[Senate Hearing 109-437]
[From the U.S. Government Publishing Office]
S. Hrg. 109-437
ROUNDTABLE DISCUSSION: THE OLDER AMERICANS ACT
=======================================================================
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
SECOND SESSION
ON
EXAMINING THE REAUTHORIZATION OF THE OLDER AMERICANS ACT
__________
TUESDAY, FEBRUARY 14, 2006
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
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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
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STATEMENTS
TUESDAY, FEBRUARY 14, 2006
Page
DeWine, Hon. Mike, Chairman, Subcommittee on Retirement Security
and Aging, opening statement................................... 1
Enzi, Hon. Michael B., Chairman, Committee on Health, Education,
Labor, and Pensions, prepared statement........................ 2
Mikulski, Hon. Barbara A., a U.S. Senator from the State of
Maryland, opening statement.................................... 3
Prepared statement........................................... 5
Kennedy, Hon. Edward M., a U.S. Senator from the State of
Massachusetts, prepared statement.............................. 7
Clinton, Hon. Hillary Rodham, a U.S. Senator from the State of
New York, prepared statement................................... 7
Kennelly, Barbara, B., chair, Leadership Council of Aging
Organizations, Washington, DC.................................. 11
Prepared statement........................................... 12
Reed, Jo, National Advocacy Coordinator, Federal Livable
Communities and Consumer Issues, AARP, Washington, DC.......... 15
Prepared statement........................................... 16
Bedlin, Howard, vice president, public policy and advocacy, The
National Council on Aging, Washington DC....................... 21
Prepared statement........................................... 22
Howard, Laura, executive director, National Association of
Nutrition and Aging Services Programs, Washington, DC.......... 27
Prepared statement........................................... 28
Borden, Enid, A., chief executive officer, Meals on Wheels
Association of America, Alexandria, VA......................... 31
Prepared statement........................................... 32
Markwood, Sandy, chief executive officer, National Association of
Area Agencies on Aging, Washington, DC......................... 34
Prepared statement........................................... 35
Flood, Patrick, Commissioner, Vermont Department of Disabilities,
Aging, and Independent Living, on behalf of the National
Association of State Units on Aging, Washington, DC............ 39
Prepared statement........................................... 40
Mintz, Suzanne, president and co-founder, National Family
Caregivers Association, Kensington, MD......................... 45
Prepared statement........................................... 46
Jones, Karyne, president and chief executive officer, the
National Caucus and Center on Black Aged, Inc., Washington, DC. 48
Prepared statement........................................... 49
Blancato, Bob, national coordinator, Elder Justice Coalition,
Washington, DC................................................. 52
Prepared statement........................................... 53
Lacayo, Carmela, G., president and chief executive officer,
National Association for Hispanic Elderly, Pasadena, CA........ 55
Prepared statement........................................... 57
(iii)
Fong, Clayton, S., president and chief executive officer,
National Asian Pacific Center on Aging, Seattle, WA............ 61
Prepared statement........................................... 63
Kourpias, George, J., president, Alliance for Retired Americans,
Washington, DC................................................. 66
Prepared statement........................................... 67
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Easter Seals Disability Services............................. 78
Traci L. McClellan, National Indian Council on Aging......... 80
American Dietetic Association................................ 85
ROUNDTABLE DISCUSSION: THE OLDER AMERICANS ACT
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TUESDAY, FEBRUARY 14, 2006
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 2:35 p.m., in
Room 430, Dirksen Senate Office Building, Hon. Mike DeWine
[chairman of the subcommittee] presiding.
Present: Senators DeWine and Mikulski.
Opening Statement of Senator DeWine
Chairman DeWine. Let me thank everyone for being here.
Welcome to the Subcommittee on Retirement Security and Aging's
first roundtable on the reauthorization of the Older Americans
Act. Let me thank Senator Mikulski, who I have worked with on
so many other occasions--she is the subcommittee's ranking
member--for her great interest in these issues and, of course,
for being here today. As many of you remember, during the
reauthorization process in 2000, we were the chair and ranking
member, as well. I look forward to working with her again on
the Older Americans Act.
The last time this subcommittee convened to discuss the
Older Americans Act was in May last year. At that time, we
heard from Assistant Secretary Emily DeRocco from the
Department of Labor and the Assistant Secretary from the
Department of Health and Human Services. They promised me then
that they would provide the administration's recommendations
for the reauthorization of this act. While I have not yet
received those recommendations, I do intend to move forward in
the process of reauthorization.
I look forward to hearing all of your thoughts and
receiving your recommendations for this reauthorization. We
appreciate all of you being here very much.
Since the last time this subcommittee met to discuss the
Older Americans Act, most, if not all, of you participated in
the White House Conference on Aging. At the Conference, you
voted on the issues affecting older Americans that are most
important to you. I am happy to see that you listed the
reauthorization of the Older Americans Act as one of your top
priorities. I look forward to working with all of you to make
that reauthorization happen this year.
As you know, older Americans are a vital and rapidly
growing segment of our population. As we discussed in our May
hearing, 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 years and older will number nearly 90 million people
in the United States and comprise, at that time, 21 percent of
our population. Further, we know that 4.6 million people aged
65 and older are still today employed.
The Older Americans Act is an important service provider
for these Americans. Through this important act, our parents,
grandparents, aunts, and uncles are able to access services,
including congregate and home-delivered meals, community
service employment, and services to prevent the abuse, neglect,
and exploitation of older persons.
Reauthorizing the act is the primary goal of this
subcommittee and I look forward to working with all of you
together. Let me thank our panel participants here today. Thank
you for being here. I will introduce everyone by name and
affiliation, after which we will proceed to your 3 minute
prepared remarks. After the first 3 minute round, we will
proceed to a second round, where you will be given the
opportunity to respond to remarks made by your colleagues and
by me. To be recognized to make a remark during the second
round, I would ask that you place your placard on its end and I
will recognize you. Now, that assumes the placard will stand
up. I am not really sure if that is going to work or not. If it
is not, just raise your hand, which might be an easier way to
do it.
Let me turn to Senator Mikulski for her comments but before
I do I would like to submit the statement of Senator Enzi.
[The prepared statement of Senator Enzi follows:]
Prepared Statement of Senator Enzi
Good afternoon. First, I would like to thank Chairman
DeWine and ranking member Mikulski for holding this roundtable
as the Committee on Health, Education, Labor, and Pensions
prepares for reauthorization of the Older Americans Act. In
addition, I would like to thank each of the participants today
for taking time out of your schedules to attend this roundtable
discussion. The Older Americans Act was created to enrich the
lives and well being of older Americans through social services
and programs. As Americans live longer, it is important to
create an environment that allows our older Americans to live
better. The programs of the Older Americans Act are an
important tool for accomplishing this goal.
When originally enacted in 1965, the act envisioned a wide
range of social services and programs, including supportive
services, congregate and home-delivered nutrition services,
community service employment, the long-term care ombudsman
program, and services to prevent abuse, neglect and
exploitation of older individuals. It is important to note that
the act supports specific grants to Native Americans, as well
as research, training and demonstration activities.
Fourteen amendments since 1965 have continued to shape the
delivery of services and add new programs to the Older
Americans Act that will benefit individuals as they age. Major
amendments have created a national nutrition program for the
elderly that benefited my own mother, and many others, in the
State of Wyoming. In addition, amendments have provided more
flexibility in the administration of State and area agencies on
aging that are the foundation of a comprehensive network of
services for all older Americans. In 1992, the amendments
created a new title VII to consolidate and expand certain
programs that focus on the rights of older persons, including a
long-term care ombudsman program; program for the prevention of
elder abuse, neglect and exploitation; elder rights and legal
assistance development programs; and outreach, counseling and
assistance for insurance and public benefit programs. The 2000
amendments were enacted after 6 years of congressional debate
on reauthorization and authorized the National Family Caregiver
Support Program.
It is my goal to move through the reauthorization process
expeditiously, while balancing the need to understand what
programs have worked and what programs have not. The process of
reauthorization provides an opportunity for all of us to
examine the success of prior years and prior programs and to
determine what improvements can be made. This committee looks
forward to a full and open discussion of the Older Americans
Act in the months ahead. We will be working across party lines
to ensure reauthorization is conducted in a timely fashion.
Certainly, we will work toward the goal set forth by the
resolution of highest priority at the December 2005 White House
Conference on Aging, which called for reauthorization within 6
months. If we address the controversial issues upfront, it will
help expedite the legislative process.
I look forward to hearing how the changes that accompanied
the 2000 reauthorization have affected the organizations we
have represented here today. The participants today represent
some of the groups that are recipients of title V funding for
Senior Community Service Employment Programs through the
Department of Labor. While we do not have the final figures on
the past 3 years of performance measures from the Department of
Labor, I look forward to learning how these programs have been
influenced by the changes that occurred in this program as a
result of the 2000 amendments. I also look forward to learning
how the National Caregiver Support Program has benefited older
Americans and their families.
As we move forward with reauthorization, it is important
that we focus on the reason the Older Americans Act was enacted
in 1965. Moreover, we must consider additions or changes to
programs that are needed as we prepared for 77 million Baby
Boomers who are turning 60 in record numbers. Beginning this
year, everyday 7,918 people will turn 60 years old. The Older
Americans Act must embrace programs that ensure our seniors
remain healthy, fed, housed, mobile, and safe from scams and
abuse. I look forward to learning from today's participants the
ways we can improve the Older Americans Act for future
generations to come. Again, I thank you for your participation
in today's roundtable discussion.
Opening Statement of Senator Mikulski
Senator Mikulski. Thank you very much, Senator DeWine, and
welcome to all of you. I am looking forward to this
conversation. I want to take this opportunity to wish you a
happy Valentine's Day. I would hope, though, that on such a day
of such good feelings that we commit ourselves to being able to
pass this bill.
I want to thank Senator DeWine for convening this hearing
and also the way we worked together in 2003. We got the bill
authorized after years of stalling and fussing and fretting and
a variety of things and we look forward to that and I want to
thank him for his collegiality and for his civility and I
believe we can do it again.
I want to thank the senior network in attendance today
because ultimately, our best ideas have to come from the
people. And as much as we would like, we can't hold town hall
meetings throughout the entire country on this authorization.
But you, speaking today for the groups that you represent,
create in many ways a national town hall by proxy. So we look
forward to hearing your advice and your recommendations.
This program has been around for a while, but it continues
to be fresh because of the principles that I believe we follow.
And when we look to reauthorization, we need to talk about
those principles.
First, that it is vital to continue and improve the core
services of the act. Seniors have come to depend on the
information and referral, as well as the family caregiver
support services, as well as congregate home-delivered meals,
transportation, and home care.
The other important part of this program is though it is a
national framework, it allows for local flexibility. One of the
joys I have in traveling my home State of Maryland is that you
can see the variety and richness and creativity of the local
community in the way it delivers the services, whether it is in
Garrett County, which is an Appalachian part of my State, or in
the inner city of Baltimore, or even different than the
sophisticated community of Bethesda, or the the poor rural part
of the Eastern Shore in Somerset County. But through it all, we
want to preserve a national framework, national standards,
local flexibility, and local creativity.
Not all seniors have family and friends, and we want to
work to ensure that they continue to stay independent and we
will look at those services.
Our senior population is not the same as when this bill was
passed in 1965. This is the first time the boomers will be
eligible for services under the Older Americans Act, and we
know the boomers. When they come, they boom, and we expect that
we will be hearing from them. But they are also going to look
for a more modernized Older Americans Act to meet the changing
needs. But it also means that we have an increasing population
of 85 and older, and an increasing aging population in general.
We need to take advantage of new technologies and innovations
to be able to provide the kind of services that we need.
I look forward to working on this program, but I must say
that as we work on reauthorization, we have to also work on the
budget. I was deeply concerned that this year's budget has a
cut in Meals on Wheels, eliminates two important programs in
Alzheimer's and other very important services. So we want to
not only create the right Federal lawbook, but we have got to
make sure we put the Older Americans Act in the Federal
checkbook.
We look forward to your advice, and I am sure you will have
our consent. Thank you very much.
[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 how Older American's Act programs and
services have benefitted our Nations seniors. I look forward to
hearing suggestions about what legislative changes should be
made to improve these important programs so they continue to
meet the day-to-day needs of America's growing population of
older Americans. I would like to thank the chairman, Senator
DeWine, for calling this roundtable discussion today, as well
as all the representatives of the senior network in attendance.
I am looking forward to reauthorizing the Older Americans
Act. It is an important responsibility that we have to our
Nation's seniors. However, I must say that I was disappointed
last week when I learned that President Bush's fiscal year 2007
budget proposed a decrease of $72 million below last years
funding level for Older Americans Act programs. The budget
completely eliminates two programs--the Alzheimer's
Demonstration Grant program, and the Preventative Health
Services program for seniors. The budget also reduces funding
for two programs near and dear to my heart--and in many
instances the life line for many seniors and the family members
who care for them. Nutrition programs were cut by $2 million--
and the Family Caregiver Program--which is a resource for
thousands of families across the country was cut by $3 million.
On the heels of the White House Conference on Aging--where
resolutions stating that additional funding for these important
programs must be appropriated were adopted--our Nations budget
for senior programs should be going up--not down.
PRINCIPLES
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. We need a national program, with national standards
that ensure consistency--but also allows for local flexibility
and creativity. 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, family caregiver support 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 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 of senior citizens with chronic
conditions live in the community and have 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, and decreased 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 all of the groups represented on today's panel, as
well as others that we will hear from during this
reauthorization process.
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 2006 and beyond.
Chairman DeWine. Thank you.
I want to introduce all 13 members of the panel and then we
will start with Barbara over here but before I do that I would
like to submit for the record the statements of Senator Kennedy
and Senator Clinton.
[The prepared statement of Senator Kennedy follows:]
Prepared Statement of Senator Kennedy
It's a privilege to be part of this roundtable discussion
today. The Older Americans Act is a lifeline for our senior
citizens. The act was one of the first bills I worked on in the
Senate in the 1960's.
Like Social Security, Medicare and Medicaid, it's part of
our commitment to take care of our Nation's seniors in their
golden years.
One of its major goals is to encourage healthy living and
disease prevention, and the Meals on Wheels program enacted in
the 1970's has been one of its most impressive successes.
Massachusetts has been in the forefront of the effort to
provide community-based nutrition services to elders. The State
program coordinates 28 nutrition projects throughout the State
to deal with seniors' problems of poor nutrition and social
isolation.
Unfortunately, the administration's new budget cuts $3
million from these important nutrition programs, and cuts the
Older Americans Act by a total of $28 million. It zeros out
programs such as disease prevention and Alzheimer's
demonstration grants, and it cuts the National Family Caregiver
Support Program by $2 million. Funding for the Older Americans
Act was already failing to keep pace with inflation, and this
budget goes even further in ignoring the needs of seniors and
the successful programs that keep them healthy and self-
sufficient.
According to the Census Bureau, there will be 6.7 million
persons aged 55 or older who will be living in poverty by 2008,
a 22 percent increase from 2000. By 2015, the number will
increase to 9 million low-income older Americans if we allow
the current trend to continue.
The Older Americans Act also provides essential
opportunities for employment for older Americans through the
Senior Community Service Employment Program, which provides
seniors with job training while involving them with the
communities they love, and which also love them. Last year,
this program supported over 61,000 jobs and served over 91,000
people.
These and other programs under the act will become even
more important in the years ahead. We know that this year, the
first of the baby boom generation will be eligible for the
act's services. By the year 2030, one in five Americans will be
over age 65. We obviously need to get our priorities right, and
I look forward to working with all of you to strengthen the
safety net for the Nation's seniors. A good place to start is
with the reauthorization of the Older Americans Act this year.
Thank you all for taking part in this roundtable discussion to
help us chart the path ahead.
[The prepared statement of Senator Clinton follows:]
Prepared Statement of Senator Clinton
I would like to thank Senators DeWine and Mikulski for
holding this important hearing. In less than 10 years, the
first wave of Baby Boomers will turn 65. As we prepare for the
upcoming reauthorization of the Older Americans Act, we must
consider how we will meet the increasing needs of this elder
boom and the demands placed on our local, State, and Federal
health systems in the next 30 years.
As Baby Boomers begin to require these essential senior
services, it is not the time to be cutting programs for older
Americans. The Bush administration's budget for fiscal year
2007 cuts Aging programs by $28 million, which will jeopardize
our seniors' access to critical services, like Meals on Wheels.
Originally enacted in 1965, the Older Americans Act is the
major vehicle for the delivery of social and nutrition services
to our seniors. New York receives the third largest allocation
of the Older Americans Act funds, just behind California and
Florida.
At the White House Conference on Aging in December 2005,
the delegates' primary recommendation for Congress was to
reauthorize the Older Americans Act within the next 6 months.
As we prepare to make that recommendation a reality, I believe
there are a number of important areas to examine.
One of the first areas we must address is the long-term
care crisis in our country resulting from the growing longevity
of Americans. We must look for solutions to this mounting
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 provides 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.
According to the AARP, more than 90 percent of older adults
prefer to remain in their current residence as long as
possible.
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 developing legislation that would amend the
Older Americans Act to assist older adults who are just above
the Medicaid threshold obtain supportive services necessary to
remain safely in their communities. This legislation would
provide seniors with the option of using a consumer directed,
long-term care approach based on their individual choices and
preferences, in collaboration with service coordinators. This
approach would not only respect the wishes of older adults, but
also reduce the burden on the Medicaid system.
As we anticipate an increase in demand for long-term care
services from the Baby Boom generation, Naturally Occurring
Retirement Communities or NORCs are another area of interest to
me. NORCs refer to a variety of residential housing constructs,
such as apartments, condominiums, cooperatives, and
neighborhoods of attached or single-family dwellings, where
large concentrations of older adults reside. NORCs exist in
many demographic spheres--urban, suburban and rural. They
evolve naturally, primarily through the aging in place of the
population or through large-scale migration of seniors to
particular buildings or neighborhoods. According to AARP, as
many as 25 to 36 percent of seniors live in NORCs.
A study funded by the Robert Wood Johnson Foundation and
conducted by the Florence Heller Graduate School of Brandeis
University found NORCs provide unique opportunities to: (1)
deliver health and supportive services cost effectively; (2)
increase service availability; (3) organize cooperative health
promotion, crises prevention, and community improvement
initiatives and (4) develop new human, financial, and
neighborhood resources for the benefit of older residents.
There has been a growing interest in NORCs, as well as an
increasing number of them. Successful set aside NORC
demonstration projects have been funded through the Older
Americans Act in the past.
With the older adult population expected to mushroom to 20
percent of the U.S. population by 2025, we should put more
permanent language into the upcoming Older Americans Act that
would authorize funding for NORCs in all States, rather than
just for demonstration projects in some States.
Another issue of considerable importance to me is
caregiving. 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. Although caregiving 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 stress, 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
caregivers. Prior to the establishment of this program, there
was no comprehensive Federal program that supported family
caregivers of seniors. 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.
Unfortunately, in New York and across our country, quality
respite care remains hard to find today 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.
That is why I reintroduced the Lifespan Respite Care Act
with my cosponsor Senator Warner. This legislation would
improve efficiency and reduce duplication in respite service
development and delivery. The Lifespan Respite Care Act would
bolster the National Family Caregiver Support Program by making
quality respite care available to family caregivers of
individuals with special needs across the lifespan--from
children to seniors--regardless of their Medicaid status, age
or disability.
In addition to caregiving, I believe we must focus on the
growing mental health needs of our seniors during the upcoming
reauthorization of the Older Americans Act. Although older
adults enjoy good mental health, it is estimated that nearly 20
percent of Americans age 55 or older experience a mental
disorder. The number of seniors with mental and behavioral
health problems is anticipated to reach 15 million in 2030.
Among the most prevalent mental health concerns older
adults encounter are anxiety, depression, and cognitive
impairment. If left untreated, these disorders 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. For example, depression has a
significant negative impact on the ability to function,
resulting in high rates of disability.
In order to address the mental health needs of our seniors,
I have reintroduced the Positive Aging Act with my cosponsor
Senator Collins. This bill 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 extend
them to other settings where seniors reside and receive
services, such as NORCs. Interdisciplinary teams of mental
health professionals and other health providers would provide
evidence-based services to seniors under this legislation.
