and----
Ms. Carbonell. Yes.
Senator Mikulski. Those things that don't require actual
home health, but they require assistance for independence,
whether it is the chore service, the transportation service----
Ms. Carbonell. The beauty about the Family Caregiver
program, the way it was designed by the Congress, it gave us
the flexibility to give to States that flexibility to design
the program based on caregiver needs in that local community.
So it allowed us to, for instance, if the caregiver needed a
ramping built in their home and that meant the difference
between somebody being active and social and being able to be
transported out of their home safely, then the ramp was allowed
to be built. That means that we gave that provider the
flexibility to do that.
Consumer training, that means caregiver training. You know,
many caregivers, unfortunately, are faced with caring for their
loved ones and not knowing how to pick up people and not be
injured, you know, from beds, and transporting people. One of
the abilities that we had was through the demonstration grants
that were funded under the Caregiver program, there were
several programs that tested other innovative ideas, including
in, of course, your district, the ARC of the United States
actually did cross-training between the disability networks and
the aging networks on the needs of caregivers----
Senator Mikulski. Ms. Carbonell, I see that my time is up.
When we come back, either for a second round of questioning,
but in our ongoing work, what you are saying is that the
original pillars of the program stand. The program will stand
on that and then there has to be changing demography, since we
need to look at it in a creative way. But this Family Caregiver
program is really one of the new pillars----
Ms. Carbonell. That is right.
Senator Mikulski. [continuing]. That will be a cornerstone
to independence, is that correct?
Ms. Carbonell. That is so correct.
Senator Mikulski. We will forward actual specific
suggestions, and thank you for your insightful testimony.
Senator DeWine. Senator Murray?
Senator Murray. Mr. Chairman, thank you very much. There is
a lot going on in the Senate, but I did want to come by for a
couple minutes of this hearing to thank you and Senator
Mikulski for the hearing today and for your work on this issue.
Certainly, the Older Americans Act is something I think is
extremely important and I hope we can move through the process
and reauthorize this quickly and strengthen the program, not
dismantle it. It is one that I hear about everywhere I go in my
community. People say how important this legislation is to them
personally, in their own lives, and certainly as we see the
baby boomers retire and a number of pension systems that are
under duress right now, we are going to see a greater need for
this program. We need to make sure that we are doing the right
thing.
So I really wanted to especially come and say I support you
in the work on this and want to work with you.
But I did want to ask, as we begin the process of
reauthorizing this act, I am really interested in getting some
more specific information on how HHS and DOL have improved
outreach, especially to minority groups. I know that during the
last reauthorization, we focused a lot on diversity within the
programs, but we still today have a lot lower participation
rates for most minority populations, and in my State, I am
especially concerned about aging Pacific Islanders and Native
Americans.
I realize that, nationwide, these are smaller minority
populations, but in some regions of the country, they make up a
larger share of the population, and I think we should be
looking more at minority outreach and participation rates on a
more regional basis.
So, Ms. Carbonell, I know in your prepared statement I had
a chance to look at, you mentioned that one of the four
strategic priorities for implementation for the 2000
reauthorization was to make it easier for older people to
access an integrated array of social supports. I am concerned
that we still have a lot of work to do to achieve that goal,
especially with the Asian Pacific and Native American
communities.
You might know that in 2004, I got funding for a specific
outreach effort in Indian Country in Washington State, and that
was sort of due in part to my frustration in making sure that
Native Americans, especially older, low-income elders, were
aware of a lot of these important social services. So could you
provide for us today an update on diversity in all the programs
and how the administration is working to make sure it is
culturally sensitive, the manner that they work in these
minority communities?
Ms. Carbonell. Thank you, Senator Murray. I think that we
have a good report on the targeting issue. I think that, number
one, it is a requirement of the Older Americans Act, and as you
have said, the 2000 amendments strengthen our commitment to
targeting vulnerable populations throughout the country and we
have got a good story to tell.
I think, overall, the percentage of Older Americans Act
clients that are being served that are poor almost tripled the
poverty rate. That means that we are serving three times the
number of poverty-level individuals that we did some years
back.
The percentage of the Older Americans Act clients that are
minority was almost 20 percent higher than the minority rate
for all elderly people in 2001, and rose over 40 percent higher
by 2003.
Specifically, minority participation in OAA programs have
increased in the last 4 years, especially for Hispanics and
Asian Pacific Islander categories, including extra efforts with
Native American programs and increases that we have dedicated
to specifically resource centers and to improve the training
and technical assistance to minority communities. So we are
very proud of the work that we have done in the area of
minority and then targeting those in most risk.
We have also made some very important strides in serving
clients in rural areas. For instance, the Older Americans Act
clients that live in rural areas is at least 25 percent higher
than the rural rate for all elderly people, and we have
certainly seen just in the last 3 years a tremendous increase
both in the minority participation in centers, and that is
thanks to a very concerted effort by us and all of the network
providers at the State and local level to make sure that we
have created and continue to build upon improved access to
services, information, and programs and resources for this
population----
Senator Murray. I really appreciate it. I think that is
really an important emphasis that we have to maintain and
continue.
I know my time is up. I just want to ask, Mr. Chairman, if
you don't mind, one quick question, and that is I know an
important part of the Older Americans Act is coordination of
services and programs. We have a lot of veterans who are aging,
who need assistance, and I would like to know if you are
working with the VA, because I am finding that a lot of those
veterans don't know of the services that are available to them.
So do you coordinate with the VA?
Ms. Carbonell. Yes. There is continuous coordination with
the VA, particularly as we develop the Caregiver program. We
have had specific coordination efforts for caregiving support,
technical assistance. We have also coordinated at the local
level with the Area Agencies as we develop plans to serve the
needs of communities. We see that coordination happening at the
local level and at the State level. So we see that continuing
to grow and expand as we move forward. And, of course, Senator
Craig is now chairing the Veterans' Affairs Committee and we
look forward to working and to continue to work with our
counterparts----
Senator Murray. I think it is really important that we
continue to do that because it is a population that often gets
lost, doesn't know of those services, and it is a great way to
avail those veterans who served our country with the knowledge
of what is out there to support them.
So, Mr. Chairman, I thank you very much for having this
hearing and I look forward to working with you and Senator
Mikulski on the reauthorization of this bill.
Senator DeWine. Good. Ms. DeRocco, you say that you would
like to increase the number of participants who receive jobs in
the private sector. What is the Department doing now to help
SCSEP grantees find jobs for participants, and also is the dual
purpose of SCSEP, valuable community service activities, and
unsubsidized employment outcomes, working as intended?
Ms. DeRocco. Absolutely. Yes. Let me say that the dual
mission, dual purpose of SCSEP is an important and not
exclusive set of focus. They work together well. The community
service opportunities for our older Americans to actually learn
new job skills is a tremendous opportunity for them to gain the
skills necessary to move into unsubsidized employment.
We are finding that the more we can integrate the SCSEP
program with the Workforce Investment System and assure that
the services of both and the participants in both understand
the array of resources, services, and opportunities available
to them, the better off our mature workers are going to be
coming out of or through either of those programs.
We have established a strong relationship between the SCSEP
program and the One-Stop Career Centers across the country. As
I indicated, we have issued a protocol to our one-stops about
serving older workers and assuring that older workers who
access services in the one-stops understand what the SCSEP
program is and what services it might provide, especially for
low-income workers or those who need the work experience in
order to then gain the skills to access employment in the job
market.
We have had from both programs an aggressive outreach to
employers, and quite frankly, the employers are the ones now
aggressively outreaching to us in their wisdom, understanding
the demographics of this workforce and the fact that mature
workers are a critical component, a solution for the workforce
challenges that lie ahead. They are interested in making the
connections and the arrangements with our Workforce Investment
System and with the SCSEP program to offer job opportunities,
training opportunities, and then integration into eventually
unsubsidized employment.
So we have a focus on integrating these two systems and a
focus on assuring employers recognize the value of mature
workers in their solutions, human capital solutions, for the
future.
Senator DeWine. We have heard--and I appreciate your
answer--there have been some who have said that since the 2000
amendments were implemented, there has been too much emphasis
on placement in unsubsidized jobs and really not enough on
community service aspects of the program. Do you want to
comment on that?
Ms. DeRocco. Well, again, we don't see these as mutually
exclusive missions.
Senator DeWine. I understand.
Ms. DeRocco. They are very complementary missions. But
still, it is our mission at the Department of Labor and through
the Workforce Investment System, of which SCSEP is a part, to
provide as many opportunities as possible for individuals to
gain the kind of independence Senator Mikulski spoke about,
which means the independence of having a job and a job at a
wage and with benefits that assure opportunities for families
and within the communities.