Finally, I believe we must promote elder justice by
providing resources to States and local agencies to combat
elder abuse, neglect and exploitation and by increasing
resources, awareness and leadership on this issue. That is why
I support the Elder Justice Act that Senators Lincoln and Hatch
have spearheaded this Congress. This is the first comprehensive
piece of Federal legislation that addresses and prevents the
suffering and disgrace so many of our seniors experience--that
too often goes unreported.
We face an important yet exciting challenge as we prepare
our country for the aging boom. 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.
Chairman DeWine. Barbara Kennelly, our former colleague, we
welcome her as the chair of the Leadership Council of Aging
Organizations; Jo Reed, chief executive officer of the AARP;
Howard Bedlin, vice president for public policy of the National
Council on Aging; Laura Howard, executive director of the
National Association of Nutrition and Aging Services Programs;
Enid Borden, chief executive officer of the Meals on Wheels
Association of America; Patrick Flood, the commissioner of the
Vermont Department of Aging and Disabilities, today, he is
representing the National Association of State Units on Aging;
Sandy Markwood, chief executive officer of the National
Association of Area Agencies on Aging; Suzanne Mintz, president
and co-founder of the National Family Caregivers Association;
Karyne Jones, president and chief executive officer of the
National Caucus and Center on Black Aged; Clayton Fong,
executive director of the National Asian Pacific Center on
Aging; Carmela Lacayo, president and chief executive officer of
the National Association for Hispanic Elderly; Bob Blancato,
the national coordinator of the Elder Justice Coalition, and
finally, George Kourpias, President of the Alliance for Retired
Americans.
Barbara, why don't you start, please.
STATEMENT OF BARBARA B. KENNELLY, CHAIR, LEADERSHIP COUNCIL OF
AGING ORGANIZATIONS, WASHINGTON, DC.
Ms. Kennelly. Thank you, Senator. I am absolutely delighted
to be here as chair of the Leadership Council of Aging
Organizations. I am also president of the National Committee to
Preserve Social Security and Medicare. In addition, I was a
member of the policy committee with Clayton Fong and with Bob
Blancato and Gail Hunt, who is in the audience, and we were
voting on resolutions. It wasn't even a contest. The number one
resolution of people, 1,200 people who came from around the
United States, Republicans, Democrats, Independent, they wanted
the reauthorization of the Older Americans Act.
I have not much time and you were good enough to ask me to
send all the recommendations of our group and I sent you 31
recommendations that we all agree on. But I also just want to
say to you that LCAO supports a substantial increase in the
Older Americans Act authorization levels above current 2006
funding levels to reflect inflation and assure that the aging
network has adequate resources to meet its challenges. I know
that is asking a lot, but I think it should happen.
And then I know the two things that you both are interested
in, both Senators, is to help family caregivers. LCAO supports
strengthening the National Family Caregivers Support Program,
which I know you both have supported so beautifully in the 2000
reauthorization. I also have had the honor, Secretary Carboneli
had me over last week to see the Choices for Independence
Initiative, the new program. We want to look at it very, very
carefully.
You are here today, and you know, in this day and age, it
is not often that a whole audience, people who are testifying
and people who are in the audience, agree on where we are
today. I have been in senior issues for 31 years, but I don't
think there has ever been as successful a program as the Older
Americans Act. Now, I know and everybody in this room knows
that we are going to be arguing and debating and challenging
each other about Social Security and about Medicare, but I
think the Older Americans Act is something that we can all
agree on.
Therefore, I just think this is an opportunity to authorize
this act and authorize it to the point where it really works.
Thousands and thousands and thousands of rides to the bank, to
the grocery store, just getting people out of their homes and
they can stay independent and they can live with dignity. This
act does its work, but it can't do its work unless it is
authorized at an adequate amount of funding, and I think we are
so lucky to have all of us agree on that.
We are 54 organizations that belong to the LCAO, but we all
agree the authorization of this act is terribly important. We
can't agree on much in this town, but this one we can agree on.
Chairman DeWine. Thank you very much.
[The prepared statement of Ms. Kennelly follows:]
Prepared Statement of Barbara B. Kennelly
LCAO OLDER AMERICANS ACT REAUTHORIZATION RECOMMENDATIONS
The Older Americans Act (OAA) is the major Federal discretionary
funding source for home- and community-based services for seniors.
Programs supported through the OAA include home-delivered and
congregate nutrition services, the Senior Community Service Employment
Program, the long-term care ombudsman program, services to prevent the
abuse, neglect, and exploitation of older persons, the National Family
Caregiver Support Program, and other supportive services. These
programs provide vital support for those seniors who are at significant
risk of losing their ability to remain independent in their own homes
and communities.
The Leadership Council of Aging Organizations (LCAO), which has
played a significant leadership role in past reauthorizations, is
committed to a reauthorization that will strengthen the OAA for both
the seniors currently receiving services and for the baby boomers who,
starting in 2006, are eligible to receive services provided by the OAA.
The Aging Network established by the act has been a successful model of
service delivery for over 30 years and through this reauthorization
should be positioned to assist the country's growing aging population
to remain healthy, active, and in their communities for as long as
possible.
The number one priority at the recent 2005 White House Conference
on Aging, an event held only once a decade, concerned reauthorization
of the OAA. Delegates from across the county, largely appointed by
Governors and Members of Congress, expressed strong support for
strengthening the program, along with serious concerns about its
current underfunding. We urge Congress to act on the will of these
delegates by updating and improving the act and providing the funding
needed for the OAA to keep seniors independent and productive.
Therefore, the LCAO makes the following recommendations to
strengthen and enhance the OAA:
GENERAL
1. Increase OAA authorization levels by at least 25 percent above
current fiscal year 2006 funding levels to reflect inflation and ensure
that the Aging Network has the necessary resources to adequately serve
the projected growth in the numbers of older adults, particularly those
over the age of 85, who are the most frail, most vulnerable and in the
greatest need of aging supportive services.
2. Provide for a 5 year authorization period to ensure continuity,
promote quality improvements in programs and services and allow newly-
authorized programs and amendments to be fully implemented.
TITLE II
3. Strengthen the National Long-Term Care Ombudsman Resource Center
by increasing the authorized appropriation level to $1 million annually
to provide support and training for the Long-Term Care Ombudsman
Programs that protect the rights and interests of residents of long-
term care facilities and their families.
4. Strengthen the National Center on Elder Abuse by increasing the
authorized appropriation level to $1 million annually to promote
understanding, knowledge sharing, and action on elder abuse, neglect,
and exploitation.
TITLE III
5. Encourage and support the development and implementation of
greater opportunities for innovative, community-based service delivery
methods, including consumer-directed models that promote independence,
autonomy, choice and control for senior adults and their caregivers.
6. Strengthen the National Family Caregiver Support Program (NFCSP)
under title III-E by:
a. Doubling the original authorization to $250 million per year;
b. Revising the definition of ``kinship'' in the NFCSP to include
non-blood relationships;
c. Adding a new program focusing on the needs of older persons with
Alzheimer's disease and related dementia and their caregivers, building
on the success of the current State demonstration program;
d. Promoting the value of senior volunteers, particularly low-
income seniors, in providing respite care to relieve caregiver stress.
7. Establish an authorization level of at least $60 million for the
title III-D Health Promotion and Disease Prevention program, including
$25 million specifically for local implementation of evidenced-based
promotion and prevention programs and a $10 million set aside for a
demonstration program on a community-based collaborative involving
State or local aging, health care and public health providers to
advance health promotion and disease prevention services.
8. Include statutory language in the Older Americans Act that
increases support to the aging network to promote senior mobility and
to facilitate coordination of human services transportation.
TITLE IV
9. Authorize funds for the administration on Aging (AOA) to conduct
a study on the status and effectiveness of the nutrition programs which
should be done by an independent organization such as the Institute of
Medicine, and thoroughly disseminate the study's findings.
10. Authorize funds for a demonstration project to study the ways
technological innovations can be used to promote the independence,
health and well being of seniors and their caregivers.
TITLE V
11. Maintain the Senior Community Service Employment Program's
(SCSEP's) dual structure of funding State and national grants and
operating through State Units on Aging and the National Sponsoring
Agencies.
12. Maintain the title V SCSEP's vital, historic focus on community
service, which significantly benefits the aging population.
13. Reduce the barriers to participation of older workers in SCSEP.
For example, strengthen the income security provided to low-income
older workers in the SCSEP by exempting wages earned in the program as
income for purposes of determining eligibility for Medicaid and other
Federal benefits.
14. Develop reasonable performance expectations based on population
served, particularly regarding unsubsidized placements.
15. Oppose efforts to consolidate the SCSEP with other employment
programs and oppose burdensome administrative requirements or
significant programmatic changes. Low-income seniors face barriers to
employment far different from the challenges other seniors face in
seeking workforce engagement; to divert resources or program focus away
from this population would significantly lessen the likelihood that
they will find and retain meaningful employment. Frequent changes in
SCSEP regulations and administration have created serious negative
consequences for both participants and community-based organizations
and it is now appropriate to let the changes of the last few years
settle in.
16. Strengthen the involvement of the Administration on Aging in
the title V program by requiring the Secretary of Labor to consult
with, and obtain the written recommendations of the Assistant Secretary
for Aging on operation and administration of title V.
TITLE VI
17. Strengthen title VI Aging Grants to Indian Tribes and Native
Hawaiian Organizations by increasing authorized appropriations level to
$50 million annually to provide for adequate delivery of nutrition and
other supportive services.
18. Increase the authorized appropriations level to $20 million
annually for Part C, the Native American Caregiver Support Program, and
provide training to Tribes to use the caregiver funds effectively.
TITLE VII
19. Strengthen the capacity of the aging network to develop and
implement a comprehensive elder rights system through:
a. Authorizing funding to support the rights of elders through
existing title VII elder rights services. In particular, we recommend
the following authorized funding levels:
i. Long-Term Care Ombudsman Program at $45.5 million;
ii. Legal Services Developer at $10 million;
iii. Elder Abuse Prevention at $10 million;
iv. Pension Counseling at $10 million;
v. Native American Organization Provisions at $10 million.
b. Authorizing a funding level of $50 million to provide assisted
living residents and recipients of home- and community-based services
access to services of the Long-Term Care Ombudsman Program.
c. Recognizing the critical role of adult protective service (APS)
in the prevention of and response to elder abuse, neglect and
exploitation.
d. Statutory recognition of the existing role of State units on
aging in administering APS programs.
20. Strengthen provisions and increase the authorized funding
levels for title VII services to enhance access to Legal Assistance to
the Elderly and ensure the viability of elder abuse and domestic
violence prevention, intervention and related elder justice activities
and outreach demonstrations. Also, support title VII services to
enhance capacity and increase training of law enforcement officials and
medical staff; broaden public education; and facilitate coordination
among all professionals and volunteers involved with the prevention,
detection, intervention and treatment of abuse and neglect of
vulnerable older adults.
ADDITIONAL WAYS TO STRENGTHEN THE OAA
21. Establish a new title in the OAA that would support the Aging
Network to work with State and local Governments to actively prepare
for the aging of the baby boomers, as well as today's elderly
population. Through the new title, funds would support new resources in
the Aging Network to coordinate community plans to prepare for the
aging population's impact on the social, physical, and fiscal fabric of
our Nation's cities and counties. The new title would also establish a
national resource center to provide the necessary guidance, training,
and technical assistance to aging programs in their efforts to help
communities develop livable communities for all ages. This title shall
be evaluated and sunsetted as necessary.
22. Provide permanent authority and authorize funds to design and
implement Aging and Disability Resource Centers to assist older people
and adults with disabilities to make informed decisions about their
service and support options and serve as the one-stop center for the
States long-term care service and support system.
23. Include a national education and training program for new
leaders in the aging network that would reinforce and broaden the
capacity of aging network to meet future challenges and opportunities.
24. Authorize the creation of a new National Center on Senior
Benefits Outreach and Enrollment. The Center would work closely with
State Health Insurance Assistance Programs (SHIPs), State Units on
Aging (SUAs), Area Agencies on Aging (AAAs), and CMS Regional Offices
to create and support a nationwide network of certified enrollment
centers.
25. Establish a permanent, evidence-based disease prevention and
health promotion program to support healthy, productive aging by
capturing the critical lessons learned from the current Evidence-based
Prevention Initiative demonstrations. Establish a range of programs in
each State. Expand the size (both the number of providing agencies and
the number of participants) of the best of the current demonstrations
to ensure that these programs can go to scale and to develop more
accurate cost estimates and establish readiness to implement criteria.
Document adjustments that are being made to current organizational
processes and systems to gain a better understanding of which practices
can be modified and which practices need to be rebuilt. Provide
incentive grants, training and technical assistance to the next
generation of agencies that meet the readiness criteria to implement
evidence-based prevention programming.
26. Strengthen collaboration between the Administration on Aging
and the Corporation for National and Community Service to promote their
roles as:
a. Catalysts in forging a national policy framework and
infrastructure that greatly expands opportunities for millions of older
adults to give back and participate in the affairs of their
communities;
b. Innovators to foster the growth of promising practices,
evidence-based and outcome focused program models, and community
capacity building initiatives;
c. Collaborators with the private sector to change workforce
policies and practices and support transition planning for retiring
workers;
d. Researchers to establish, and routinely assess against, a
baseline for financial savings and cost benefits resulting from older
adults remaining active, contributing members of society and from the
direct and demonstrable impact they have on reducing serious social
problems.
27. Strengthen the authority of State Government to ensure that the
act's resources are targeted to those older persons most in need of
support to maintain dignity and independence, such as the very old, the
poor, the near poor who may not qualify for Medicaid, the frail, those
geographically or socially isolated, limited English speaking
individuals, and low-income minority persons.
28. Strengthen and broaden the Federal leadership role of the
Assistant Secretary for Aging to include new partnerships with the
Centers for Medicare and Medicaid Services (CMS):
a. To administer the Home and Community-Based Services (HCBS)
Medicaid Waiver Programs and other long-term care programs.
b. To ensure that older qualified individuals with disabilities
have access to services in the most integrated setting appropriate to
their needs.
c. To provide information, education and counseling to people with
Medicare in partnership with CMS.
d. To assist in efforts to ensure the integrity of the Medicare
program in partnership with CMS.
29. Strengthen collaborative efforts between the Administration on
Aging, with its Federal leadership role, and all relevant Federal
agencies with a significant aging portfolio, including but not limited
to: the Department of Housing and Urban Development, the Federal
Transit Administration, the Corporation for National and Community
Service, the Social Security Administration, the Centers for Disease
Control, and the Centers for Medicare and Medicaid Services.
30. Strengthen and broaden the leadership role of the State Units
on Aging and Area Agencies on Aging (AAAs) to eliminate the
institutional bias in their State's long-term care system through:
a. New partnership with the State Medicaid agencies to ensure that
older qualified individuals with disabilities have access to services
and adaptive equipment in the most integrated setting appropriate to
their needs.
b. Requiring active participation in the development and
implementation of the State's Olmstead plan, long-term care rebalancing
plans or meeting ADA title II requirements for older people.
c. Statutory recognition of their expanded responsibilities in the
design and implementation of home- and community-based service systems
including the State Medicaid Home and Community-Based Services Waiver
programs for the aged and people with disabilities and other long-term
care programs.
31. Make proven title IV projects, including legal hotlines, Family
Friends, and Medicare Patrol Projects, permanent service options
through stable and reliable funding sources.
Note: The numbering system used in this document is for reference
purposes only and should not be considered a prioritization of
recommendations.
Chairman DeWine. Ms. Reed.
STATEMENT OF JO REED, NATIONAL ADVOCACY COORDINATOR, FEDERAL
LIVABLE COMMUNITIES AND CONSUMER ISSUES, AARP, WASHINGTON, DC.
Ms. Reed. Thank you. First of all, on behalf of AARP, I am
delighted to be here, as well. I have to tell you, however,
that I am the National Coordinator for Livable Communities and
Consumer Issues for Advocacy Operation, although I appreciated
that promotion. I will briefly summarize the key points in our
longer statement for the record.
Regarding the delivery of home- and community-based
services, helping people to grow older in their communities
with independence and dignity is the bedrock goal of the Older
Americans Act, and coordination of available resources to
achieve this goal is essential. So we are encouraged by the
administration's new initiative, Choices for Independence, and
we think this initiative holds tremendous promise and really
deserves favorable attention from Congress. However, we are
concerned that funds for other important activities, such as
the Alzheimer's demonstration grants, should not be sacrificed
in a move to launch this effort.
Monitoring and improving quality in the delivery of long-
term care services is critical. We strongly support the
maintenance of the Office of the Long-Term Care Ombudsman and
the program's authority to be an effective watchdog in nursing
homes and other long-term care facilities.
Regarding the title V Senior Community Services Employment
Program, AARP believes that the current SCSEP project
management structure has proven effective and should be
preserved, along with its original dual job opportunity and
community service mission. In that regard, we do not support
the title V proposal outlined in the administration's 2005
budget, which would eliminate national grants and administer
the program through State contracts with national and other
groups. Such a drastic and premature change would, in our view,
create significant confusion for participants and serious
program inefficiencies. Further, it would squander the
opportunity for experienced grantees to build on past success
and new ones to prove their worth. Mr. Chairman, let me add
that we believe in this program so strongly that we subsidize
it with AARP resources.
AARP continues to support targeting of Older Americans Act
services established in previous reauthorizations, an effort
more critical in these days of austere budgets than ever. To
that end, we support uniform data collection procedures and
definitions. These are necessary to strengthen evaluation of
program effectiveness and better target services to the most
vulnerable populations.
AARP supports retaining the critical advocacy functions of
the Older Americans Act, highlighted in Title VII of the act.
Advocates for seniors need to engage fully in all aspects of
OAA planning and work to improve access to public benefit
programs by low-income older persons whose participation in
such programs continues to lag behind that of other age groups.
Legal assistance should continue to be a required service
in the act.
Finally, AARP continues to believe that broader cost-
sharing and sliding scale fees should be implemented only after
carefully monitored demonstrations affirm that the most
economically and socially vulnerable populations do not
encounter barriers.
In conclusion, we thank you for acknowledging the concerns
of older Americans. We strongly urge your support for a simple
reauthorization that makes only targeted changes in existing
programs to improve efficiency. Thank you.
[The prepared statement of Ms. Reed follows:]
Prepared Statement of Jo Reed
EXECUTIVE SUMMARY SHEET
A. Delivery of Home and Community-Based Long-Term Care & Ombudsman
Services
1. Develop and use comprehensive, coordinated systems of long-term
care that ease consumer access through a single point of entry.
2. Encourage States to develop their own home- and community-based
care programs using combinations of OAA and other funds to serve
persons unable to meet Medicare and Medicaid requirements.
3. Encourage use of combined funding sources to supplement services
provided through Medicaid.
4. Retain the separation between the roles of assessing eligibility
and actual provision of service for OAA-funded entities.
5. Retain demonstrations capacity to assess new and improved ways
to more effectively deliver LTC and supportive services.
6. Retain Ombudsman provisions that authorize their advocacy
functions and ensure adequate funding.
7. Do not expand the roles or requirements of Ombudsmen without
providing adequate new funding.
B. Title V--The Senior Community Service Employment Program (SCSEP)
1. Do not block grant SCSEP funds to States or compel grant
competitions in all States;
2. Do not impose a higher burden of administrative costs to run the
program;
3. Make no major revisions in SCSEP's administrative structure or
reporting requirements that are unrelated to identified problems;
4. Do not alter the current percent allocation split of program
funds between the national sponsors and the States as provided for in
the OAA Amendments of 2000.
C. Targeting of Older Americans Act Services
1. Retain current targeting language in the act.
2. Do not raise the age of eligibility for service because of its
adverse impact on vulnerable older minority individuals.
3. Defer any plan to broaden cost-sharing under the act pending an
evaluation of the impact on under-served groups with critical needs.
D. Vulnerable Elder Rights and Consumer Rights Protections
1. Retain the current advocacy functions of entities created under
the act and their roles in all aspects of planning and implementation.
2. Retain the mandate of OAA legal services and include a floor of
funding at the local level.
3. Retain Ombudsman provisions that authorize their advocacy
functions and ensure adequate funding.
______
On behalf of AARP, thank you for this opportunity to comment on the
reauthorization of the programs and services of the Older Americans Act
(OAA) and how they might be made more responsive to the needs of mature
and older Americans. I am Jo Reed, AARP National Advocacy Coordinator
for Federal Livable Communities and Consumer Issues.
AARP is most concerned that programs, authority and partnerships
that have already proven effective in meeting the needs of vulnerable
older Americans be maintained and strengthened. We believe that older
persons are best served by a simple reauthorization that makes only
minor changes in existing programs to improve efficiency. Better
coordination of existing OAA programs with other Federal programs, such
as proposed by the administration in its ``Choices for Independence''
initiative, holds tremendous promise and merits the support of
Congress.
I. Delivery of Home and Community-Based Services
Helping people to grow older in their communities with independence
and dignity is a bedrock goal of the Older Americans Act. All too
often, advancing age and increasing frailty threaten the ability of
older persons to remain in their own homes. The fear of having to enter
a nursing home, with its attendant loss of independence and threat of
impoverishment, weighs heavily on the minds of many older persons and
their caregiver families.
Indeed, this concern is a major basis for the National Family
Caregiver Support Program and the ``Choices for Independence''
initiative that the administration fiscal year 2007 Budget proposes as
part of this reauthorization cycle. AARP welcomes this initiative as
both a complement to existing caregiver and service programs and an
innovative step in addressing aspects of the much larger home- and
community-based service challenge. If this new program is adopted,
however, higher OAA appropriations will be required so that other
important OAA activities are not displaced. This will require real
commitment and creativity given tight Federal spending caps.
Over the past 15 years, States have made great strides in improving
the options for older persons with disabilities who want to remain in
their own homes and communities for as long as possible. AARP and our
partners in the aging network have been strong advocates for the
development of effective networks for delivering home- and community-
based long-term care services. Successful State delivery strategies
include:
expanding home- and community-based care programs by
consolidating Federal and State funding (such as Medicaid, state-only
funded programs, OAA, and Social Services Block Grant);
streamlining administrative operations by designating a
single State agency to serve as a single point of entry into the long-
term care system;
adopting assessment and care management practices that
allow targeting of resources to the persons most in need.
In many States, the area agencies on aging serve as ``single points
of entry'' into comprehensive, coordinated systems of care. Such
systems can ease the ability of older persons and their families to
find and use long-term care services, and can help States to manage
their resources effectively.
AARP supports the single point of entry approach. Maximizing
linkages between various delivery systems is critical, especially
access linkages like transportation or legal assistance. Without such
coordination, persons who need long-term care must go from agency to
agency, trying to locate programs and services for which they are
eligible. They also must try to decipher the multiple and often
conflicting eligibility requirements of various programs.
At the same time, AARP believes that, in general, it is preferable
to retain the current separation between the assessment of eligibility
and the actual provision of services, so that the agency that conducts
eligibility assessments does not have a financial interest in the type
and amount of services authorized. We believe that the existing
arrangements function effectively.
II. Long-Term Care (LTC) Ombudsman
Finding methods of monitoring and improving quality in the delivery
of long-term care services is critical. Federal legislation to protect
vulnerable seniors from abuse, neglect and exploitation is still
pending, so the resources of the OAA remain critical [see our later
comments on elder rights protections]. Long-term care clients are
particularly vulnerable, and the aging network has a vital role to play
in quality assurance. AARP supports adequate funding for the LTC
Ombudsman program, authorized by the OAA. We strongly support
maintenance of the Office of the LTC Ombudsman and the program's
authority to be an effective watchdog in nursing homes and other long-
term care facilities. We urge retention of provisions that enable the
Ombudsman to:
provide information to the public and lawmakers;
comment on laws or regulations affecting care
institutions;
execute their mission free of conflict of interest at any
level;
assure the confidentiality of resident complaints and
program records.
III. Title V--The Senior Community Services Employment Program (SCSEP)
First, we should note that the AARP Foundation is 1 of 13 SCSEP
national sponsors. As a 501(C)(3) organization, the Foundation is a
separate entity from AARP, a 501(C)(4) organization. AARP believes that
the current SCSEP project management structure has already proven
effective in meeting the needs of vulnerable older Americans, and
should be preserved. In our view, the program can be best served by a
simple reauthorization that makes only targeted changes to improve
efficiency.
The reauthorization should not be encumbered by amendments that
make major changes in the existing SCSEP program or its original, dual
job opportunity and community service mission. While some constructive
proposals have been made to improve title V--SCSEP, we have serious
concerns regarding plans outlined in the administration's fiscal year
2007 Budget. That proposal would eliminate national grants and
administer the program through State contracts with national and other
groups. Such a drastic and premature change would, in our view, create
significant confusion for participants and serious inefficiency in the
program itself. Further, it would squander the opportunity for
experienced grantees to build on past success, and new ones to prove
their worth.
In general, AARP opposes proposals that:
block grant SCSEP funds to States or compel grant
competitions in all States;
impose a higher burden of administrative costs to run the
program;
make major revisions in SCSEP's administrative structure
or reporting requirements that are unrelated to identified problems;
alter the current percent allocation split of program
funds between the national sponsors and the States as provided for in
the OAA Amendments of 2000.
SCSEP works because it is administered in a way that responds to
both older workers' and local community service needs, without the
State or local Government bureaucracy that would be required if
administered primarily by State agencies or as a block grant. This is
especially important considering the minimal attention of State and
earlier Federal jobs programs in addressing the special needs of older
workers. SCSEP is the only remaining Federal job training initiative
specifically designed to meet the needs of our aging workforce. It is
critical that this highly successful program continue without disabling
changes.
SCSEP is a work training program for low-income persons age 55 and
older. It is authorized to assist participants in gaining job skills
and paid work experience needed to transition to permanent,
unsubsidized jobs. As SCSEP is the only means-tested part of the act,
participants meet income, age, and residency requirements.
Once enrolled, participants receive a temporary, part-time, minimum
wage assignment with a host agency (a non-profit community service
organization), job search assistance, and skills training as needed.
The program gives ``enrollees'' a chance to earn an income, develop new
skills, and serve their community while continuing to pursue a
permanent job. Typical assignments include jobs as cashiers, clerk
typists, custodians, data entry clerks, grounds keepers, teacher's
aides, hospital workers, home/health care service providers, day care
workers, food preparers and public agency staff support workers.
A long-standing goal for SCSEP under the Department of Labor's
rules has been to place 20 percent of all participants in unsubsidized
jobs in any program year. This goal is extremely challenging given that
older workers qualify as ``hard-to-serve'' based on age alone. The AARP
Foundation has regularly exceeded this goal, placing 48 percent of
participants in the last program year and nearly doubling the goal in
each year for the past decade. Because other national sponsors have
also performed well, the average unsubsidized placement rate for
national sponsors as a group has consistently exceeded that of the
States.
National sponsor performance has also exceeded that of States with
regard to serving individuals with multiple employment barriers, cost
per placement, administrative costs and service to the general
community. While there have been occasions over the 35-plus year life
of the program where administrative cost issues have been raised, it is
important to keep in mind that sponsors operate under a maximum
administrative cost cap of 15 percent, still well below what is allowed
for most other Federal jobs programs.
SCSEP meets the needs of those most economically vulnerable seniors
who must work to subsist. Of those served by SCSEP in 2004, 82 percent
were below poverty (participants qualify at up to 125 percent poverty),
66 percent were female, 62 percent were age 60+, 36 percent did not
graduate high school, 15 percent had a disability, 16 percent were
veterans, and 41 percent were minority (14 percent Hispanic, 38 percent
African-American, and 1 percent other, while 47 percent were white).
Clearly, SCSEP serves a population that faces multiple barriers to
employment. Some smaller national organizations bring unique skills for
reaching older worker populations that are often underserved,
especially older minority individuals. For this reason, among others,
AARP has always supported using national sponsors to provide employment
training opportunities.
Finally, AARP would also be very concerned about any proposals to
lower the administrative cap. The practical effect of such a change
would be to disadvantage minority elders because it would fall more
heavily on smaller minority national sponsors such as those serving
Native American, Hispanic, Asian and African-American elderly. The
impact would simultaneously be felt by minority communities and the
national sponsors in the form of diminished service delivery capacity.
Some likely consequences of a lower administrative cap that can be
anticipated include:
Outreach and support services to eligible seniors would be
reduced due to decreased project staff and resources;
Job opportunities would be diminished for low-income and
minority elders and their communities, since minority sponsors serving
such communities have the smallest grants, yet their program
participants have the greatest need for support;
Important community services now staffed by title V
participants might be dropped by financially strapped communities,
thereby eliminating both services and job training opportunities for
low-income seniors; and
Non-profits might be discouraged from seeking to be
sponsors because the severe administrative caps would not be viewed as
realistic for administering an effective program, and there would be
concerns about draining financial resources from other organizational
priorities.
IV. Targeting of OAA Services
Administration of the programs and services of the act is more
critical in these days of austere budgets than ever before. It is
important to direct resources to areas that achieve the most impact
while aiming to meet the goals of the act. Toward this end, the
Association supports uniform data collection procedures and definitions
which permit evaluation of program effectiveness, especially regarding
gaps in service to rural, frail, low-income and minority older persons.
Years of studies show pockets of under-service to certain older
populations by the programs of the act. AOA has improved its ability to
collect participant data in recent years. However, there are not
adequate measures of the unmet need for services. Broadening the scope
of data collection for title III programs could help demonstrate their
impact on special populations.
For many years, AARP has advocated targeting OAA services to
persons with the greatest social and economic need and, in particular,
to low-income, older minorities. AARP continues to strongly support
retention of the targeting provisions of the act. The flexible nature
of the OAA programs is one of its strengths because it helps to garner
broad public and political support. However, historically there have
been problems in achieving adequate service delivery to older minority
individuals. It is critical that new participation data collected by
AOA be disseminated, so that the adequacy of current service delivery
to older minorities can be evaluated. By tracking results, it is
possible to ensure that more funding goes to those programs that
achieve the best results with the targeted populations. Better tracking
would also enhance ability to assess delivery of services to other
underserved target populations like rural elders and enable more
effective allocation of OAA service dollars.
V. Vulnerable Elder Rights Protection, Consumer Protection & Legal
Assistance
AARP supports retaining the advocacy functions of the OAA programs.
In order to fulfill the act's mission, it is critical that State and
area agencies on aging continue to be effective and visible advocates
for older persons. A critical component of this function is allowing
for public participation in all aspects of the act's planning and
implementation processes.
AARP continues to support efforts by the aging network to improve
access to public benefit programs by low-income older persons.
Participation by older persons in public benefit programs continues to
lag behind participation rates for other age groups. With the extensive
changes in public benefit programs enacted by welfare reform and recent
proposals to eliminate nutrition alternatives like the Commodity
Supplemental Food Program (CSFP), there is even greater uncertainty
among older persons regarding both access and possible eligibility. The
OAA programs can play an important role in helping older persons with
low incomes to gain access to other programs for which they are
eligible. Such assistance can make a critical difference in the quality
of life for these vulnerable individuals.
Similarly, a host of problems confronting older consumers in
today's marketplace require redress. These problems range from the
refusal of some managed care providers to cover certain necessary
treatments to predatory lenders who convince older individuals to
accept high-interest loans secured by their only asset, the equity in
their homes. Older persons need quick access to legal advice before
they sign a document or take action they may later regret. A 1994 AARP
survey found that 13 percent to 18 percent of persons age 60 and older
need the assistance of a lawyer each year to protect their rights or to
redress a wrong. We suspect that the increased complexity of financial,
personal and public assistance requirements have greatly increased that
need, but the lack of current research on the legal needs of seniors
remains a barrier to resource allocation.
AARP urges that legal assistance continue to be a required service
under the act unless waived in accordance with guidelines from the
Secretary. It is critical that the current waiver process be retained.
This process provides that interested parties be notified and a public
hearing be held before a waiver can be granted. Without this
protection, the vital interests of many of the most vulnerable elders
can be waived without recourse. Legal assistance helps older persons
obtain access to vital medical, insurance, housing, and social security
benefits as well as providing guidance regarding nursing home and
estate issues.
Unfortunately, according to the Comprehensive Legal Needs Survey
conducted by the American Bar Association (ABA) in 2004, most moderate
and low-income persons facing problems with legal dimensions do not
seek the benefit of a lawyer's services. This reaffirms similar
findings in the ABA's 1994 study. Among the reasons noted are lack of
awareness that their problems are legal in nature, the perceived cost
of a lawyer, the effort required to find a good, qualified lawyer, and
the discouraging fear of dealing with lawyers.
The OAA's mandate to provide legal services is therefore extremely
important. This ensures the availability of legal help for at least
some of the most critical problems of the neediest older Americans.
Requiring services rather than providing discretion in this area is
critical because legal services are controversial in some communities.
Without the mandate, the fundamental principle of access to justice
will be denied to some older persons. For the same reason, area
agencies should be required to spend a minimum percentage of their
title IIIB funds, set by the State Unit on Aging, on legal services.
Before establishment of the mandate, less than 50 percent of area
agencies funded any legal services. Many others spent insignificant
amounts on legal services. A 2002 study of legal services in New Jersey
noted among its conclusions that pro bono services are inadequate to
make a significant difference in access to legal assistance by those
who need it. AARP therefore opposes any changes that would substitute
pro bono services for OAA legal assistance without reliable data to
affirm that legal needs are being met by such services.
VI. Cost-Sharing Initiatives
Any proposals to broaden the scope of cost-sharing under the act
should be deferred pending a national, independent and verifiable
impact analysis. AARP continues to believe that broader cost-sharing
and sliding scale fees should be implemented only after carefully
monitored demonstrations affirm that the most economically and socially
vulnerable populations do not encounter barriers. While it may be
possible to limit the number and types of services that would be
affected by an expanded cost-sharing policy, the fact remains that no
uniform national studies have been conducted to assess impact.
Conclusion
Again, AARP thanks the committee for acknowledging the concerns of
older Americans and strongly urges your support for the recommendations
we have presented. AARP welcomes every opportunity to work with
Congress, the administration and others to preserve essential OAA
programs and services while more effectively coordinating Federal
resources through initiatives that permit State and local flexibility
in meeting the needs of an aging America.
Chairman DeWine. Mr. Bedlin.
STATEMENT OF HOWARD BEDLIN, VICE PRESIDENT FOR PUBLIC POLICY
AND ADVOCACY, THE NATIONAL COUNCIL ON AGING, WASHINGTON, DC.
Mr. Bedlin. Good afternoon. I am Howard Bedlin with the
National Council on Aging.
The Older Americans Act plays an essential role in keeping
seniors independent. In fact, among 73 resolutions the 1,200
delegates to the once-per-decade White House Conference on
Aging chose reauthorization of the Older Americans Act as their
number one priority. We support a noncontentious
reauthorization, and as co-chair of the LCAO Community Services
Committee with Laura here as the other co-chair, we helped to
craft a consensus document that reflects the reforms that are
broadly agreed upon.
Several controversial issues delayed the reauthorization
last time for 5 years. We believe the act works well and that
delegate carefully crafted compromises should not be reopened.
The primary controversy last time concerned the title V SCSEP
program, the most effective workforce program for low-income
older Americans. There is broad consensus that the current
structure of States and national sponsors and the historic
emphasis on community services should be maintained. This issue
merits its own roundtable discussion.
NCOA proposes several improvements to the act. First, we
support the AOA Choices for Independence Initiative, which can
strengthen the act and provide significant benefits to seniors
in need. We enthusiastically support its healthy lifestyle
component, building on evidence-based prevention demonstrations
that have proven effective in reducing the risk of disease and
disability. We recommend making the program permanent and
focusing on low-cost evidence-based interventions and providing
training, technical assistance, and accurate measures of
program costs.
Second, it is a national tragedy that millions of low-
income seniors eligible for help are not actually getting it.
Even after 40 years, only about one-third of eligible seniors
in need receive food stamp or Medicare cost sharing benefits
available to them. We need a focused, coordinated effort to
assist them to get the benefits Congress intended. We recommend
a new National Center on Senior Benefits Outreach and
Enrollment be formed to develop sophisticated, cost-effective
strategies to assist those in greatest need to actually get the
help available under the law.
Third, we must stop viewing the aging population as a
problem rather than recognizing older adults as powerful
resources. We should develop new civic engagement models to
take advantage of the resources baby boomers offer America. The
aging network should be strategically mobilized to help seniors
give back to their communities. We recommend that a civic
engagement innovation fund be created, a sophisticated cost-
benefit analysis be conducted, and a blueprint developed on how
to best tap older adults to address critical societal needs.
Finally, one of the most effective programs tapping senior
volunteers is Family Friends, which recruits and trains senior
volunteers to work with children with disabilities. We
recommend that the act include a permanent authorization in
this program.
Additional recommendations are included in my written
statement, including those concerning senior centers.
Thank you for this opportunity to share our views and we
look forward to working with you.
Chairman DeWine. Thank you very much.
[The prepared statement of Mr. Bedlin follows:]
Prepared Statement of Howard Bedlin
Thank you for the opportunity to submit this statement on behalf of
the National Council on the Aging (NCOA). I am Howard Bedlin, Vice
President for Public Policy and Advocacy.
The delegates to the recent once-per-decade White House Conference
on Aging (WHCOA) were asked to vote on their priorities from among 73
resolutions that were crafted by the White House Conference Policy
Committee. A majority of the over 1,200 delegates from across the
Nation were selected by Members of Congress and the Governors. To the
surprise of some, those delegates--leaders in the aging network from
every corner of the country--chose as their number one priority the
resolution regarding reauthorization of the Older Americans Act (OAA).
That is a powerful statement to Congress, to the White House, and to
the Nation.
Since its enactment in 1965, the OAA has been reauthorized 14 times
and has made an enormous positive difference in the lives of millions
of older Americans. The act established the primary vehicle for
organizing and delivering community-based services through a
coordinated system at the State level. Nutrition, home care, senior
center services, transportation, employment, protections against abuse
and neglect, disease prevention, family caregiver support--all of these
have been extremely beneficial over the years. Programs operating
through the OAA provide vital support for those elders who are at
significant risk of losing their ability to remain independent in their
own homes and communities. These services help older persons avoid or
delay costly nursing home care.
The act works well, given its limited finances. Funding for the
program has essentially remained frozen at $1.783 billion since fiscal
year 2002--failing to keep pace with inflation or increases in need due
to demographics. The most recent Federal PART Performance Measurements
concluded that AOA programs:
address a specific and existing problem, interest or need;
are not redundant or duplicative of any other Federal,
State, local or private effort;
are free of major flaws that would limit effectiveness or
efficiency;
effectively target resources to reach intended
beneficiaries;
use strong financial management practices.
While current OAA programs work well, much can be done to leverage
relatively modest additional resources to achieve significantly greater
results. Too many frail older Americans should be able to remain
independent in their homes and communities, but--for a wide variety of
reasons--are prematurely admitted into expensive nursing homes. Too
many low-income seniors are not applying for and receiving assistance
they are eligible for. Too many family caregivers are burning out under
growing financial, emotional and physical burdens. Too many older
Americans were found in a recent study to be food insecure. And we are
not taking full advantage of experienced, able-bodied seniors who want
to volunteer to give back to their communities. NCOA proposes several
key improvements to the OAA that would help address these concerns.
We support a smooth, non-contentious reauthorization of the OAA,
and hope that it can be accomplished during 2006. In an attempt to
promote such a process this year, as co-chair of the Community Services
Committee of the 54-member Leadership Council of Aging Organizations,
we worked with many other groups to craft a consensus document on OAA
reauthorization issues. We believe the document is an accurate
indicator of the reforms the aging network generally agrees upon.
A small set of controversial issues delayed the last
reauthorization for 5 years. We believe that, on balance, the act is in
good shape and that these same controversial issues should not be
revisited in the upcoming reauthorization. We should learn from the
experience from the previous reauthorization and not reopen and pour
salt on old wounds that reflect carefully crafted compromises that are
now working well.
For example, one of the major controversies that held up
reauthorization last time concerned cost sharing. To help break the
logjam, NCOA and the National Association of State Units on Aging
(NASUA) collaborated on a delicately balanced compromise that is the
foundation of the current law provision. We oppose reopening this
contentious issue.