We use the work experience in community service, both to
benefit the community during the term of community service, but
also to gain the skills necessary for unsubsidized employment.
And it is important, I think, that Congress recognized this
when you reauthorized in 2000 and amended the Older Americans
Act.
There are two huge benefits to focusing on the
opportunities for those, where it is appropriate, to move from
community service to unsubsidized employment, and that is
number one, that they do gain more income, which means more
independence for them individually. But it also means that they
move out of a slot and additional older Americans who need the
services of the SCSEP can move in. So it expands our
opportunity to serve more low-income Americans who need work
experience.
Senator DeWine. Ms. Carbonell, the OAA Title 3(d) program
provides funding for disease prevention and health promotion
services. This program has become increasingly really
invaluable, as recent evidence-based research continues to
prove that health promotion, disease prevention, not only
contributes significantly to an individual's quality of life,
but also really are cost-effective means of reducing the key to
chronic care costs.
How do you see this program fulfilling today's needs and
how can the aging network's role in disease prevention and
health promotion be enhanced?
Ms. Carbonell. Well, the preventative health line item is a
very important service that is provided to communities across
this country. Thanks to your support in the innovations line
item, we have invested in looking at the evidence-based science
that is coming out of the Institutes of Health and implementing
the best science into community-based programs that are simple
and understandable by lay people so they can maintain their
health at an optimal level.
So it means that we have built upon the existing core
programs under preventative health and added that extra
component of modernizing and testing ways in which our core
programs, our aging services network providers at the community
level, whether it be an adult day care facility, whether it be
a senior center, whether it be a nutrition program or a home-
bound program, can instill in their clients the ability to give
them tools to take care of themselves better, to manage chronic
conditions, which is going to be one of the toughest challenges
facing an older population in the United States, giving them
proven techniques and tools to maintain independence.
For instance, in Maryland, we are funding a very important
health promotion program which looks at wellness and instills
the wellness and prevention techniques into programs. In
Washington, Senator Murray's State, we are implementing the
models that Susan Snyder implemented in Washington State for
wellness programs and physical activity and chronic disease
management. We are looking at nutrition. We are looking at
physical activity. We are looking at chronic disease
management. And, of course, we are looking at falls prevention,
which is another area of high cost, both dollar-wise and in
quality of life for many seniors, to prevent falls and to
improve the quality of health care for individuals.
In the medication management, you know Congress has
dedicated a certain amount that is being spent on improving
people's abilities to understand proper medication management,
particularly when there are complex or there are multiple
medications being taken. So efforts at the community level are
being improved by this special emphasis on medication
management to assist people to look at their medications and
the safety of those medications and how they take them, both in
our congregate programs and our home-delivered programs.
We see that as the reauthorization is upon us, we see
another unique opportunity to build on the work that we have
done in the preventative health area and to take it to the next
level, modernize it, bring the best science to bear, and to
have that as a central focus as we look at long-term care. It
is not only giving people better choices to remain at home and
better control and independence in their own lives, it is also
giving them adequate tools and simple tools that they can
follow that science has proven that with physical activity and
improved health and improved nutrition, health status can be
maintained even in later years even with people with chronic
conditions.
So that is what we are trying to look for as we look at
reauthorization, being health and wellness as a key component
as we look at modernizing long-term care.
Senator DeWine. Good. Senator Mikulski?
Senator Mikulski. Thank you, Mr. Chairman.
I would like to come back to the jobs issue, the so-called
title V. The chairman asked many of the questions I had related
to community service, but could you refresh my memory? What is
the One-Stop Career Center? Is that----
Ms. DeRocco. Certainly. The One-Stop Career Center is the
service delivery system for the entirety of the Workforce
Investment Act System. Seventeen mandatory partners that are
federally funded, employment and job training programs----
Senator Mikulski. I have got it. So it is for everybody.
Ms. DeRocco. [continuing]. All come together at a
community-based job resource center, so that in Maryland, your
One-Stop Career Centers are where both your job seekers of all,
a universal population----
Senator Mikulski. Are they tend to be run out of the
unemployment offices?
Ms. DeRocco. Pardon?
Senator Mikulski. Do they tend to be run out of the
unemployment offices?
Ms. DeRocco. I think when they were created in 1998, many
of the One-Stop Career Centers were built on the old
Unemployment Insurance Employment Service local office
structure, but many are also new. Many are on community college
campuses. Many are in community-based organizations. It is up
to each State to determine where, in conjunction with local
elected officials, the best place is.
Senator Mikulski. Let me tell you where I am heading with
this----
Ms. DeRocco. OK.
Senator Mikulski. [continuing]. Because usually, it
requires them knowing about a center and going to it. That
doesn't always happen, and it doesn't happen in many ways,
which I am sure you have already identified. But let us go to
one, just think older, and deciding you would want to return to
the labor market because your money is running out and you want
to come back part-time, don't even know where to begin. So you
go to maybe Ms. Carbonell, or you don't know and you are
immobilized. So that is one issue.
The other issue is what I know is something Senator DeWine
and I have faced, which is the collapse, say, in the
manufacturing base. All of a sudden, you are a steelworker. You
have worked there 30-some years. You are now maybe 58. Maybe
you are 60. You are one or two--you are not going to be
eligible for Medicare, Social Security, etc. Pow! Are you
involved in where we see plant closings?
Our last minivan rolled out of General Motors. I can't
believe a Baltimore that doesn't make steel or doesn't make
cars, but that is the reality. And what we see is particularly
men, particularly men. They are going to sit around the union
hall. They are going to go to local cafes. How can we reach out
to them to even know that there are services, and not only the
resume class and so on. These are guys who don't even like to
dial their own phone to talk to their granddaughter.
Ms. DeRocco. Oh, absolutely.
Senator Mikulski. Do you know what I mean?
Ms. DeRocco. I sure do.
Senator Mikulski. It is a cultural thing that we see. It
is, one, a terrible emotional shock. It is a terrible financial
shock. Then we are seeing a whole other category, which is
people who thought they had pensions. It has not been dumped
into Pension Guaranty, like what we are dealing with here, and
those pensions are gapped. So even for the middle-income, where
they thought they were going to have a pension, say, of 50, it
might now be 35, no small change, the poor would tell you. If
you have planned on a certain income, here is the shock.
So they are going to want to work, and they had skills.
Where are you going to come in here----
Ms. DeRocco. Those are exactly the reasons----
Senator Mikulski. [continuing]. Modernization, this is what
I am thinking about.
Ms. DeRocco. Those are exactly the reasons why we cite the
integration with the One-Stop Career Center. When a plant
closes in your State or district, the One-Stop Career Center is
the place that sends in the rapid response team that brings,
for example, trade adjustment assistance, and for older
workers, the alternative trade adjustment assistance for
individuals over 55. They bring in all of the job training
resources for individuals at whatever age that want to learn a
new skill. They bring in the job availability list, who is
hiring and who is not. And SCSEP, as a part of this, is a
service that can be offered to older workers who need a
different work experience.
But primarily, your workers who are in a dislocation or an
economic dislocation have skills that are either transferrable
to another hiring industry or they at least have work readiness
and we can provide some job training for some additional skills
that would make them ready for another business or industry
that is hiring or interested in moving into your community.
But the fact of the matter is, each of these programs now
have different eligibility, different sets of resources, and
different services. Bringing them together at the community
level and providing the flexibility that you spoke about to
respond specifically to the needs of those workers, whether it
is an age requirement or issue, a skills requirement or issue,
an education, remedial education that might be needed, the fact
that they all come together in the One-Stop Career Center
allows us to best serve the workers and the employers----
Senator Mikulski. Do you go back--I know my time is up, but
let us say the crisis happens. The plant closes, and often,
there is the appropriate notification that is required by law.
But, you know, hope springs eternal. They either think that
something is going to happen that is going to be different, or
there might be initially where we just, after hard, hard work,
but then all of a sudden, reality sets in and even a form of, I
don't want to say depression, but sadness, melancholy. Then is
there an organized outreach, particularly where maybe there has
been a workers' association, a union, any number of types of
organizations, do you all then go back to them?
Ms. DeRocco. Absolutely. Our State and local workforce
systems are always outreaching, not only in areas where there
have been dislocations and layoffs, but in areas where there
are individuals, disadvantaged individuals who haven't--they
have been marginalized in our labor force, because now
employers need them. So there is a constant marketing to the
individuals and to the employers to bring them together in this
community-based job center to ensure that we can make the best
matches possible.
The coordination with the Agencies on Aging is critically
important for older workers who do go to those agencies to
access supportive services----
Senator Mikulski. I see.