Nutrition providers are currently required to provide participants
with an opportunity to make non-coercive, voluntary contributions, and
AOA data show that many seniors do contribute. These voluntary
contributions by seniors account for 32 percent of the total income in
congregate meals programs and 25 percent in home-delivered meals. That
system works well and should be retained. We should not be erecting
additional barriers to participation in nutrition programs. Congress
should do its utmost to assure that no senior who needs nutrition
assistance is denied because of inability to pay mandatory cost-
sharing.
It is important to note that the 2000 reauthorization required the
AOA to complete a study of cost-sharing practices, to determine their
impact on participation [see Section 315(d)]. That study has not been
completed. Clearly, we should await the results of this analysis before
considering any change to the compromise in effect.
The other primary controversy from the last reauthorization
concerned the title V Senior Community Service Employment Program
(SCSEP).
THE TITLE V SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM (SCSEP)
SCSEP is our Nation's most effective workforce program for low-
income older Americans, and NCOA strongly hopes that it is not again a
source of controversy in this reauthorization. The best course for
Congress to take with title V is to continue it as it is, with minor
improvements.
The 2000 reauthorization of the OAA made significant changes in the
SCSEP, based largely on another compromise initiated by NCOA and NASUA,
and it took 4 more years--until late 2004--for the Department of Labor
to issue final regulations for those changes. Thus, the sponsoring
agencies and the program participants are still adapting to the new
rules and systems that were only recently made final.
We are concerned that the Department of Labor may propose far-
reaching structural changes to SCSEP, such as eliminating the historic
emphasis on community service (which benefits program participants, the
aging network, and communities served), eliminating national sponsors,
eliminating service to participants under age 65, and eliminating
fringe benefits for participants. The President's budget proposal,
released last week, clearly pointed to an intention to eliminate
national sponsors and block grant the funds to the States, in addition
to other significant legislative changes.
NCOA strongly opposes these changes, which would make the program
far worse, not better. Such changes are unwarranted, and would be
disruptive and harmful to older workers and communities. There is not a
single senior organization that would likely support these proposals.
There is broad consensus that the following principles should help
guide Congress's efforts in reauthorizing title V, many of which are
likely to be included in the final report of the WHCOA in June: (1)
Continue the current system of funding both national and State grants,
including the current percentage split of the funds; (2) Maintain the
program's historic dual emphasis on both community service placements
and unsubsidized placements for participants; (3) Maintain the current
age and eligibility requirements for participants, so that services can
be targeted to persons with the greatest economic and social need; (4)
Retain current policy on program budgets; and (5) Strengthen the role
of the Administration on Aging in SCSEP, because Section 505(a) of the
OAA does not appear to be working as intended.
We suggest that SCSEP can be improved by developing measures of
grantee performance that more closely reflect Congressional intent and
by streamlining performance data collection.
In summary, SCSEP is a proven program that has a good track record
of providing training and placement for difficult-to-serve populations
of older adults. The program should be allowed to continue doing what
it does well. During the last attempt to reauthorize the OAA, the
primary reason for the 5 year delay may well have been a proposal to
shift the funding formula of 78 percent for national sponsors and 22
percent to States, to a 50 percent-50 percent split. Any attempt now to
overturn the current compromise (which national sponsors and States
supported) and go, in effect, from a 78 percent-22 percent split to a
0-100 percent split could harm older workers, derail efforts to
reauthorize the program this year, and deflect attention from important
proposals that would help seniors--such as Choices for Independence.
AOA'S CHOICE FOR INDEPENDENCE INITIATIVE
In sharp contrast to the approach that the Department of Labor
appears to want to take, the AOA is proposing an initiative that we
think can strengthen and improve the OAA and provide significant
benefits to seniors in need. The proposed Choices for Independence
initiative has three components. The Consumer Empowerment component can
provide important information on planning for long-term care, including
using reverse mortgages to stay at home. The Community Living
Incentives component can help address the expensive institutional bias
in our Nation's long-term care system by improving access to more cost
effective home and community services for vulnerable, moderate income
seniors. The Healthy Lifestyle component can build on AOA's current,
highly successful Evidence-Based Prevention Demonstration Program to
assist older adults to make behavioral changes that have proven to be
effective in reducing the risk of disease and disability. Additional
comments on the significant opportunities that exist under the act on
health promotion and disease prevention are provided below.
NCOA is supportive of the Choices for Independence initiative and
looks forward to receiving additional detail on the proposal, and to
working closely with AOA and Congress to incorporate it into the OAA.
Although we appreciate the proposed $28 million investment in the
initiative, we believe additional resources will be needed to fully
achieve the proposal's goals, and that funding should not be taken away
from current OAA programs.
STRENGTHENING EVIDENCE-BASED HEALTH PROMOTION AND DISEASE PREVENTION
A variety of Federal agencies and private funders have recently
supported rigorous studies on health promotion, prevention, chronic
disease self-management, and related topics that have resulted in a
strong base of efficacious interventions that can make a measurable
difference in the quality of life of older adults and their caregivers.
These interventions are generally much less expensive than medical
treatments and can be implemented through community aging service
providers much more easily than through medical care systems.
Unfortunately however, there is considerable delay in the diffusion
of these innovative and proven interventions into the hands of those
who can run the programs. This deficiency must be addressed now. Over
70 percent of health care spending on seniors is directly related to
problems associated with chronic disease--problems that can be
effectively addressed through less expensive non-medical interventions
such as physical activity, falls prevention, dietary modification, and
supports for behavior change. But these interventions will not reach
the seniors who can benefit from them if we do not make a priority of
the systematic translation of highly structured research interventions
into practical, real world programs.
Due to the foresight of AOA's leadership, we have an excellent
start on addressing this problem. Although their Evidence-based
Prevention Initiative was launched with a modest investment, it has
succeeded establishing a basic foundation on which to build a national
program. By every indication, this initiative is demonstrating
remarkable success.
NCOA recommends building on AOA's current, highly successful
Evidence-Based Prevention Demonstration Program to assist older adults
to make behavioral changes that have proven to be effective in reducing
the risk of disease and disability among the elderly. Reforms should
focus on low-cost, evidence-based interventions at the community level
that support self care, physical activity, and fall prevention. Special
emphasis should be placed on reaching older adults with one or more
risk factors and reducing health disparities.
Specifically, we should establish within the OAA a permanent,
fully-funded program composed of a limited repertoire of specific
interventions that have proven effective in supporting healthy,
productive aging. This permanent program should:
Implement specific evidence-based programs across the 50
States based upon State and agency readiness to implement and monitor
the most successful tested prevention/promotion interventions. Working
with Federal research agencies and other scientists, establish criteria
for programs that qualify as evidence-based and prepare a list of
programs that meet these criteria and are suitable for implementation
under this program.
Provide training, technical assistance and systems
development for States and local areas to support evidence-based
prevention programs at community sites and for frail elders at home.
Provide incentive grants to study new, published, efficacious
interventions that are best suited for testing in community settings
and with diverse populations.
Establish a system for documenting the impact of these
programs on health care utilization and health status. Develop more
accurate measures and estimates to track program costs, implementation
processes, and program improvements and to disseminate evidence-based
innovations and improvements.
CREATING A NATIONAL CENTER ON SENIOR BENEFITS OUTREACH AND ENROLLMENT
The history of public benefits outreach efforts to low-income
seniors is very discouraging. Studies show that even after 40 years,
large percentages of older Americans who are eligible for important
public benefits are not receiving them. An estimated 47 percent of the
elderly eligible for Supplemental Security Income (SSI), 70 percent of
seniors eligible for food stamps, 67 percent of people eligible for
Qualified Medicare Beneficiary (QMB) protections, and 87 percent of
those eligible for Specified Low-Income Medicare Beneficiary (SLMB)
protections are not receiving the assistance for which they are
eligible. It is a national tragedy that this help is not getting to
those in greatest need. Congress's responsibility should not end after
a program for our poorest seniors is enacted. Additional steps need to
be taken to better ensure that eligible beneficiaries actually receive
the help Congress intended.
There are many trusted, non-profit community organizations and many
caregivers that can help find and assist low-income seniors, but they
will need easy-to-use tools to help seniors understand what they are
eligible for and to assist them with enrollment. Trusted intermediary
organizations also need resources to be able to reach beneficiaries and
provide one-on-one counseling and enrollment assistance. While some
support is currently being provided in conjunction with outreach for
the new Medicare prescription drug benefit, there is no focused,
coordinated effort to assist low-income seniors in receiving the range
of assistance they are eligible for under the law.
The public and private sectors must work together to develop a
sophisticated, cost effective, permanent, person-centered program to
assist those in greatest need get the help the law provides. NCOA
recommends that the OAA authorize the creation of a new National Center
on Senior Benefits Outreach and Enrollment. The Center would work
closely with the aging network, as well as State Health Insurance
Assistance Programs (SHIPs), CMS Regional Offices, and other Federal
agencies to create a nationwide network of certified, coalition-based
Enrollment Centers using state-of-the-art technology and best practices
to achieve cost-effective results. Services provided by this nationwide
network should include:
Promoting greater use of person-centered strategies, as
opposed to single benefit outreach strategies, to find and enroll
seniors in all of the benefits for which they are eligible;
Promoting and maintaining the use of the latest
technologies and integrated systems by updating web-based screening,
decision support and enrollment tools;
Promoting the use of in-reach strategies which utilize
computer matching of existing lists of low-income program enrollees to
find and enroll seniors in need;
Conducting research and benchmarking on best practices and
the most cost effective methods for enrolling seniors in benefits they
need;
Providing training and technical assistance on the most
effective outreach, screening, enrollment and follow-up strategies
through a network of regionally-based trainers.
TAPPING THE POTENTIAL OF CIVIC ENGAGEMENT
Rather than recognizing older adults as potentially powerful
resources, our Nation has viewed the aging population primarily as a
problem. Thus, policy debate concentrates on costs associated with
perceived decline and increasing frailty, and repeatedly misses vital
opportunities. This negative focus promotes a national aging model that
stigmatizes and dis-empowers, stifles creativity and discourages
meaningful contributions. In the next 20 years, the population of the
persons 65 and older in the United States will double as 77 million
baby boomers reach retirement age. They will also live longer and more
healthily. Aging baby boomers will be, and should be treated as,
powerful allies and assets.
A June 27, 2005 Business Week article stated convincingly that:
``If society can tap [Boomer] talents, employers will benefit, living
standards will be higher, and the financing problems of Social Security
and Medicare will be easier to resolve''. The article goes on to state
that: ``Increased productivity of older Americans and higher labor-
force participation could add 9 percent to gross domestic product by
2045 on top of what it otherwise would have been. This 9 percent
increase would add more than $3 trillion a year, in today's dollars to
economic output.'' This is the type of calculation and reasoning that
needs to take root in communities across the country. It is time to
consider a national strategy and a policy agenda that not only measures
work productivity and economic output, but also recognizes the value
and return on investment of new initiatives that can foster and support
volunteering and service. We must develop new models for civic
engagement to make effective use of the incredible resource that these
seniors can offer our society. The net result would be billions of tax
dollars saved because of wise forethought and planning.
Currently, civic participation occurs to some degree on its own,
but its extent is surprisingly limited without organizational support.
Thus, for civic engagement to reach its full societal potential,
visionary leaders must lay the foundation. The reauthorization of the
OAA can galvanize the creation of vital support, with AOA playing a
central role in partnership with the Corporation for National and
Community Services (CNCS). The OAA has historically focused on the
needs of the frail elderly while paying insufficient attention to the
significant benefits to be derived from older adults making meaningful
contributions. The demographic and longevity revolutions collide to
challenge AOA's limited and now outdated role. This reauthorization is
the time to correct this costly oversight. As part of AOA's established
aging network, cadres of older adults across the country could be
strategically mobilized to tutor and mentor children, facilitate access
to health services, strengthen families, provide respite to caregivers,
and bolster the long-term care system--all civic activities shown also
to contribute to their own well-being. There is much to gain by
leveraging relatively small investments in civic engagement into major
returns on the value of contributions in education, health care,
transportation, housing, and long-term care.
Specifically, the OAA should include language to authorize the
following activities:
In coordination with the CNCS, develop a civic engagement
fund for innovations, under Title IV of the OAA. The purpose would be
to foster the growth of promising practices, evidence-based and
outcome-oriented program models, and community capacity building
initiatives focused on developing older adults as community assets;
Conduct a research based cost-benefit analysis to
establish a credible base line on the potential for Federal and State
budgetary savings resulting from enlisting older adults, through paid
and unpaid, positions which have direct and demonstrable impacts on
serious social problems;
Develop a national blueprint on how to best tap older
adults as a new source of social capital to address critical local
needs of national concern and recommend public policy changes necessary
for its implementation.
AUTHORIZING THE FAMILY FRIENDS PROGRAM
One of the most effective current programs successfully tapping the
potential of senior volunteers is the Family Friends program, a
national family support program that recruits and trains volunteers 55
and older to make weekly visits to the homes of families who have
children with disabilities and chronic illnesses. For 20 years this
highly successful intergenerational program has been administered by
NCOA.
Family Friends is unique among volunteer programs. It provides in-
depth, home-based intervention by highly-trained volunteers who focus
on both the child and his/her family. Volunteers support the families
with whom they work in many ways--such as engaging the children in
educational and recreational activities that promote development,
connecting families to resources and services, accompanying families on
doctor visits, providing breaks for parents, and expanding the social
networks of the families.
Studies of the families involved in the program have shown
important positive results for those families, including decreased use
of hospitals and increased ability of parents to cope with emotional
strain and to control what is happening in their lives.
The national Family Friends program is at a crucial point in its
history. The need for its services is increasing and the pool of
potential volunteers is increasing. In order to help communities that
want to start a Family Friends program and provide the necessary
training for volunteers, Family Friends needs a permanent
authorization. We ask that the OAA reauthorization include such an
authorization for the Family Friends program.
OTHER NCOA RECOMMENDATIONS
We continue to work with our members to solicit their views on
reauthorization, and to review the implementation strategies from the
White House Conference. The final report to Congress is expected in
June. For example, we are:
looking closely at the senior center resolution #15 from
the conference, which, according the WHCOA Web site, included a draft
implementation strategy to ``support an expanded role for senior
centers as focal points for community based services and civic
engagement;''
analyzing how to include language to increase support to
the aging network to promote senior mobility and to facilitate
coordination of human services transportation;
considering how to best respond to the concerns of many
senior centers who want to have the opportunity to provide input into
the development of area plans;
reviewing possible improvements to the National Family
Caregiver Support Program.
Thank you again for this opportunity to share our views. We look
forward to working closely with members of the committee to enact a
reauthorization bill this year that will empower and support older
Americans, their families and communities.
Chairman DeWine. Ms. Howard.
STATEMENT OF LAURA HOWARD, EXECUTIVE DIRECTOR, NATIONAL
ASSOCIATION OF NUTRITION AND AGING SERVICES PROGRAMS,
WASHINGTON, DC.
Ms. Howard. Thank you. I am Laura Howard, Executive
Director of the National Association of Nutrition and Aging
Services Programs, and on behalf of our membership, thank you
for this opportunity to present you with our concerns about the
reauthorization of the Older Americans Act.
I and 30 NANASP members had the opportunity to participate
in the recent White House Conference on Aging, and it has been
mentioned. We were very pleased to see that the Older Americans
Act reauthorization was the number one priority of over 1,200
delegates.
Nutrition services play a key role in the Older Americans
Act. The three nutrition programs make up the largest service
program in the act, and there is no doubt that nutrition
significantly impacts the health and long-term living of older
Americans. Through the nutrition program, seniors can receive a
meal at a congregate site or through a home-delivered program
that provides one-third of their daily recommended nutritional
intake. This provides a greater health status to seniors who
might otherwise not be able to achieve proper nutrition. It may
also allow seniors to remain independent and in their homes
instead of being prematurely institutionalized.
According to the U.S. Administration on Aging, the average
age of participants in the combined programs is approaching 80.
As long-term care needs grow with increased life expectancy,
home- and community-based services, such as those provided
under the act, will play an integral part in maintaining the
dignity, independence, and health status of many seniors and
will continue to offer a cost-effective alternative to
institutionalization or hospitalization.
But it cannot be stressed enough that these programs are
more than just a meal. The congregate programs provide an
opportunity for education and socialization and allow seniors
to maintain community ties and stay active in society. The same
is true in the home-delivered program, where the meal delivery
can be the only chance for an isolated senior to engage in
human contact. This socialization is important to reducing
isolation and is a tool used to monitor the safety and well-
being of seniors living alone.
The Older Americans Act nutrition programs are truly a win-
win Federal program. This reauthorization provides an
opportunity to assess the effectiveness of existing programs
and identify future needs. In doing so, we urge you to reaffirm
and expand the commitment to the largest service program in the
act.
Among its top priorities for the future, NANASP urges
Congress to increase authorization levels for all programs in
the act by at least 25 percent above current fiscal year 2006
funding levels to reflect inflation and the projected growth in
the number of older adults. We hope an increase in
appropriations for these programs will also be considered by
Congress this year as opposed to the cuts in the President's
proposed fiscal year 2007 budget.
In my written statement, I have outlined several other
proposals for reauthorization on issues of importance to
NANASP, including title V, transportation, the National Family
Caregiver Support Program, and other title III issues, but
thank you for this opportunity today.
Chairman DeWine. Thank you very much.
[The prepared statement of Ms. Howard follows:]
Prepared Statement of Laura Howard
Senators Enzi, Kennedy, DeWine, and Mikulski, and members of the
committee. I am Laura Howard, Executive Director of the National
Association of Nutrition and Aging Services Programs (NANASP). On
behalf of NANASP's more than 750 members across the country, I thank
you for this opportunity to present NANASP's thoughts on the
reauthorization of the Older Americans Act (OAA).
I and 30 NANASP members had the opportunity to participate in the
recent White House Conference on Aging. We were pleased to see that the
reauthorization of the Older Americans Act was the number one priority
of the delegates. As a professional membership organization
representing those at all levels of the aging network who are dedicated
to providing quality nutrition and other direct services for older
Americans, NANASP has a particular interest in this reauthorization.
This is the year the first baby boomers become eligible for the OAA
nutrition and other service programs, making it the first Federal
service program for the elderly to confront this demographic challenge.
Nutrition providers are acutely aware that the population they
serve today is both changing and growing. One of the major challenges
will be to attract those seniors newly eligible for OAA programs to
participate. This may require a redefinition of congregate meals for a
new generation. Nutrition programs will need to reassess and possibly
redesign menus, service delivery methods and ancillary services offered
to meet the expectations and desires of this new population, while
continuing to serve those currently receiving services. Programs must
balance these demands while adhering to Federal nutritional standards
in an ever-tighter budget environment.
Nutrition significantly impacts the health and long-term living of
older Americans. Through the nutrition programs, seniors above the age
of 60 can receive a meal at a congregate site or through a home-
delivered program that provides one-third of their daily recommended
nutritional intake. This provides a greater health status to seniors
who otherwise might not be able to achieve proper nutrition. The
nutrition programs also allow seniors to remain independent and in
their homes instead of being prematurely institutionalized. According
to the U.S. Administration on Aging, the average age of participants in
the combined programs is approaching 80. As long-term care needs grow
with increased life expectancy, home- and community-based services,
such as those provided under the OAA, will play an integral part in
maintaining the dignity, independence, and health status of many
seniors and will continue to offer a cost-effective alternative to
institutionalization or hospitalization.
The OAA nutrition programs also provide opportunities for social
engagement in both congregate and home-delivered meal programs. It
cannot be stressed enough that congregate programs are more than just a
meal--they provide an opportunity for education and socialization and
allow seniors to maintain community ties and stay active in society.
The same is true in the home-delivered program, where the meal delivery
is at times the only chance for an isolated senior to engage in human
contact. This socialization is important to reducing isolation and is a
tool used to monitor the safety and well-being of seniors living alone.
The nutrition programs also allow seniors to remain active by providing
opportunities for volunteerism and civic involvement.
Through their health, social and other benefits, the OAA nutrition
programs are truly a win-win Federal program. This reauthorization
provides an opportunity to assess the effectiveness of existing
programs and identify future needs. We thank you for the opportunity to
provide input from the perspective of nutrition service providers
during this process and urge you to reaffirm and expand the commitment
to the largest service program in the act.