Ms. DeRocco. [continuing]. That they, in turn, can then
refer to the job opportunities, and SCSEP and the workforce
system.
Senator Mikulski. As we move on, we look forward to
creativity.
Ms. DeRocco. Great.
Senator DeWine. We thank you both very much.
Senator Mikulski. Before we end, could I come back to Ms.
Carbonell?
Senator DeWine. Sure.
Senator Mikulski. Ms. Carbonell, I essentially have two
areas of questions, one of which is the success of the Older
Americans Act has been based on the concept of the senior
center that is a multipurpose center, that provides organized
and structured activities and then partnerships like Meals on
Wheels. However, new generations, the caregiving generation and
so on, how do you see using the Internet for news that you can
use? In other words, when my sisters and I were caring for our
mother, we knew what to do. I am a social worker. Another
sister was a lab technician with expertise in orthopedics. So
we knew how. But a lot of people have to get information on
just very different times.
Are you using the Internet? I know that one of the most
interesting and dynamic places in centers that I visit were
seniors themselves learning to be the e-generation now. But how
do you see this, even in the integration of services for
information and referral, for news that you can use, both to
the senior or to the family who wants to support independence?
And do we have the framework to support that, because it bears
its own expense?
Ms. Carbonell. It goes back again to the ability that we
have had, thanks to Congressional support, to invest in
particular efforts. For instance, the Aging and Disability
Resource Centers are so-called One-Stop Centers in which we
access information for the long-term care. In addition to that,
we have invested in improving our elder care locator number,
which is a toll-free number. We have expanded the Web site to
have access, so anyone in the United States--for instance, I as
a caregiver was able to locate--even having worked in the
system for a while and knowing the ropes, it takes a little bit
of help and it takes a little bit of navigation to go through.
That is why we are trying to be able to integrate the
services, both the social support services and working with CMS
on health care, particularly for long-term care, as we look at
being able to give better access to information and assistance
to seniors, not only through technology. Obviously, technology
is improving in the areas of both health care and access to
information of all sorts. I think baby boomers will demand to
have--you know, we are used to going to the computer and
finding the answer right there and we are building. We are
building and improving the infrastructure and strengthening the
aging services network's capacity to meet the growing demands,
including technology.
So a very important part of the Aging and Disability
Resource Initiative, which we fund in 24 States to date,
including one right in your State, Senator, is technology. That
means the improvement of technology not only to create access
and improve access, but also in the efficiency of the programs,
how we provide that information to seniors and how we can track
clients and also build multiple funding sources----
Senator Mikulski. That will be fantastic.
Ms. Carbonell. Right.
Senator Mikulski. What I will be looking forward to in the
information as you come back in the next month or so, or even
as we get information from the White House Conference, will be
the use of technology to support the seniors and those who love
them in terms of their goals of independence. And I am
particularly interested in the areas of information and
referral, in wellness and nutrition, and also kind of a
resource base. Where can they go on their own?
And if I might add, alerts on scams, because this alerts on
scams, we have areas that are often flooded with schemes for
investment, schemes for home-based work, etc, and we find that
the alert system that is now in some places in the senior
network really works well. So that would be very important.
Ms. Carbonell. Thank you. We look forward to providing
extra information on that.
Senator Mikulski. The next area is, are you familiar with
the Natural Occurring Retirement Community effort?
Ms. Carbonell. Yes, I am.
Senator Mikulski. The aging in place? We funded some
demonstration projects even through an earmark process,
otherwise known as Congressional designated projects. I am a
big believer in the NORCs, and Senator, just maybe to help you,
this is where often there is a zip code where people have aged
in place. Like after World War II, you know, where people--yes,
some neighborhoods, and people are independent, they have got
their homes. They are aging in place. Their housing is aging in
place. Like Mom once said to me, ``Barb, I don't know what is
going to give out first, my pipes or my knees.''
[Laughter.]
Could you have ideas and recommendations on what we could
do in terms of the NORCs, because I think this goes to your
coordinated, systematic way of bringing fragmented or
smokestack, we will call them programs, stovepipe, and so on.
Do you think they have been effective, and can you bring us
recommendations on that area, as well?
Ms. Carbonell. Well, we thank you for your interest in that
area, and I know that there is a lot of Congressional interest
because there are over 40 sites, 40 NORCs, Naturally Occurring
Retirement Communities, throughout the county that have been
funded through Congressional action.