Specifically, NANASP proposes that the OAA reauthorization:
Increase OAA authorization levels by at least 25 percent
above current fiscal year 2006 funding levels to reflect inflation and
ensure the Aging Network has the necessary resources to adequately
serve the projected growth in numbers of older adults.
In 2006, the oldest of the baby boomers turn 60 and are
now eligible to receive services under the OAA.
One of the fastest growing segments of our population is
made up of those 75 and over. These seniors are often the most frail,
most vulnerable and in the greatest need of aging supportive services
such as those provided by the title III nutrition programs. In fact, 69
percent of those receiving home-delivered meals and 64 percent of those
receiving congregate meals are age 75 and over.
Request that the Institute of Medicine Food and Nutrition
Board conduct a study on the status and effectiveness of the nutrition
programs and thoroughly disseminate the study's findings.
The Older Americans Act Nutrition Program, in existence
for 35 years, has not been comprehensively evaluated by the Food and
Nutrition Board (FNB) in relation to nutrition and health, quality of
life, and independence. Since there were very few nutrition questions
in recent national outcome studies, the cost effectiveness of the food
and nutrition services may be underestimated. However, the cost of 1
day in a hospital equals the cost of 1 year of Nutrition Program meals,
based on 2003 reported total expenditures and number of home-delivered
meals provided by States.
The FNB at the Institute of Medicine, the National
Academies, produces widely disseminated reports that provide
Government, industry, academia, and the public with the best available
information and recommendations about food safety, food security, and
nutrition, thereby promoting public health and preventing diet-related
diseases. Studies have served as the basis for national policy by being
thorough, balanced, and objective. National policymakers need advice on
nutrition and food science in relation to health to ensure that
decisions are supported by the best scientific analysis. Other Federal
food and nutrition assistance programs have been regularly evaluated
and re-evaluated in whole and/or in part by the FNB.
Raise the visibility of nutrition as an important health
and welfare issue for unpaid family caregivers by exploring ways to
provide meals and nutritional services to these caregivers and also
have these meals counted toward NSIP totals.
Unpaid family caregivers can sacrifice their own health,
financial security and quality of life in the course of their efforts
to care for a loved one. If the caregiver is not eating well, this puts
them and their charge at risk. Also a client is more likely to eat more
and receive better nutrition if the caregiver joins him/her in eating
the same meals.
Currently, meals provided to caregivers under the age of
60 are not able to be paid by title IIIC or NSIP money; they must be
paid by title IIIE, though whether this service is covered varies by
State.
If caregiver meals are paid using title IIIE funds,
allowing these meals to be counted toward NSIP totals will allow OAA
nutrition programs to better meet the needs of the client and his or
her caregiver by providing a nutritious meal.
Ensure that the National Family Caregivers Support
Program's (NFCSP's) match rate is equal to that of other OAA programs.
Currently, the match rate for the NFCSP is 25 percent,
while the match rate of other title III programs is 15 percent.
The increased match rate puts a significant burden on
service programs already stretching limited resources and competing for
local and public funding. Programs need to be encouraged to continue to
provide services to at-risk caregivers and to plan for the future with
additional services for the long-term population growth. With the
increased match, many programs may not be able to continue with
caregiver programs and services.
Establish and authorize adequate funding for one or more
Nutrition and Physical Activity Resource Centers.
The OAA Nutrition Program is the largest program
administered by the U.S. Administration on Aging. Yet, there is no
requirement for the Assistant Secretary to fund a Resource Center for
Nutrition and Physical Activity. Funding such a Resource Center is
currently at the discretion of the Assistant Secretary for Aging.
The Aging Network needs technical assistance, access to
the latest scientific information, guidance to establish outcome-based
model programs, and help to implement newly released Federal
guidelines, such as the Dietary Reference Intakes (DRIs) and Dietary
Guidelines for Americans, as well as national physical activity
recommendations targeted to older adults. A Resource Center or Centers
can assure that the Aging Network technical assistance needs are met.
Another goal is to promote better cooperation between the food industry
and the OAA Nutrition Program. Development and/or reformulation of more
nutritious food products would expand menus options, food quality, and
cost-effectiveness.
Require each State unit on aging and encourage area
agencies and local programs to employ registered dietitian(s) (RDs)
because of their specific nutrition, food safety and foodservice
expertise, as well as their program administration abilities.
Currently, there is no requirement at the State level to
have a registered dietitian on staff, though budgetary and major
administrative decisions are made at the State level that impact local
nutrition programs.
An RD would bring specific skills to the design,
implementation and evaluation of the nutrition program. Application of
the basic nutrition science of the Recommended Dietary Allowances and
the Dietary Guidelines for Americans is essential to help keep older
adults active, healthy and at home. This science is increasingly
complex. The RD can integrate and disseminate this information about
nutrition science advancements to ensure that the most recent science
evidence is put into practice.
An RD can ensure that the role of nutrition is addressed
in home- and community-based nutrition services in the context of long-
term care, especially since programs are serving more frail, impaired
older adults at home who have more complicated nutrition needs.
An RD can be a resource for training other professionals
and function as a team member in designing comprehensive and
coordinated service systems to meet the unique needs of older
individuals in each State.
Include statutory language in the Older Americans Act that
increases support to the Aging Network to promote senior mobility and
to facilitate coordination of human services transportation, especially
as it relates to nutrition.
Transportation is a priority service under OAA Title III.
Mobility is essential to live at home in the community. Providing safe,
convenient modes of transportation to those who can no longer drive is
necessary, but transportation funding competes with limited funding for
many other needed services.
The act needs to allow flexibility for agencies to
collaborate together in meeting the community needs.
Maintain the title V Senior Community Service Employment
Program's (SCSEP's) vital, historic focus on community service, which
significantly benefits nutrition programs and the entire aging
population.
Low-income older adults who want or need to remain in or
re-enter the workforce need options for employment. SCSEP allows older
adults who must work to stay independent but who may not have the
education or resources to compete with younger workers.
Workers under the SCSEP program provide incredible value
to the aging network that needs dedicated staff, but has increasingly
limited funds.
Through these principles, we believe the act will be strengthened
and improved to allow service providers to adequately prepare for the
projected increase in demand while continuing to serve the seniors who
rely on these services.
Chairman DeWine. Ms. Borden.
STATEMENT OF ENID A. BORDEN, CHIEF EXECUTIVE OFFICER, MEALS ON
WHEELS ASSOCIATION OF AMERICA, ALEXANDRIA, VIRGINIA
Ms. Borden. Senator DeWine, Senator Mikulski, I am Enid
Borden, CEO of the Meals On Wheels Association of America. You
have asked that I focus my remarks on the broad issue of the
effectiveness of the Older Americans Act since the 2000
reauthorization.
As you might expect, I will say emphatically that senior
nutrition services have benefited older Americans by, one,
improving some seniors' declining nutritional and health
status; two, restoring others to wellness; three, keeping many
individuals out of institutions; and four, preventing seniors
from going hungry, yes, going hungry.
Whenever I tell people what I do, the response usually is,
Meals On Wheels is a wonderful program. On the one hand, it is
gratifying to have such a positive image, the one of the
smiling volunteer walking up with a nutritious meal to the
front door of a waiting homebound senior, and that is an
accurate picture in that it portrays the heart of our program.
But allowing local senior meals program to be portrayed only as
warm and fuzzy social service programs, however, fails to
emphasize the critical, often life-saving role these programs
play in the lives of the people we serve.
Perhaps more serious and hard to discuss is that the rosy
picture of our success fails to acknowledge the consequences of
those individuals who don't get served because of a lack of
resources. It is not a pleasant subject, but we need to admit
that those consequences and the tragic fact that hunger exists
among the elderly in this, the richest Nation on the planet. We
need to admit that lack of proper nutrition leads to poor
health and even death. And then we need to commit to working
together to ensure that not one senior goes hungry.
How do we do that? By increasing resources. That is usually
the province of appropriations, but MOWAA's proposal is one
that only you as the authorizing committee can enact.
Nutrition programs are the largest OAA program and last
year accounted for approximately 46 percent of AOA's agency
budget. But current law allows States to transfer up to 30
percent between title III(b) supportive services and title
III(c) nutrition services. In the 5 fiscal years since the last
reauthorization, total net transfers from nutrition services
into supportive services was over $174 million. MOWAA has
supported allowing flexibility to States to shift some funds to
meet specific needs and we continue to do so.
But given the current limitation on resources, we propose
that transfers should be allowed only if there is no unmet need
in the category for which the allocations were explicitly made.
There should be no transfer from nutrition services to
nonnutrition-related supportive services as long as any waiting
list for nutrition service exists or while even one senior is
going hungry.
I mentioned $174 million was transferred out of nutrition
services in 5 years. Here is that figure in context. At an
average cost of $5 per meal, that equates to a loss of
approximately 35 million meals. Those funds, if reserved for
nutrition, could have gone a long way toward eliminating
current waiting lists in four out of our ten programs.
I want to close by thanking you for your dedication to
improving the lives of our older Americans. Leadership and
national commitment come from the top. The Older Americans Act
that Congress created and that you on this committee continue
to refine is the foundation that makes our work possible. Thank
you.
Chairman DeWine. Thank you.
[The prepared statement of Ms. Borden follows:]
Prepared Statement of Enid A. Borden
Chairman Enzi, Senator Kennedy, Members of the Health, Education,
Labor, and Pensions Committee and particularly of the Subcommittee on
Retirement Security and Aging, I am Enid Borden, CEO of the Meals On
Wheels Association of America (MOWAA), and on behalf of the hundreds of
home-delivered and congregate senior meal programs that are MOWAA
members and the literally hundreds of thousands of older Americans they
serve, I want to thank you for holding this roundtable today. MOWAA is
pleased to participate and most encouraged that the committee has
turned its attention to the reauthorization of the Older Americans Act
this early in the second session of the 109th Congress. We hope that it
will remain a top priority until reauthorization is completed.
For the purposes of this roundtable you have asked that we focus on
the broader issue of the effectiveness of the Older Americans Act since
the 2000 reauthorization and specifically how the programs have served
older Americans. As you might anticipate, I will confine my comments to
the benefit of meal services. And as you must also expect, I will say
emphatically and without equivocation that senior nutrition services--
whether delivered in senior centers or to the doors of frail, homebound
men and women in communities across America--have been of significant
benefit to hundreds of thousands of individuals in communities in every
State of the country. But saying it that way understates the critically
important role those meals and related services play in the lives of
people who receive them. Meals furnished under Title III of the Older
Americans Act, particularly home-delivered meals, have (1) improved
seniors' declining nutritional and health status, (2) they have
restored older Americans to wellness, (3) they have contributed to
keeping many individuals out of institutions and from isolation (4)
they have kept seniors from going hungry, Yes, you heard me correctly
they have kept seniors from going hungry. Please think about that as
you work through the reauthorization.
Whenever I tell people what I do, the response is usually, ``Meals
On Wheels is a wonderful program.'' On the one hand, it is gratifying
to have such a positive image . . . the one of the smiling volunteer
walking up with a nutritious meal to the front door of a waiting home
bound senior. That is an accurate picture in that it portrays the heart
of our program. But allowing local senior meal programs to be portrayed
only as warm and fuzzy social services programs fails to emphasize the
critical, often life saving, role these programs play in the lives of
the people we serve. Perhaps more serious--and hard to discuss--is that
the rosy picture of our successes fails to acknowledge the consequences
for those individuals who don't get served because of a lack of
resources. It is not a pleasant subject. But we need to admit to those
consequences and the tragic fact that hunger exists among the elderly
in this, the richest Nation on the planet. We need to admit that lack
of proper nutrition leads to poor health and even death. Then we need
to commit to working together to ensure that not one senior goes
hungry.
How do we do that? Incrementally, of course. It starts with raising
awareness. Then it relies on resources. I know that you are authorizers
and not appropriators, and although I certainly want to make a pitch
for higher appropriation levels, the one proposal that I will raise
today only you as the authorizing committee can enact.
As background, you know: The OAA nutrition program is the largest
program administered by the Administration on Aging (AOA). Last year
funding for senior nutrition programs (title III-CI and III-C2 and the
Nutrition Services Incentive Program) accounted for approximately 46
percent of the total agency budget. That is, as authorized and
appropriated, it was 46 percent. As you are also aware, currently the
act allows States to transfer up to 30 percent of the total line item
amount between titles III-B, Supportive Services, and title III-C,
Nutrition Services.
In the 5 fiscal years since the last reauthorization--2000 through
2004--total net transfers from title III-C to title III-B was over $l74
million dollars. MOWAA has always supported allowing flexibility to
States to shift some funds to meet specific State and local needs. We
continue to support some flexibility but, given current needs and the
limitation on resources, only under specific conditions. MOWAA proposes
that the act be amended to specify that transfers be allowed to be made
between titles III-B and III-C only if there are no unmet needs in the
category for which the allocations were explicitly made. In other
words, there should be no transfer from title Ill-C to title Ill-B for
non-nutrition related Supportive Services while waiting lists for
nutrition services exist in any community or while even one senior goes
hungry.
Consistent with this proposal to establish line item integrity,
MOWAA also believes that the act should stipulate that general and
administrative dollars must be taken from the line item or category in
which the services are performed. In other words, title Ill-C dollars
may not be used to pay the administrative cost associated with managing
title III-B services.
If I may put the $174 million I mentioned earlier in context, let
me suggest that at an average cost of $5 per meal, that equates to a
loss of approximately 35 million meals. Those funds, if reserved for
nutrition, could have gone a long way toward eliminating current
waiting lists that more than 4 out of 10 home-delivered meal programs
have. Preservation of nutrition funds for nutrition services will help
assure that no senior of today or aging Baby Boomer goes hungry.
Before I close, Mr. Chairman and members of the committee, let me
raise two other points. Ever since the Mathematica Study was conducted
over a decade ago, we have been in the habit of using the concept of
waiting lists to measure unmet needs. It may be the only mechanism we
have, but it is flawed and clearly understates the extent of the real
need that exists today and is bound to grow as the Baby Boomers age.
For one thing, not all programs keep waiting lists. Even more
significant than that is the fact that not all seniors who could
benefit by our services even try to access them. MOWAA is involved in
two pilot projects--one called ``Community Connections'' that is a
cooperative agreement with AOA and the other is a partnership with
Humana. Both entail working to see that patients leaving the hospital
who need home-delivered meals services get them upon discharge. Our
preliminary results with ``Community Connections'' demonstrate positive
health impact for those seniors, and we will soon be releasing our
results. Another important finding of both these projects is that many
of these eligible seniors either do not know of the availability of
local meal programs or how to access them. This is another layer of
unmet need.
My second point is that the services we do provide are themselves
limited. Most programs, again because of resource constraints, can
serve only the minimum that the act allows--one meal per day, 5 days
per week. Most Americans eat 21 meals per week. My fellow delegates at
the 2005 White House Conference on Aging, who participated in the
Implementation Strategy Session for the Older Americans Act, listed
among their priorities for the future that senior nutrition programs be
expanded to three meals per day, 7 days per week, That is a goal that
MOWAA embraces and a vision that we share. The impediment to achieving
that is a lack of adequate resources.
Having said that, MOWAA acknowledges that the Federal Government
cannot and should not be the sole source of the funding needed to
provide services. This Association and our member programs work on a
daily basis to raise funds from other sources and to engage other
entities within the community in our important work. It helps our
programs build capacity and it enriches communities. But the undeniable
fact is that the Federal commitment, embodied in the Older Americans
Act, is the foundation on which we build. Leadership is important; in
fact, in a real sense, putting an end to senior hunger depends as much
on leadership as it does on food. How the act directs the use of
designated funding streams is vital, particularly in the face of the
limitation on Federal dollars now and in the near term. Congress can
and must lead by reforming policies and setting set priorities to
address changing demographics and needs. That is what MOWAA is asking
of you today.
Some things--like the rising price of gasoline that has severely
impacted our programs by raising their program costs, the changing
demographic that will put additional strains on our programs, or even
an across-the-board reduction in discretionary spending that have left
our programs faced with trying to provide services with shrinking
resources--are not within the purview of this committee or your power
to change. But the simple amendment to the statute that MOWAA proposes
is. We implore you to give it your most serious consideration. We would
be delighted to work with you and your staff in any way we can on this
issue.
I want to close by thanking you, not just for this opportunity to
address you, but for your dedication to improving the lives of
America's great resources--its older Americans. You have demonstrated
your commitment in the past and America's most vulnerable older adults
are counting on you to do so.
Chairman DeWine. Ms. Markwood.
STATEMENT OF SANDY MARKWOOD, CHIEF EXECUTIVE OFFICER, NATIONAL
ASSOCIATION OF AREA AGENCIES ON AGING, WASHINGTON, DC.
Ms. Markwood. Senator DeWine, Senator Mikulski, my name is
Sandy Markwood. I am the CEO of the National Association of
Area Agencies on Aging, and on behalf of our membership of 650
Area Agencies across the Nation, I want to thank you for having
me at this roundtable today.
Since it was enacted in 1965, the Older Americans Act has
served as a legislative vehicle and the guiding force behind
efforts to help older Americans successfully age where they
prefer the most, in their homes and in their communities, and
to do this safely with security and with independence for as
long as possible. As the baby boom generation ages, ensuring
that the necessary supports that are in place to promote
healthy and productive aging has never been more important.
According to the CDC, roughly 26 million older adults over
the age of 65 have physical limitations or need assistance with
activities of daily living. This figure jumps to almost two-
thirds for older adults who are age 80-plus.
The system of supportive services the Older Americans Act
operates in communities across this Nation, through State Units
on Aging, Area Agencies on Aging, title VI Native American
aging programs, and also a broad array of service providers,
every year serves over 8 million older adults with physical
limitations and helping them to remain independent and live
where they choose. Additionally, they are saving taxpayers
money and saving the Federal Government money because they are
at home and in the community and not in institutional care,
which is much more expensive.
Given the age explosion this Nation is going to be facing,
the 77 million baby boomers, as well as the increase in the old
old, those 85-plus in this Nation, the need for these
supportive services is great. Now is the time to ensure that
the Older Americans Act is ready to continue its successes to
address the challenges and the opportunities of the aging
population.
To do this, n4a is recommending several different proposals
that we have in our written statement, but I would like to
highlight a few of those today, and that is, first, to enhance
the act to assist our older adults to be able to age in the
community for as long as possible, to enhance the opportunity
for communities to prepare for the aging of the population. The
aging of the population is going to impact aging services
directly, but it is also going to impact on a whole broad array
of services that are provided in our Nation's cities and
counties, from transportation to housing, land use planning,
public safety, parks and recreation, workforce development.
These are programs that will be directly and dramatically
impacted by the aging of the population. However, today, very
few communities have started planning and preparing for the
aging of the population. Building on the role that State Units
and Area Agencies already have as part of the act, n4a is
recommending that we build on that and enhance the role of Area
Agencies and State Units on Aging to be able to help
communities prepare for the aging of the population.
Additionally, we would like to strengthen the aging
network's role as a single point of entry. We applaud the AOA's
pilot programs in aging and disability resources and think it
is now time to make these aging and disability resources a
permanent part of the act.
Additionally, third, we would like to enhance the aging
network's role in health promotion and disease prevention. More
and more research and studies clearly indicate that health
promotion and disease prevention activities, even if initiated
late in life, can reap substantial benefits for older adults.
Additionally, they can also eliminate or offset the onset of
chronic diseases. This improves the quality of life for older
adults, but again, saves the Nation and its taxpayers millions
of dollars every year. Now is the time to enhance Title III(d)
of the Older Americans Act, not eliminate it.
These are a few of our proposals. I have gone into more
detail in our written statement. But again, we believe that now
is the time to be bold, to modernize this act, and to make it
successful for today's and tomorrow's seniors.
Chairman DeWine. Thank you.
[The prepared statement of Ms. Markwood follows:]
Prepared Statement of Sandy Markwood
ABOUT N4A
N4A is the leading voice on aging issues for area agencies on aging
across the country and a champion for title VI Native American aging
programs in our Nation's capital. n4a advocates on behalf of its member
agencies for enhanced services and resources for older adults and
persons with disabilities in local communities nationwide. With
independence, dignity and choice strongly held American values, n4a has
long promoted the development of a service system that provides older
consumers with access to the most appropriate services in the least
restrictive environment. In addition to advocacy, n4a also provides
training, technical assistance and support to the national network of
650 AAAs and 240 title VI agencies to assist them in achieving our
collective mission of building a society that values and supports
people as they age.