Again, I don't have any up-to-date data. There are
different levels of performance in the sites. Some are smaller,
some are larger. But it certainly affirms--the NORC concept
certainly affirms the aging in place and the community-based
care that we have been working on and that the act is so
central to. So we look forward to, as the proposals get fine-
tuned, the details get out, we look forward to working with you
on that.
Senator Mikulski. I would like you to look at the 40 that
are on the books and just preliminarily, not some complicated
one, but what are we learning from lessons learned, best
practices, and what have been, quite frankly, duds, so that we
can make sure we get on the track, in a no-fault environment so
that we can really look at this, because I think this is going
to be an accelerating issue and if we can get our arms around
it in this reauthorization and give you the tools you need to
sponsor these programs on a competitive basis based on what we
already know so we can make wise use of taxpayers funds, and
yet an opportunity that presents itself.
Ms. Carbonell. Thank you. We look forward to that.
Senator Mikulski. So we want to have you tell us about the
NORCs. I was thinking about ``Knock on the NORCs'' or
something, but you get what I am saying.
Ms. Carbonell. Well, we know that the NORCs--clearly, the
NORCs is a perfect example of how people are wanting to remain
at home in their own communities and the support services that
are brought to and the coordination and the improvement of the
coordination of care and support between all the services that
are being provided, whether public or private, come to bear to
keeping people quality of life in their later years.
Senator Mikulski. Thank you, Mr. Chairman. You have been
very generous. I appreciated the extra time.
Senator DeWine. Well, we appreciate both of your testimony
and we look forward to your recommendations and we look forward
to working with both of you.
Ms. Carbonell. Thank you.
Senator DeWine. This committee will hold additional
hearings in the future. Thank you very much.
Ms. Carbonell. Thank you.
Senator DeWine. The subcommittee is adjourned.
[Additional material follows.]
Additional Material
Prepared Statement of Senator Clinton
I would like to thank Subcommittee Chairman DeWine and
Senator Mikulski for holding this important hearing. In less
than 10 years, the first wave of Baby Boomers will turn 65. As
Americans are living longer, we will continue to see increasing
demands on our local, State, and Federal health systems over
the next 30 years.
As we prepare for the upcoming reauthorization of the Older
Americans Act, we must take a long hard look at how well
prepared we are to meet the increasing needs of our country's
older adult population.
Today, the Older Americans Act is the major vehicle for the
delivery of social and nutrition services for older persons.
Originally enacted in 1965, the act supports a wide range of
social services for older persons, including the congregate and
home-delivered nutrition program; community service employment;
the long-term care ombudsman program; services to prevent the
abuse, neglect, and exploitation of older persons; grants to
Native Americans; and research, training, and demonstration
activities.
There are a variety of areas which I believe will be
important to examine as we prepare for the next generation of
older adults and consider this reauthorization.
The first issue of considerable importance is caregiving.
Caregiving issues touch the lives of families from all
socioeconomic, ethnic, and educational backgrounds. Research
suggests that more than a quarter of adults are currently
providing care for a chronically ill, disabled, or aging family
member or friend, while 59 percent of adults will care for a
loved one at some point in their lifetime.
Caregivers today are not simply family members lending a
hand, but rather, providers of a large portion of our health
and long-term care for the aging. Older adults are now the
fastest growing segment of the U.S. population, and almost half
require some help with personal care and daily needs.
Grandparents or other relatives caring for children
referred to as ``kinship caregivers'' comprise another growing
group of family caregivers. According to the 2000 U.S. Census,
kinship care families are growing with more than 4.5 million
children living in grandparent-headed households.
Some people are caring for children or grandchildren with
special needs and older adult parents at the same time. Many
have referred to people in these circumstances as the
``sandwich'' generation, sandwiched between the caregiving
demands of children or grandchildren and the caregiving demands
of aging parents.
Although the role of family caregiver can be personally
rewarding, it can also result in substantial psychological,
physical, and financial hardship. Research suggests that
caregivers often put their own health and well being at risk
while assisting loved ones. These difficult demands can lead to
depression, relationship stressors, physical illness, anxiety,
and emotional strain.
As you know, my husband signed the National Family
Caregiver Support Program into law as part of the 2000
amendments to Title III of the Older Americans Act. This was a
tremendous step toward recognizing the heroic efforts of our
family caregivers.