MEETING THE NEEDS OF OUR NATION'S OLDER ADULTS
Since it was enacted in 1965, the Older Americans Act (OAA) has
served as the legislative vehicle and guiding force behind efforts to
help older Americans age in their homes and communities safely and with
maximum dignity and independence for as long as possible. As the baby
boom generation ages, ensuring that the necessary supports are in place
to promote healthy and productive aging has never been more important.
According to the Centers for Disease Control and Prevention (CDC),
roughly 26 million older adults over the age of 65 have physical
limitations or need assistance with activities of daily life, such as
eating, bathing, dressing or getting around (2003). Among adults over
age 80, almost three-quarters (73.6 percent) report at least one
disability.
The most preferred form of long-term care is provided through home-
and community-based services, such as home-delivered meals, homemaker
services, and respite care. Community-based supports and services allow
older adults with physical limitations to remain independent and live
where they choose, saving the Federal Government and the Nation's
taxpayers the cost of expensive institutional care.
Recent data from the Administration on Aging (AOA) show how
successful OAA programs and services have been assisting older adults
and their caregivers. AOA reports that 86 percent of family caregivers
of OAA clients said the services ``allowed them to care longer for the
elderly than they could have without the services.'' Additionally, OAA-
provided meals and services have allowed the nearly one-third of
elderly home-delivered meals clients who have health conditions that
make them nursing home-eligible remain in the community.
The OAA offers an extensive range of options for older adults,
including, but not limited to homecare services, transportation,
ombudsman, case management, advocacy and assistance. The breadth and
depth of OAA programs and services provide essential support to older
adults who wish to age in place.
One of the reasons the OAA is so successful is that it is based on
an effective and efficient system--the national Aging Network--which
serves as the infrastructure for aging service delivery at the Federal,
State and local level. The OAA binds together all 650 AAAs and 240
title VI Native American aging programs across the country, providing a
support structure for planning, service coordination, oversight, and
advocacy on programs and services that reach more than 8 million older
Americans every year. AAAs serve as the focal point at the community
level to link seniors and their family caregivers to a myriad of
services.
AAAs serve as a single point of entry for the complex and
fragmented range of home- and community-based services for older adults
and their caregivers, including congregate and home-delivered meals,
other in-home services for the vulnerable seniors (such as personal
care and chore services), elder abuse prevention and protections, the
nursing home ombudsman program, senior centers, transportation,
consumer information, education and counseling and senior employment.
AAAs and title VI agencies leverage Federal dollars with other
Federal, State, local and private funds to meet the needs and provide a
better quality of life for millions of older adults. According to AOA:
``In fiscal year 2003 . . . State and local communities leveraged
approximately $2 from other sources for every $1 of Federal funding;
for intensive in-home services, the ratio was closer to $3 to $1.''
Many AAAs manage or receive funding from a variety of sources in
addition to the OAA, including Medicaid waivers for home- and
community-based care, social service block grants, transportation
funds, and state-funded in-home service programs. AAAs have
demonstrated an extraordinary record of achievement in stretching
limited Federal resources to help hundreds of thousands of older people
avoid costly nursing home placement and remain independent. OAA funds
make it possible for AAAs to leverage millions of non-federal dollars
from local Governments, foundations, the private sector, and
participant and volunteer contributions.
THE NEXT EVOLUTION: REAUTHORIZATION 2006
Since its inception, the OAA has evolved to meet the changing needs
of older adults and those who care for them. The creation of the AAA
network in 1973 developed the community-level infrastructure that, to
this day, serves to coordinate the core services that older adults have
come to depend on, including nutrition programs, senior centers,
community service employment, and a range of supportive services such
as home care, transportation, elder abuse prevention, and legal
assistance. In 2000, the OAA again evolved to directly address the
needs of family caregivers--the backbone of our Nation's long-term care
system--through the National Family Caregiver Support Program.
n4a is pleased that the Senate Health, Education, Labor, and
Pensions Committee is examining how the Older Americans Act needs to
evolve again to meet the current and future challenges of older adults
and their caregivers.
Our challenge in 2006 and beyond is largely one of demographics. It
is projected that the 65 years and older population, which numbered 35
million in 2000, will more than double in size to about 70 million in
the next 26 years. By 2030, one out of every 5 people in the United
States will be age 65 and older. People 85 and older are currently the
fastest growing segment of the population, increasing at a rate four
times faster than any other age group.
This year, the first baby boomers are turning 60, the age of
eligibility for OAA services. Over the course of the next 3 decades,
the aging of the baby boomers will have a direct and dramatic impact on
national, State and local policies, programs and services. With the
first of the 77 million baby boomers approaching retirement age, and
the current senior population experiencing a ``longevity boom'' of
unprecedented proportions, now is the time for individuals, families,
communities and the Nation as a whole to plan and prepare for this
coming demographic explosion.
To balance the current and future needs of the older adult
population, n4a believes that legislative changes are needed to improve
the accessibility and quality of OAA programs, while meeting rising
demand.
As such, we make the following recommendations:
1. Help Communities Prepare to Meet Demographic Challenges. The
increase in the numbers of aging citizens will impact the social,
physical and fiscal fabric of our Nation's cities and counties,
directly and dramatically affecting local aging, health, human
services, land use, housing, transportation, public safety, workforce
development, economic development, recreation, education/lifelong
learning, and volunteerism/civic engagement policies and services.
Given their mandated role under the OAA to create multi-year plans
for the development of comprehensive, community-based services which
meet the needs of older adults, AAAs and title VI Native American aging
programs are in a unique position to help communities prepare to
address the challenges and opportunities posed by the growing numbers
of older adults.
n4a recommends that new language be included in the OAA to
authorize State Units on Aging, Area Agencies on Aging and title VI
Native American aging programs to help communities prepare for the
aging of the baby boomers.
New funds will be needed to support this expanded role, which would
support a full- or part-time planning staff position in every AAA. This
professional planner would offer the Aging Network's expertise to help
State agencies, local city and county elected officials, local
Government agencies, tribal councils, and private and nonprofit
organizations to develop policies, programs and services to foster
livable communities for all ages. In addition we recommend that:
Funding be non-formula based, with a minimum level of
funding and additional formula-based funding to increase resources to
more heavily populated service areas, and have a 25 percent non-federal
match requirement.
It includes non-formula based funding to State Units on
Aging to coordinate state-level preparedness planning.
A national resource center on aging in place be
established to provide the necessary guidance, training and technical
assistance to SUAs, AAAs and title VI Native American aging programs in
their efforts to help communities become livable communities for all
ages.
The new provision be evaluated and sunsetted in 10 years.
2. Strengthen the Aging Network as a Single Point of Entry. n4a
urges that the OAA reauthorization permanently establish authorized
Aging and Disability Resource Centers (ADRCs) within every service area
in the Nation, with AAAs given the right of first refusal to be
designated as the ADRC within their service areas. The ADRC program,
part of the President's New Freedom Initiative, and spearheaded by the
U.S. Administration on Aging and Centers for Medicare and Medicaid
Services, has helped 43 States integrate their long-term support
programs for the elderly and people with disabilities into a single
coordinated system.
The OAA and the Aging Network comprise the Nation's non-Medicaid
long-term care system, and also many AAAs manage Medicaid home- and
community-based long-term care services. In order to structure a system
that is easily accessible to all who need long-term care, AAAs and
title VI Native American aging programs should be the single point of
entry for both Medicaid and non-Medicaid long-term care services.
Many individuals with disabilities, whether age-onset or life-long,
need information on and access to basic supportive services that will
enable them to become or remain active and contributing members of the
community. Over the last 30 years, AAAs and title VI Native American
aging programs have developed the infrastructure that coordinates a
host of programs that provide information on, access to and choices for
individuals who seek such services.
AAAs have become the first and most trusted source for older
Americans and their caregivers who are seeking information on home- and
community-based services, both public and private, anywhere in the
Nation. The rising numbers of aging baby boomers will bring a
corresponding increase in the need and demand for a ``one stop'' source
of information as well as a single point of entry into the aging
services system.
3. Enhance the Aging Network's Role in Health Promotion and Disease
Prevention. To enhance the ability of AAAs to carry out health
promotion and disease prevention efforts, n4a seeks an authorization
level of $50 million for the title III-D program and proposes that $10
million of the appropriation be set aside to pilot, through the AAAs, a
community-based collaborative between local aging and healthcare
providers to promote disease prevention services.
Although only funded at $21 million in prior years and targeted for
elimination in the President's fiscal year 2007 budget, Title III-D of
the OAA has played a pivotal role in disease prevention and health
promotion services for seniors in communities across America. This
program has become increasingly invaluable as recent evidence-based
research continues to prove that health promotion and disease
prevention not only contribute significantly to an individual's quality
of life, but also are a cost-effective means of reducing, or in some
cases eliminating, acute or chronic care costs.
As the coordinators and providers of home- and community-based
services at the local level, AAAs and title VI agencies have long
recognized the critical importance of health promotion and disease
prevention. With limited title III-D funding, these agencies have
developed innovative programs that improve the physical and mental
well-being of older adults, while reducing the need for more intensive
chronic and acute care services. To enable older adults to remain in
their homes and communities for as long as possible, one critical
element is engaging in activities that promote healthy living.
4. Increase Authorization Levels to Enhance Home and Community-
Based Services. AAAs, as part of the larger Aging Network, have the
ideal structure, the established reputation, and the expertise to
engage in community planning, to serve as the ADRC, and to manage
health promotion and disease prevention programs. What they lack are
adequate financial resources.
The OAA has provided vital community-based supports to millions of
older adults for 40 years. Since 1980, however, there has been a
substantial loss in the OAA's capacity to provide services to older
Americans due to rising costs, an increasing number of older adults in
need of services in general, and the need to provide more extensive
services to larger numbers of vulnerable older persons living into
their 80s, 90s and beyond.
To illustrate how the cost of providing services has risen over the
last 5 years, we'd like to share examples of a few situations in the
State of Ohio.
In many areas of Ohio, especially the more rural areas, a pattern
that holds up across the country, transportation is one of the most
requested services by older adults. It is also one of the most under-
funded and suffers from the most rapidly rising costs. Lack of funding
has forced the Toledo-based AAA to provide 40 percent fewer trips in
2005 than it did in 2002. Its AAA neighbor to the southeast, Ohio
District 5 out of Mansfield, reports it could offer transportation
services to 21.5 percent fewer consumers between 2000 and 2005. Besides
the oft-recognized increases in fuel costs, vehicle maintenance and
insurance costs have also risen dramatically.
Food prices have also risen in recent years, driving up the cost of
home-delivered and congregate meal programs that are funded under OAA
Title III. The Central Ohio AAA paid $4.60 for each home-delivered meal
served in 2000; that same meal is $5.05 today. In Southeastern Ohio,
the cost of a home-delivered meal has reached $6.53, up from $5.81 5
years ago.
Unfortunately, appropriations for OAA programs over the past 5
years have not reflected these and other increased costs. As a result,
they have not kept up with demand. A senior center in Perry County
reports that they keep waiting lists for home-delivered meals and
homemaker services, but that ``many of the clients are deceased before
we can serve them.'' In Lucas County, the number of seniors enrolled in
programs has increased by 42 percent since 2000.
Another factor also needs consideration. In Ohio and nationwide
this year, the roll-out of the new Medicare Part D prescription drug
plan has placed additional responsibilities on AAAs, largely without
additional funding. Older adults and their families have turned to AAAs
and title VI programs en masse during the 2005-2006 enrollment
campaign. Yet only a small number of local aging programs received new
resources from States or national pilot projects to support their one-
on-one counseling and enrollment assistance efforts.
To respond to the overwhelming demand for Medicare Rx assistance,
AAA staff were often shifted from other responsibilities to help with
Medicare Part D enrollment, making this level of effort unsustainable.
Even when the initial enrollment period ends, the public will continue
to turn to AAAs and title VI aging programs. Millions of seniors will
continue to need counseling and enrollment assistance every year, as
they become newly eligible for Medicare or seek to change their
prescription drug plans.
In order for AAAs and title VI Native American aging programs to
continue the tremendous amount of work that Medicare Rx enrollment
assistance has generated, they will need new funding to support and
sustain their efforts.
In conclusion, to compensate for inflation and the rising costs of
providing services, n4a seeks to raise the authorized funding levels of
all the Titles of the OAA by at least 25 percent above the fiscal year
2006 appropriated funding level, except for Title III-E which should be
authorized at $250 million. The increased authorization levels will
ensure the Aging Network has the necessary resources to adequately
serve the projected growth in the numbers of older adults, particularly
the growing ranks of the 85 and older population who are the most
vulnerable and in the greatest need for aging supportive services.
CONCLUSION
n4a appreciates the opportunity to present our suggestions for
modernizing and strengthening the Older Americans Act. We look forward
to working with Congress to reauthorize the OAA in a way that respects
the needs of today's older adults and their caregivers, recognizes and
rewards the cost-effectiveness of home- and community-based care vs.
institutional care, and prepares adequately and responsibly for the
aging boom.
Chairman DeWine. Mr. Flood.
STATEMENT OF PATRICK FLOOD, COMMISSIONER, VERMONT DEPARTMENT OF
DISABILITIES, AGING, AND INDEPENDENT LIVING, ON BEHALF OF THE
NATIONAL ASSOCIATION OF STATE UNITS ON AGING, WASHINGTON, DC.
Mr. Flood. Thank you. Good afternoon. My name is Patrick
Flood. I am the Commissioner of Vermont's Department of
Disabilities, Aging, and Independent Living and I am here today
to represent the National Association of State Units on Aging,
of which we are one, otherwise known as NASUA. NASUA is the
national organization of State Units. The State Units in State
Government administer the Older Americans Act in partnership
with Area Agencies on Aging and the rest of the aging network,
as well as manage a broad range of other State and Federally-
funded programs.
I started out my career in aging services as a case manager
in the AAA and for 5 years, I was the State long-term care
ombudsman, so I have been living the Older Americans Act for a
number of years. The act has developed a system in this country
of services for elders that this country should be and can be
proud of. It has made a huge difference in the daily lives of
millions, millions of older Americans over the years.
The act needs to be strengthened and the service system
needs to be strengthened. Over the years, the act has been
reauthorized and this reauthorization provides an opportunity
to modernize the act's programs in preparing to serve the next
generation of older people as well as to better meet the needs
of today's growing and diverse aging population.
NASUA has submitted to the committee detailed positions on
the act's reauthorization. Today, I just wanted to highlight
four key recommendations.
First, the Older Americans Act services have been the
cornerstone upon which State Units on Aging have built their
home and community-based long-term care systems. I think that
is something that is not well known. Today, almost all State
Agencies on Aging also administer State-funded long-term care
programs, and two-thirds of them manage their State Medicaid
waiver programs for both elders and, in many cases, people with
physical disabilities.
The Aging and Disability Resource Centers funded under
title IV have made it easier for older people to both access
various public and private programs and obtain information that
will help them make the informed decisions they need to make
about their long-term care needs and about other benefits and
options. We recommend that these resource centers should become
a permanent part of the act.
Second, we recommend adding a distinct component to the
National Family Caregiver Support Program to focus on persons
with Alzheimer's disease and their families, because if there
is any family that has to deal with caregiver issues, it is a
family with an Alzheimer's victim, and to continue the progress
of the Alzheimer's disease demonstration program in developing
and testing new ways to meet this population's need.
Third, we propose an expansion of the act's emphasis on
health promotion and disease management. I used to be a nurse,
as well, and there is tremendous discussion in this country now
about disease prevention and health promotion, and I am here to
tell you that I don't believe those efforts will truly succeed
unless the aging network is involved, because it doesn't matter
what you order in the doctor's office. If the person can't get
their prescription drugs or if they can't get the nutrition
that they need to remain healthy or they can't get the
transportation that they need to get their groceries, it won't
matter what you order for treatments and services.
Fourth, the act has created important programs that form
the core of State elder rights systems, such as the Long-Term
Care Ombudsman Program, legal assistance, and elder abuse
prevention. Most State agencies also administer their State's
adult protective services systems as well as the State Health
Insurance Assistance Counseling Program known as SHIP. We
propose that new authorities and resources be added to the act
to help States and Area Agencies on Aging enhance information
and counseling for older people, covering a wide range of
benefits such as health and prescription drug plans and long-
term care financing options, retirement security, and income
support.
Nothing highlights the need for this more than the recent
implementation, flawed implementation, I might add, of the
Medicare prescription drug program. If it weren't for the aging
network in this country, there would still be many, many more
seniors not getting the prescription drugs that they need, and
if that is not--if we are not included, if we are not funded
appropriately to help seniors, that is going to continue to be
a problem in the coming months and years.
So thank you for the opportunity to present NASUA's
recommendations to this committee and we look forward to
working with you.
Chairman DeWine. Thank you very much, Mr. Flood.
[The prepared statement of Mr. Flood follows:]
Prepared Statement of Patrick Flood
Introduction
The National Association of State Units on Aging (NASUA) is pleased
to share with you a comprehensive set of recommendations for reform of
the Older Americans Act (OAA) when it is reauthorized by the 109th
Congress in 2006. These recommendations are based on a set of
principles adopted by the NASUA membership in June 2004 at our 40th
Anniversary Annual Meeting in Washington D.C. These principles provided
the policy framework within which these recommendations for reform were
developed by the membership in December of 2004.
NASUA believes that the forthcoming reauthorization of the act
provides an opportunity to modernize its structures, programs, and
services to prepare to serve the next generation of older persons and
their families. As you may know, the first cohort of baby boomers will
become eligible for most of the services provided under the act during
the next reauthorization period. Therefore, we strongly believe that it
is critical that the Congress, the administration, national
organizations, and State and local stakeholders take this opportunity
to focus attention on the current status of the act, its overall
effectiveness, and future ideas to enhance its capacity to serve the
Nation.
We look forward to an open and productive dialogue with all
interested parties on the recommendations for changes that NASUA deems
necessary from our perspective to further strengthen the act. Working
together we can ensure a reauthorization process that results in an OAA
that continues to be responsive to the dynamic circumstances, needs,
and preferences of older Americans and their families as America
diversifies and ages.
POLICY RECOMMENDATIONS FOR THE 2006 OAA REAUTHORIZATION
1. Continue the Federal Government's responsibility to assist States
and communities to meet the needs of older people by increasing the
authorized Federal funding level of all OAA Titles and chapters to
reflect demographic change and inflation.
Recommended Statutory Change
A. Raise the authorized funding level of all currently funded
programs by at least 25 percent above the fiscal year 2005 appropriated
funding level except for title III part E which should be authorized at
$250 million.
B. Provide specific funding levels for all programs currently
authorized but not funded and all new programs authorized.
2. Strengthen the authority of State Government to ensure that the
act's resources are targeted to those older persons most in need of
support to maintain dignity and independence, such as the very old,
the poor, the near poor who may not qualify for Medicaid (Title XIX
of the Social Security Act), the frail, those geographically or
socially isolated, limited English speaking individuals, and low-
income minority persons.
Recommended Statutory Change
A. In all provisions of the statute which require State and area
agency assurances and/or preferences related to targeting resources or
activities to those most in need add references to ``the near poor who
may not qualify for Medicaid (Title XIX of the Social Security Act),''
``the very old,'' and ``limited English-speaking older persons.''
3. Provide for an authorization period that is sufficient to ensure
continuity, promote quality improvements in programs and services
and allow newly authorized programs and amendments to be fully
implemented.
Recommended Statutory Change
A. Amend all appropriate sections authorizing current and new
programs for 5 years, except where noted.
4. Strengthen and broaden the Federal leadership role of the Assistant
Secretary for Aging to:
Include a new partnership with the Centers for Medicare
and Medicaid Services (CMS) in the administration of HCBS Medicaid
Waiver Programs and other long-term care programs.
Include a new partnership with CMS to ensure that older
qualified individuals with disabilities have access to services in the
most integrated setting appropriate to their needs.
Provide information, education and counseling to people
with Medicare in partnership with CMS.
Assist in efforts to ensure the integrity of the Medicare
program in partnership with CMS.
Advocate with other Federal agencies to end age bias and
increase access by older persons to Federal programs and services.
Recommended Statutory Change
A. Add a new provision in section 202(a) requiring the Assistant
Secretary to work with the Centers for Medicare and Medicaid Services
in the development, approval, and administration of Medicaid HCBS
Waivers for older persons.
B. Add a new provision in section 202(a) requiring the Assistant
Secretary to work with the Centers for Medicare and Medicaid Services
in the design, review, and approval of Medicaid research and
demonstration projects in long-term care.
C. Add a new provision in section 202(a) requiring the Assistant
Secretary to prepare, publish, and disseminate a report, either
directly or through grant/contract, which details all existing Federal
policies that create barriers to community living for older people and/
or have an inherent age bias, and make specific recommendations for
change to the administration and the Congress, and submit annual
progress reports.
D. Add a new provision in section 202(a) requiring the Assistant
Secretary to work with the Centers for Medicare and Medicaid Services
in the development of policies for, and in the administration of, the
State Health Insurance Assistance Programs and Medicare and Medicaid
integrity programs.
E. Add a new provision in section 202(a) requiring the Assistant
Secretary to develop a strategic plan to assist States and communities
in preparing for the rapid aging of America and the increased longevity
and diversity of the current population of older individuals.
5. Strengthen and broaden the leadership role of the State units on
aging to eliminate the institutional bias in their State's long-
term care system through:
New partnership with the State Medicaid agency to ensure
that older qualified individuals with disabilities have access to
services in the most integrated setting appropriate to their needs.
Requiring active participation in the development and
implementation of the State's Olmstead plan, long-term care rebalancing
plans or meeting ADA Title II requirements for older people.
Statutory recognition of their expanded responsibilities
in the design and implementation of home- and community based service
systems including the State Medicaid Home and Community-Based Services
Waiver programs for the aged and people with disabilities and other
long-term care programs.
Expanded advocacy with other State agencies to end age
bias and increase access of older persons to Federal and State programs
and services.
Recommended Statutory Change
A. Add a new provision in section 307(a) a new State plan assurance
that the State unit on aging will be involved in the planning,
coordination of, and where designated by the State in the
administration of home- and community-based long-term care programs
including Title XIX of the Social Security Act.
B. Amend section 305(a)(D) to include the following: ``. . . which
affect older individuals including State Olmstead plans where
applicable, long-term care rebalancing initiatives, and meeting
Americans with Disabilities Act (ADA) Title II requirements for older
individuals . . . .''
C. Add a new provision in section 307(a) a new State plan assurance
requiring the State unit on aging to participate in State planning and
coordination activities related to State's Olmstead plan, long-term
care rebalancing plans or meeting ADA Title II requirements for older
persons.
D. Add a new provision in section 307(a) that the State plan shall
include assurances that the State has in effect mechanisms to improve
access to other federally funded State administered programs, including
home- and community-based services and food stamps, for eligible older
persons.
6. Provide authority and authorize funds to States to design and
implement Aging and Disability Resource Centers (ADRCs) to assist
older people and adults with disabilities to make informed
decisions about their service and support options and serve as the
one stop center for the State's long-term care service and support
system.
Recommended Statutory Change
A. Add a new Title VIII to the Older Americans Act authorizing the
Assistant Secretary to carry out a program for making grants to States
to streamline access to multiple public programs for older persons and
adults with disabilities through the establishment of aging and
disability resource centers at an authorized level of funding of at
least $100 million per year.
7. Further strengthen the National Family Caregiver Support Program
through the addition of a new program focusing on the needs of
older persons with Alzheimer's Disease and related dementia and
their caregivers, building on the success of the current State
demonstration program.
Recommended Statutory Change
A. Add a new subpart 3 under title III part E authorizing the
Assistant Secretary to carry out a program for making grants to States
under State plans approved under section 307 to provide multi-faceted
systems of support services for persons with Alzheimer's Disease and
related dementia and their families and caregivers with an authorized
level of funding of at least $50 million per year including a 10
percent set-aside for statewide initiatives.
B. Add a new subpart 4 under title III part E authorizing the
Assistant Secretary to carry out a program for making grants on a
competitive basis to foster the development and testing of new
approaches to sustaining the efforts of families and caregivers of
persons with Alzheimer's Disease (limit funding to 5 percent of funds
appropriated for new Subpart 2).
8. Establish a major new evidenced-based prevention, disease
management, and health promotion program to support the healthy
productive aging of current and future generations of older
persons.
Recommended Statutory Change
A. Modernize title III part D by establishing three distinct
Subparts: Subpart 1: Health Promotion/Disease Prevention Programs and
Services (current program); Subpart 2: Chronic Disease Management and
Medication Management Programs authorized at $100 million per year
(including a base amount for each State) including 10 percent set aside
for statewide initiatives; and Subpart 3: State Innovation Grants in
Evidenced Based Program Development authorized at $50 million per year
(including a base amount for each State).
9. Enhance State authority and flexibility to develop and implement
consumer directed service delivery methods that promote
independence, autonomy, choice and control for older persons and
their caregivers in all OAA programs.
Recommended Statutory Change
A. Amend title I section 101(10) by deleting the phrase which
begins, ``full participation in the planning . . . . '' and replace
with ``. . . consumer choice, direction and control in the planning and
operation of home- and community-based services and programs provided
for their benefit.''
B. Revise title III section 314 to read ``Rights Relating to In-
Home and Community Based Services for Older Individuals,'' and amend
the language to include the concepts of consumer direction and control.
10. Strengthen the capacity of State units on aging to develop and
implement a comprehensive elder rights system through:
Recognition of the critical role of adult protective
services (APS) in such systems.
Statutory recognition of the existing role of State units
on aging in administering APS programs.
Providing information, education, counseling and decision
assistance to people with Medicare on Federal, State and local
benefits.
Expanded responsibilities for Medicare program integrity.
Expanded responsibilities to design and support systems of
advocacy and protection for older persons and, when appropriate, adults
with physical disabilities, receiving home- and community-based
services.
Recommended Statutory Change
A. Amend section 705(a) by adding a new State plan assurance to
read, ``An assurance that the State will develop an elder rights system
which coordinates programs authorized under this title; includes
partnerships with appropriate public and private entities; addresses
the unique needs of the diverse older population; informs and empowers
older individuals to act on their own behalf; provides individualized
advocacy and representation as needed; and assures systemic advocacy.''
B. Amend section 705(a)(6)(A) to read, ``. . . with existing State
adult protective service activities `administered by the State unit on
aging or other component of State Government' for . . . .''
C. Amend title VII by adding a new Chapter 5--Outreach, Counseling,
Protections and Assistance Program, which provides information,
counseling and decision supports to, and representation for, older
individuals on public and private benefits, including pensions, health
and long-term care insurance, and income supports with a clearly
defined role for legal assistance. Include a $100 million authorized
level of funding.
D. Amend title VII by adding a new Chapter 6 Senior Medicare
Integrity Program: Provide allotments to States to promote awareness,
prevent victimization, implement State and community partnerships to
prevent Medicare and Medicaid fraud and abuse and restore program
integrity. Provide an authorized level of funding at $50 million per
year.
E. Amend title VII by adding a new Chapter 7 Home Care Ombudsman
Program: Provide allotments to States to establish a program to
identify, investigate, and resolve complaints that are made by, or on
behalf of, persons receiving in-home and community services with
appropriate conflict of interest, protection of privacy, outreach, and
coordination provisions. Provide for an authorized funding level of $50
million.
F. Amend section 702(c) by deleting ``such sums as may be necessary
for fiscal year 2001'' and adding an authorized level of funding at $15
million per year.
11. Enhance the capacity of the Senior Community Service Employment
Program (SCSEP) to respond effectively to the unique employment,
economic and social needs of older persons by:
Balancing community service and unsubsidized placement
expectations.
Reducing statutory and regulatory barriers to
participation of older workers in SCSEP and other Federal employment
and training programs.
Developing reasonable performance expectations
particularly regarding unsubsidized placements.
Reducing administrative burden.
Recommended Statutory Change
A. Amend title V section 502(a)(1) by adding the words ``or
underemployed'' after the word ``unemployed.''
B. Amend section 516(2) by adding after Office of Management and
Budget ``excluding (i) unemployment benefits income; (ii) 25 percent of
Social Security income; (iii) SSDI benefits; and (iv) the income of
non-spousal household residents.''
C. Amend section 516(2) by adding the words after ``. . . including
any such individual whose `average income in the last 6 months' . . .
.''
D. Amend section 513(a)(2)(C) to read ``For all grantees, the
Secretary shall establish a measure of performance of not less than 20
percent and not more than 25 percent . . . .''
12. Strengthen the income security provided to low-income older workers
in the SCSEP by exempting wages earned in the program as income for
purposes of determining eligibility for Medicaid and other Federal
benefits.
Recommended Statutory Change
A. Amend section 509 to read ``Employment Assistance and Federal
Benefits'' and add at the end ``. . . and Title XIX of the Social
Security Act.''
13. Ensure that reporting and accountability requirements and
definitions are consistent across all titles of the act and focus
on program outcomes without unduly burdening program recipients and
the various components of the aging network.
Recommended Statutory Change
A. Amend section 211 to read ``Reduction of Paperwork and
Administrative Burden.'' Add the following language: ``The Assistant
Secretary shall implement ways to improve the efficiency and
effectiveness of reporting and reduce State reporting burden. The
Assistant Secretary will implement cost effective ways to define the
common data requirements needed for policy and management
decisionmaking; reduce the information burden on program recipients;
improve data collection methods and systems to ensure unduplicated
counts; and reduce the expense of reporting systems. The Assistant
Secretary shall provide grants to States to carry out such program
information systems management changes. The Assistant Secretary shall
establish a National Resource Center on Aging Network Information
Systems to provide ongoing training, technical assistance and support
to States.''
B. Amend Section 216 Authorizations of Appropriations by adding a
new subsection (d) Program Information Systems Management Initiative
authorized at $10 million per year.
14. Ensure that States have sufficient new resources to prepare their
respective States and communities for the aging of America.
Recommended Statutory Change
A. Add a new title IX Grants for State Aging America Initiatives:
The Assistant Secretary shall establish and carry out a program of
making allotments to States to pay for the cost of carrying out
statewide initiatives to help communities develop the programs,
policies and/or services needed to address the rapid aging of America
and the increased longevity and diversity of the current population of
older individuals. Provide for an authorized funding level of $50
million per year and sunset after 2 years.
Chairman DeWine. Ms. Mintz.
STATEMENT OF SUZANNE MINTZ, PRESIDENT AND CO-FOUNDER, NATIONAL
FAMILY CAREGIVERS ASSOCIATION, KENSINGTON, MARYLAND
Ms. Mintz. Mr. Chairman, Senator Mikulski, thank you for
this opportunity. I am Suzanne Mintz, President and co-founder
of the National Family Caregivers Association and a family
caregiver myself, and as you might suspect, I am speaking here
today in support of the National Family Caregiver Support
Program.
NFCA's mission is to empower family caregivers to take
actions that will improve their life and the lives of their
loved ones by providing them with education, support, and a
public voice. Our members care for spouses, children, aging
parents, siblings, friends, and others. The majority of our
members care for seniors. The stories they share with us paint
a picture of isolation, a lack of information, a need for
respite and financial assistance.
I would like to share a story that we received some years
ago from a woman right here in Potomac, Maryland, Sheue Yann
Chen. To this day, it is imprinted on my mind. ``My husband is
now 66 years old. He has a neurological disease which has no
treatment and no cure. He can no longer walk, talk, or feed
himself. He is totally incontinent and needs full-time
assistance. I receive no financial help and work full-time to
support his full-time home care. I am now 62 years old,
overworked, and worn out.''
The National Family Caregiver Support Program, part of the
Older Americans Act, began providing services to family
caregivers of the elderly and elderly people caring for
children in 2002. Since that time, it has helped over 25
million people like Mrs. Chen across the country receive
information, respite, and support.
In my own State of Maryland, approximately 45,000 people
have been served by the National Family Caregiver Support
Program since its inception for a cost of just over $2,165,000.
That is approximately $48 per caregiver, about the cost of a
dozen lattes. That is a pretty small investment, indeed, in the
health and well-being of those Americans who are providing care
to the most vulnerable of our citizens. It is a small
investment in keeping family caregivers on the job. After all,
when a family caregiver becomes sick and cannot provide care,
society pays the price.
Unfortunately, the vast majority of family caregivers have
not had the opportunity to be served by the National Family
Caregiver Support Program, either because sufficient funds were
not available or because they were not even eligible.
America's more than 50 million family caregivers are the
mainstay of our Nation's long-term care system. Family
caregivers strive often beyond the point when it is beneficial
to all concerned to keep their loved ones at home. In times of
tight budget constraints, supporting family caregivers is sound
fiscal policy. That is why it is troubling that the
Administration on Aging's budget request seeks fewer funds for
the National Family Caregiver Support Program in fiscal year
2007 than it currently receives, approximately $2 million less,
$154 million for 2007 versus $156 million in 2006, and also
that amount in 2005. It is as if we have been losing ground
already for the past few years.
The first of the baby boomers turned 60 last month. Our
aging population is on the rise, and the number of people who
need long-term care. I am all for more flexible and integrated
programs that address the totality of a person's need, such as
the Choices for Independence Initiative being proposed, and
providing services for a person with a chronic illness or
disability does indirectly help family caregivers. But it
doesn't address the very specific needs of family caregivers.
Only the National Family Caregiver Support Program does that.
Since I am out of time, just let me say that I think it is
imperative that we not reduce funding for this program, in
fact, that we indeed increase it. In years past, there has been
talk of doubling the program. It would be a very wise and sound
investment if we did so.
[The prepared statement of Ms. Mintz follows:]
Prepared Statement of Suzanne Mintz
Mr. Chairman, members of the committee thank you for this
opportunity to speak in support of reauthorization of the Older
Americans Act, and in particular the National Family Caregiver Support
Program. My name is Suzanne Mintz, and I am the President and Co-
founder of the National Family Caregivers Association (NFCA), and a
caregiver myself for more than 2 decades for my husband who has
multiple sclerosis.
NFCA's mission is empower family caregivers to take actions that
will improve their life and the life of their loved one by providing
them with education, support, and a public voice. NFCA reaches across
the boundaries of differing diagnoses, different relationships and
different life stages to address the common concerns of all family
caregivers. NFCA is located in Kensington, MD.
Our members care for spouses, children, aging parents, siblings,
friends and others. The majority of our members care for seniors and
they tend to be ``heavy duty'' caregivers, meaning they are providing
hands-on care on a daily basis, helping loved ones, dress, bath, toilet
etc. The stories they share with us paint a picture of isolation, a
lack of information and understanding of available resources, a need
for respite, and financial assistance.
I would like to share a story that we received some years ago from
a woman right here in Potomac, MD, Sheue Yann Chen. To this day it is
imprinted on my mind.
My husband is now 66 years old. He has a . . . progressing
debilitating neurological disease, which has no treatment and no cure.
Since the diagnosis of his disease, I have been watching his slow death
day by day.
He now can no longer talk, walk, stand or feed himself. He is
totally incontinent and needs full-time assistance for daily living. I
receive no financial help and work full-time to support his full-time
home care. I am now 62 years old and shoulder the entire household
responsibility, from cooking, cleaning, shopping, learning to fix
faucet leaks, mowing the lawn and shoveling the snow. I am over-worked
and worn out. Because of his illness, we have no social life . . .
Since his illness, many friends that we used to have abandoned us. I
feel very alone, constantly worrying about my husband's health. Life
has been a struggle for me.
What can help me is to have a resource center which has names that
I can call for finding a dependable workman to install a wheelchair
ramp or fixing other household problems (e.g. leaking roof etc.), . . .
assistance for transportation when my husband needs to go to see the
doctor, . . . financial assistance for home care. At the minimum,
financial assistance for a 2 week respite leave would be extremely
helpful.
The National Family Caregiver Support Program, a part of the Older
Americans Act, began providing services to family caregivers of the
elderly and elderly people caring for children in 2002. Since that time
it has helped over 25,000,000 people like Mrs. Chenn across the
country.
Over 1.5 million caregivers have received help in
accessing services.
Almost 22 million have received information about caring
for their loved one.
Over 814,000 have received counseling, become part of a
support group, or learned new caregiving skills.
Almost one half million caregivers have gotten some of the
respite they desperately require.
Approximately 350,000 caregivers have gotten supplemental
services to help them meet very specific and immediate needs.
Research has shown over and over again that family caregivers put
their own health at risk as they assist their loved one. Family
caregivers are more prone to depression than the rest of the
population, among some subpopulations as much as six times as high.
Research has shown that the stress of family caregiving can trigger the
advent of chronic illnesses, and in extreme situations increase
mortality rates.
In my own State of Maryland just under 45,000 people have been
served by the National Family Caregivers Support Program since its
inception for a cost of $2,165,437. That's $48 and change per
caregiver--about the cost of a dozen lattes. That is a very small
investment indeed in the health and well being of those Americans who
are providing care to the most vulnerable of our citizens. It is a
small investment in keeping family caregivers on the job. After all
when a family caregiver becomes sick and cannot provide care, society
pays the price.
As impressive as some of these numbers sound, we can not lose site
of the fact that there are more than 44 million people who provide care
to a loved one over the age of 50 and the numbers of caregivers served
that I have quoted represent services over a 3 year period. There are
so many family caregivers that have not had the opportunity to be
served, either because sufficient funds were not available or because
they were not even eligible.
Family caregivers are the mainstay of our Nation's long-term care
system. Family caregivers strive, often beyond the point when it is
beneficial to all concerned, to keep their loved one at home. In times
of tight budget constraints supporting family caregivers is sound
fiscal policy. That is why it is troubling that the Administration on
Aging's budget request seeks fewer funds for the National Family
Caregiver Support Program in fiscal 2007 than it currently receives,
approximately $2 million less, $154 million for 2007 versus $156
million in 2006.
I know that there are new initiatives being proposed, that will if
implemented, provide some services to caregiving families. The budget
calls for the creation of a new program of competitive grants, Choices
for Independence, a $28 million initiative that will provide a flexible
care plan of services for eligible individuals and therefore in the
process support their family caregivers as well. I know that there are
funds allocated for the Aging and Disability Resource Center program
that began in 2003 to serve as single entry access points, but these
are all small competitive grant programs that will serve only a small
number of people and only indirectly support family caregivers.
The first of the baby boomers turned 60 last month. Our aging
population is on the rise and with it the number of people who will
need long-term care. People over 85 are the fastest growing segment of
the population and over half of them need help with personal care. I am
all for more flexible and integrated programs that address the totality
of a person's needs, and providing services for a person with a chronic
illness or disability does indirectly help their family caregiver, but
it doesn't address the very specific needs of the caregiver directly,
only the National Family Caregiver Support Program does that.
I know that money for programs to support needy Americans is very
tight right now to say the least, but I fear that the proposed
direction of the fiscal 2007 AOA budget will leave even more family
caregivers fending for themselves than has already been the case.
The implementation of the National Family Caregiver Support program
in 2000 was a milestone in this country's recognition of the critical
role that family caregivers play in our healthcare and social support
system. Reducing its allocation sends a message that the work of family
caregiving--upon which our Nation relies so heavily--is not as valuable
as once thought. That is a step backwards and one that as a family
caregiver advocate I must decry.
Hubert Humphrey, for whom the headquarters building of the
Department of Health and Human Services is named, once said ``A society
is judged by how it treats its most vulnerable citizens.'' What can we
say about America's concern for its most vulnerable citizens if we cut
back on the one and only program designed to support those they rely on
so heavily. Over two thirds of all seniors needing care get it solely
from family and friends. It is imperative that we recognize the
enormity of the work that family caregivers do in support of the
elderly and the negative impact it has on their own wellbeing. By
cutting the few social support services that exist we are only adding
to the pool of family caregivers who will require more expensive
services from our healthcare system, today and tomorrow. I implore you
to consider at least funding the National Family Caregiver Support
Program at current levels, if not adding to them.
Chairman DeWine. Ms. Jones.