Prior to the establishment of this program, there was no
comprehensive Federal program for family caregivers.
One way in which to reduce the burden of caregiving on
those providing this labor of love is through respite care.
Respite care provides a much needed break from the daily
demands of caregiving for a few hours or a few days. These
welcome breaks help protect the physical and mental health of
the family caregiver, making it possible for the individual in
need of care to remain in the home.
Unfortunately, in New York and across our country quality
respite care remains hard to find and too many caregivers do
not know how to find information about available services. Even
when community respite care services exist, there are often
long waiting lists. There are more caregivers in need of
respite care than there are respite care resources available.
Although the National Family Caregiver Support Program took
a step in the right direction, further efforts are necessary to
meet the increasing needs of family caregivers.
That is why I introduced the Lifespan Respite Care Act.
This legislation would improve efficiency and reduce
duplication in respite service development and delivery, and
make quality respite available and accessible to families and
family caregivers, regardless of their Medicaid status,
disability, or age. It assures that quality respite care is
available for all caregivers who provide this labor of love to
individuals across the lifespan.
My legislation picks up where the National Family Caregiver
Support Program leaves off by recognizing respite as a priority
for caregivers and elevating respite as a policy priority at
the Federal and State levels.
A second important issue that I believe we must focus on
during the upcoming reauthorization of the Older Americans Act
relates to the growing mental health needs of our older adult
population. Although most older adults enjoy good mental health
it is estimated that nearly 20 percent of Americans age 55 or
older experience a mental disorder. It is anticipated that the
number of seniors with mental and behavioral health problems
will almost quadruple, from 4 million in 1970 to 15 million in
2030.
Among the most prevalent mental health concerns older
adults encounter are anxiety, depression, and cognitive
impairment. These disorders, if left untreated, can have severe
physical and psychological implications. In fact, older adults
have the highest rates of suicide in our country and depression
is the foremost risk factor.
The physical consequences of mental health disorders can be
both expensive and debilitating. Depression has a powerful
negative impact on ability to function, resulting in high rates
of disability. The World Health Organization projects that by
the year 2020, depression will remain a leading cause of
disability, second only to cardiovascular disease. Even mild
depression lowers immunity and may compromise a person's
ability to fight infections and cancers. Research indicates
that 50-70 percent of all primary care medical visits are
related to psychological factors such as anxiety, depression,
and stress.
In order to address this issue I am preparing to
reintroduce the Positive Aging Act with my co-sponsor Senator
Collins later this month during Older Adult Mental Health Week.
This legislation would amend the Older Americans Act to
make mental health services for older adults an integral part
of primary care services in community settings and to extend
them to other settings where seniors reside and receive
services, such as naturally occurring retirement communities,
NORCs.
This legislation will not only increase opportunities to
diagnose and treat mental health problems in our seniors, but
will lessen the burden on their families and our health care
system.
Finally, the growing longevity of Americans has created a
long term care crisis in our country. While we consider the
reauthorization of the Older Americans Act, we must look for
solutions to this growing problem.
As the number of individuals in need of long-term care
rises, issues such as financing, quality of care, family
involvement, quality of life, end-of-life care, and overall
service delivery are growing in importance and impact.
And although Medicaid does provide some home and community-
based services and supports, the program is weighted towards
institutional care, even when many seniors would be able to--
and most times would prefer to--stay in their own homes.
Home and community-based services are not only the
preference of seniors, but they are also a more cost-effective
means of providing care. As the baby-boomers continue to age,
our current infrastructure for delivering services needs to
adjust to reflect this preference and help ease the cost of
providing care to this burgeoning group.
I am currently working on legislation that would amend the
Older Americans Act to assist older adults who are capable of
and would prefer to remain in the community. This legislation
would assist seniors, who are just above the Medicaid
threshold, to obtain the supportive services necessary to
remain safely in the community.
This consumer directed model would not only respect the
preferences of our seniors who would like to age in place, but
would also help to reduce some of the burden that long term
care services place on the Medicaid system.
We have an exciting and important challenge ahead of us as
our country's aging boom begins. What we do to prepare now will
have a tremendous impact on our systems of care tomorrow.
Again, I thank you for holding this important hearing today
and look forward to continuing to explore these and other
important issues as we prepare for the reauthorization of the
Older Americans Act.
[Whereupon, at 11:16 a.m., the subcommittee was adjourned.]