STATEMENT OF KARYNE JONES, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, THE NATIONAL CAUCUS AND CENTER ON BLACK AGED, INC.,
WASHINGTON, DC.
Ms. Jones. Senator DeWine, Senator Mikulski, I am Karyne
Jones and I am President and CEO of the National Caucus and
Center on Black Aged. From its inception, the National Caucus
and Center on Black Aged has supported the spirit and the
objectives of the Older Americans Act and continues its
longstanding support.
As the Congress considers the reauthorization of the act,
NCBA wants to state its support of the reauthorization as
follows. We strongly oppose any across-the-board cuts to
discretionary spending programs. Such cuts are likely to have a
disproportionate impact on OAA programs.
We do not support eliminating specific references to
minorities. It remains a sad reality that minorities are still
disproportionately at the lower end of the economic spectrum.
Removal of targeted languages will undermine efforts to direct
services to the neediest of older Americans and roll back the
progress that has been achieved in minority and low-income
participation.
NCBA opposes merging disability and aging services.
Although many of the needs of the two groups do converge, the
merging of these services will obscure the often distinct
priorities. The ability of the service agencies and
organizations to respond to the needs of the elderly will
suffer from this additional bureaucracy.
We also oppose these changes to the Senior Community and
Service Employment Program, SCSEP. No. 1, eliminating national
sponsors. No. 2, eliminating services to participants under age
65. And three, eliminating fringe benefits for participants.
NCBA supports preparation for the demands resulting from
the aging of the baby boomer generation. This is overdue, in
fact. The boomers have already begun to reach 55, and certainly
our systems have been ramped up to meet their needs. The impact
on all services, including those authorized by OAA, including
the Senior Community Service Employment Program, the National
Family Caregivers Support Program, nutrition programs, as well
as health and promotion of disease activities, will reach
unprecedented levels. Service providers at all levels will have
to be proactive to meet the needs of an increased number of
older Americans potentially utilizing these services.
Particular attention must be paid to prepare for those who will
be near or below the poverty line.
NCBA supports a 25 percent increase of OAA authorization
levels. This increase will offset the impacts of inflation and
compensate for the flat funding levels of the past several
years. The failure to increase the authorization levels has
amounted to cutting spending levels as a result of inflation.
NCBA supports establishment of Aging and Disability
Resource Centers. The centers will provide a one-stop source
for assisting seniors and disabled citizens with long-term care
and service needs.
I have to jump down, because 3 minutes just isn't enough to
take care of the needs of poor, low-income people in this
country. Most of it, of course, is in my statement, but I have
to mention that, of course, NCBA supports retaining the current
operational structure of the Senior Community Employment
program.
We support affordable housing for seniors, particularly
low-income seniors. This is becoming an increasing need for
older Americans, and this legislation does not address that
adequately.
We also support all I have mentioned. Following this brief
statement, I do have all of my statistics and everything to do
that.
As we wholeheartedly support the Older Americans Act's
reauthorization, we must be committed to enacting
appropriations that effectively empower these agencies to carry
out the mission and service provision for our elders. The
Congress and the administrative branch are proud of the Older
Americans Act, its goals and achievements, and we thank you for
this opportunity, Senators, to talk about these things.
Chairman DeWine. We do have your full statement.
Ms. Jones. Thank you.
[The prepared statement of Ms. Jones follows:]
Prepared Statement of Karyne Jones
THE NATIONAL CAUCUS AND CENTER ON BLACK AGED, INC. (NCBA)
RECOMMENDATIONS FOR THE 2005 REAUTHORIZATION OF THE OLDER AMERICANS ACT
(OAA)
My name is Karyne Jones and I am President and CEO of the National
Caucus and Center on Black Aged, Inc.
From its inception The National Caucus and Center on Black Aged,
Inc. supported the spirit and objectives of the Older Americans Act
(OAA) and continues its long-standing support. As the Congress
considers the reauthorization of the OAA, NCBA wants to state its
support of the reauthorization as follows:
NCBA strongly opposes any across-the-board cuts to discretionary
spending programs. Such cuts are likely to have a disproportionate
impact on OAA programs. We do not support eliminating specific
references to minorities. It remains a sad reality that minorities are
still disproportionately at the lower end of the economic spectrum.
Removal of targeting language will undermine efforts to direct services
to the neediest older Americans and roll back the progress that has
been achieved in minority and low-income participation in the OAA.
NCBA opposes merging disability and aging services. Although many
needs of the two groups do converge, the merging of these services will
obscure the often distinct priorities. The ability of service agencies
and organizations to respond to the needs of the elderly will suffer
from the additional bureaucracy. Reluctantly the example of the Office
of Homeland Security provides an almost worst-case scenario for this
type of administrative umbrella.
NCBA supports establishment of a new Title in the OAA to study and
prepare for the demands resulting from the aging of the baby boomer
generation. This is overdue in fact. The boomers have already begun to
reach 55 and will reach 60 before our systems have been ramped up to
meet their needs. The impacts on all services including those
authorized by the OAA (including the Senior Community Service
Employment Program (SCSEP), National Family Caregiver Support Program
(NFCSP), nutrition programs as well as Health Promotion and Disease
Prevention activities) will reach unprecedented levels. Service
providers at all levels will have to be proactive to meet the needs of
the increased number of older Americans potentially utilizing services.
Particular attention must be paid to prepare for those who will be near
or below the poverty line.
NCBA supports a 25 percent increase in OAA authorization levels.
This increase will offset the impact of inflation and compensate for
the flat funding levels of the past several years. The failure to
increase the authorization levels has amounted to cutting spending
levels as a result of inflation.
NCBA supports establishment of Aging and Disability Resource
Centers. The centers will provide a one stop source for assisting
senior and disabled citizens' with their long term care and service
support needs. The ability of well-trained representatives to access
and inform clients will reduce the burden of information gathering and
the application process involved.
NCBA supports retaining the current operational structure of the
Senior Community Service Employment program (SCSEP) utilizing National
sponsors and State aging units. The system has served the goals of the
legislation and the clients very effectively. We support reinforcing
income security for low-income SCSEP participants by providing
exemptions for SCSEP wages when determining eligibility for Federal
benefits programs (e.g. Medicaid). The combination of near poverty line
status and fixed incomes demands this relief in order for many elderly
to maintain a reasonable quality of life. NCBA supports establishing
practical assessment standards and performance expectations
particularly for unsubsidized placements. The benefits of workers
moving to private sector or direct Government employment are many, the
most important being making room for new participants as more baby
boomers become eligible.
NCBA supports strengthening the Health Promotion and Disease
Prevention capacity of the OAA and its service providers by
establishment of evidence-based programs that will be implemented at
the local, State and national levels. NCBA supports allocating funds
for outreach and enrollment assistance for the Medicare prescription
drug program. NCBA supports directing services to those older
individuals with the greatest economic and/or social need with
particular attention to low-income minority individuals and
demographically dense communities.
Following this brief statement are some facts and statistics that
illustrate the increasing importance of the services provided for by
the OAA. These facts highlight the necessity of carefully addressing
the authorization levels and organizational structure of service
delivery systems. There are many areas where racial, ethnic or
socioeconomic disparities continue to have an impact in our society and
the health and wellbeing of minority seniors.
The Congress and administrative branch can be proud of the Older
Americans Act, its goals and achievements. Let's not run the risk of
prematurely rolling back its authority or diluting its ability to meet
its designed objectives. Thank you for the opportunity to share NCBA's
enduring appreciation for the act and the efforts of the many agencies
and organizations that implement the resultant programs.
POPULATION DEMOGRAPHICS
``From 1950 to 2004 the total resident population of the United
States increased from 150 million to 294 million, representing an
average annual growth rate of 1 percent. During the same period, the
population 65 years of age and over grew twice as rapidly and increased
from 12 to 36 million persons. The population 75 years of age and over
grew 2.9 times as quickly as the total population, increasing from 4 to
18 million persons. Projections indicate that the rate of population
growth from now to 2050 will be slower for all age groups, and older
age groups will continue to grow more than twice as rapidly as the
total population.'' This ``preretirement age'' population, defined as
all adults 55-64 years of age, is projected to be the fastest growing
segment of the adult population during the next 10 year period.\1\
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\1\ National Center for Health Statistics, Health, United States,
2005, With Chartbook on Trends in the Health of Americans, Hyattsville,
Maryland 2005.
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HEALTH STATUS OF OLDER AMERICANS
``While many Americans age 55-64 are in good health and relatively
well off financially, minorities, primarily African-Americans, American
Indians, and persons of Hispanic origin, are more likely than non-
Hispanic white Americans to have chronic health problems, live in
poverty, lack insurance coverage, and be unable to work because of a
disability.''
The percent of the population that is black or Hispanic is
increasing. If current racial and ethnic disparities do not narrow,
this trend could indicate even higher prevalence of obesity, diabetes,
hypertension, and other diseases more common in minorities and a
corresponding higher burden on the health care system.
``Changes in the racial and ethnic composition of the population
have important consequences for the Nation's health because many
measures of disease and disability differ significantly by race and
ethnicity. One of the overarching goals of U.S. public health policy is
elimination of racial and ethnic disparities in health.'' \2\
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\2\ 2005 National Healthcare Disparities Report. Agency for
Healthcare Research and Quality.
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Adults age 55-64 have more frequent and more severe health problems
than younger people. The prevalence of diabetes, hypertension, heart
disease, and other chronic diseases increase with age. In addition,
hypertension and obesity have been increasing over time for this age
group.
CARDIOVASCULAR RISK FACTORS
Hypertension, obesity, and high cholesterol are all independent
risk factors for the leading causes of death in the United States--
heart disease and stroke. Hypertension is also a major risk factor for
congestive heart failure and kidney failure. Being obese is associated
with increased risk of morbidity and mortality. High cholesterol
increases the likelihood of developing heart disease and raises the
risk of heart attacks among those with heart disease.
Between 1988-94 and 1999-2002 the percent of adults 55-64 years of
age with one or more of the three cardiovascular risk factors examined
remained level at about 70 percent.
Almost one-half of non-Hispanic black adults had two or three of
the risk factors, compared with just under one-third of non-Hispanic
white and Mexican adults.
MAMMOGRAPHY
Breast cancer is the most common type of newly diagnosed cancer
among women and the second leading cause of cancer deaths for women. In
2002 approximately 204,000 women in the United States were diagnosed
with breast cancer and nearly 42,000 women died from the disease. Rates
of newly diagnosed breast cancer, breast cancer survival rates, and
death rates vary among race and ethnic groups.
Disparities in mammography screening among underserved women with
low income or less education also continue to exist. In 2003 poor women
remained less likely than women with higher incomes to have a recent
mammogram--55 percent compared with 74 percent.
PAP SMEAR
A Pap smear is a microscopic examination of cells scraped from the
cervix that is used to detect cancerous or precancerous conditions of
the cervix and other medical conditions. If detected, precancerous
conditions can be treated before they become malignant.
Pap smear screening rates remained lower for Asian and Hispanic
women than for non-Hispanic black and non-Hispanic white women.
HEALTH AND HEALTHCARE DISPARITIES
African-Americans are 10 times more likely than whites to be
diagnosed with AIDS.
African-Americans are 10 percent more likely than whites to have
poor access to healthcare and 9 percent more likely to receive poorer
quality care.
Hispanics are 3.7 times more likely than whites to be diagnosed
with AIDS.
Hispanics are 87 percent more likely than whites to have poor
access to healthcare and 16 percent more likely to receive poorer
quality care.
EMPLOYMENT STATUS
Employment, or past employment, is a determinant of access to
health care both in terms of supplying income to pay for care and also
because employer-sponsored health insurance is frequently offered to
employees. In 2002-2003 employment status differed by race and
ethnicity. Non-Hispanic white men and Hispanic men were more likely to
be working (about 65 percent) than non-Hispanic black men (57 percent).
Among women, a little over one-half of non-Hispanic white women were
working compared with 46 percent of non-Hispanic black women and 41
percent of Hispanic women. Hispanic women in this age group were more
likely to be taking care of home or family than non-Hispanic women.
Hispanic men and women were less likely to be retired than non-Hispanic
adults 55-64 years.
Unemployment due to disability was higher for non-Hispanic black
men and women age 55-64 years than for other racial and ethnic groups.
In 2002-2003, about one-fifth of non Hispanic black men and one-quarter
of non-Hispanic black women were unemployed due to a disability
compared with 15 percent of Hispanic adults and 10 percent of non-
Hispanic white adults.
LOW INCOME
People with low income are more likely to be in poor health and
have a higher prevalence of many serious chronic diseases than those
with higher incomes. Their worse health is a result of many factors
including a higher prevalence of health risk factors, poor nutrition
and housing, occupational and environmental hazards, and other social
ills. Poor health may also contribute to poverty by reducing the
ability to earn income. People living below or near the poverty level
are also more likely to lack health insurance, which, combined with
their low incomes reduces their access to health care.
In general the preretirement age population 55-64 years has higher
incomes than older persons age 65 and over. In 2003 more than one-fifth
of the population age 55-64 had incomes below 200 percent of poverty,
compared with almost two-fifths of older persons age 65 years and over.
More older adults than preretirement age adults had incomes in the 100-
199 percent of poverty range. The percent living below 100 percent of
poverty, however, was similar for the two groups (about 10 percent).
There is large variation in the poverty distribution by gender and race
and Hispanic origin for the preretirement age population. In 2003 women
55-64 years of age were more likely than men to be living in poverty
(10 percent compared with 8 percent). Both non-Hispanic black and
Hispanic men and women were about twice as likely to be living in or
near poverty as non-Hispanic white adults. In addition, non-Hispanic
black and Hispanic women were more likely to be poor than their male
counterparts.
Income for persons age 55-64 is not likely to increase and will
probably decrease upon retirement. Persons 55-64 currently living in
poverty most often cannot expect future increases in their employment-
based incomes. Employment prospects at this age for poor and near poor
persons diminish and are most often limited to low-income jobs with few
fringe benefits.
HEALTH INSURANCE COVERAGE
Health insurance coverage is an important determinant of access to
health services and is of particular importance for people with chronic
conditions that require ongoing care. Whereas Americans age 55-64 years
are more likely to be insured than other working-age adults under age
65, preretirement age adults do not have the guarantee of health
insurance coverage that Medicare offers to almost all older adults age
65 and over.
Adults 55-64 years of age are reaching a time of life when health
problems are likely to become more frequent and more serious.
Consequently, persons of this age group are likely to have greater
health care needs, on average, than younger persons. Because being
married is associated with higher rates of health insurance, minority
women, in particular, are more at risk for being uninsured than other
groups, as well as more likely to live in poverty.
Chairman DeWine. Mr. Blancato.
STATEMENT OF BOB BLANCATO, NATIONAL COORDINATOR, ELDER JUSTICE
COALITION, WASHINGTON, DC.
Mr. Blancato. Thank you, Senators. As National Coordinator
of the 440-member bipartisan Elder Justice coalition, thank you
for the invitation to discuss Title VII of the Older Americans
Act, allotments for vulnerable elder rights protection
activities.
Elder abuse, neglect, and exploitation is more prevalent
than in 2000, the last Older Americans Act reauthorization. A
new study by the National Center on Elder Abuse points broadly
to a 19.7 percent increase in elder and vulnerable adult abuse
and neglect cases since 2000. The Center's Special Committee on
Aging has estimated there to be more than 500,000 reported
cases of elder abuse, with as many as 5 million total cases
since so much goes unreported.
The only Federal program with dedicated funds for elder
abuse prevention is title VII. Its mission and purposes are
sound. Its resources are not. It has just over $20 million. The
President's budget would reduce it by $1 million. Two of its
programs, including the Native American Organization Program,
have never been funded.
A stronger title VII should be a goal of this
reauthorization. It must include enhancing the capacity of the
aging network to develop and implement a comprehensive elder
rights system over the coming years. It must include a strong
State and local long-term care ombudsman program that operates
with adequate resources and in an environment of autonomy. A
stronger title VII must commit more attention and resources to
help stem the alarming rise in self-neglect cases. Yes, it will
take more money, but outcomes will come from this investment:
Reducing elder abuse, neglect, and exploitation through
education, training, and better reporting.
Authorization levels proposed by LCAO deserve serious
consideration, including $10 million each for elder abuse
prevention, the Native American Organization, and the legal
services developer program. They also call for $45.5 million
for the ombudsman program to help meet a goal of the Institute
of Medicine, which calls for one ombudsman per every 2,000
nursing home residents.
Finally, the National Center on Elder Abuse and the
National Long-Term Care Ombudsman Resource Center need to
continue and each should be funded at $1 million a year. They
are both critically important to research and practice.
The Elder Justice Coalition also hopes this committee will
again adopt its version of the Elder Justice Act. The
bipartisan and comprehensive Elder Justice Act has been
introduced as S. 2010 by Senators Hatch and Lincoln. It would
greatly expand and better coordinate our Federal response to
elder abuse, neglect, and exploitation, and provide a dedicated
funding stream for adult protective services, the front line of
response to the estimated 80 percent of elder abuse cases which
occur in noninstitutional settings. APS's main funding source
is the Social Services Block Grant, which President Bush just
proposed to cut by an unconscionable $500 million.
Combine the 1,200 delegates to the White House Conference
on Aging, the Elder Justice Coalition, and the LCAO and you
have quite a powerful and bipartisan group of American
constituencies calling for the same end, more resources to
address elder abuse.
S. 2010 notes with chilling simplicity, victims of elder
abuse, neglect, and exploitation are 3.1 times more likely to
die at an earlier age than expected compared to elders who are
not victims. Is there a more compelling call to action than
that? Thank you.
Chairman DeWine. Thank you.
[The prepared statement of Mr. Blancato follows:]
Prepared Statement of Bob Blancato
Senators Enzi, Kennedy, DeWine, and Mikulski, and members
of the committee. As national coordinator of the 440 member
bipartisan Elder Justice Coalition, I appreciate the invitation
to share views on the impending Older Americans Act
reauthorization especially as it relates to Title VII
Allotments for Vulnerable Elder Rights Protection Activities. I
also serve as the Immediate Past President of the National
Committee for the Prevention of Elder Abuse.
This 15th reauthorization of the Older Americans Act may
provide one of the key opportunities for Congress to recommit
itself to the prevention of elder abuse, nearly 15 years ago
after title VII was added to the act.
Since the last reauthorization in 2000, reported cases of
elder abuse have clearly risen in our Nation. The most recent
indication comes from a new study released by the National
Center on Elder Abuse. It points to a 19.7 percent increase in
reports of elder and vulnerable adult abuse and neglect cases
since 2000 as reported to adult protective services. The study
also cites a 15.6 percent increase in substantiated cases.
The reality is this is only one dimension of elder abuse
incidence. There are other reporting entities not reflected in
this study. Furthermore as the Senate Special Committee on
Aging has reported in the past there may be as many as 4 times
as many elder abuse cases that go unreported. Using their
figures on reported cases from the only incidence and
prevalence study we may be dealing with as many as 500,000
reported cases and upwards of 5 million overall.
For the moment there is only one Federal program that
dedicates categorical funds for elder abuse prevention and that
is title VII. It was made a separate title by Congress to
consolidate and expand certain programs that focus on the
protection of the rights of older persons which had been
previously under title III. Its mission and purposes are sound.
Its resources are not. The entire title VII of the act has a
current appropriation of just over $20 million. Especially
woeful is the $4.8 million for the elder abuse prevention
program in the title which broken down by State rounded means
$206,000 for Ohio, $87, 000 for Maryland, $26,000 for Wyoming
and $116,000 for Massachusetts.
In fact, two of the sections of title VII, the Native
American program and the Legal Services Developers have never
received funding. That absence of funding needs to end this
year.
Clearly we support a stronger title VII with adequate
funding to allow it to better accomplish its missions of
supporting community-based elder abuse prevention programs,
helping with better reporting data and aiding in raising public
awareness through education. In title VII we need to commit
more attention and resources to the alarming rise in self
neglect cases in elder abuse.
Central to a stronger title VII must be a strong Ombudsman
program both State and local long-term care ombudsman.
What is more central to a national elder abuse prevention
strategy than the ombudsman program which involves dedicated
individuals who identify, investigate and resolve complaints
filed by or on behalf of elderly residents in long-term care.
In this reauthorization process I urge the subcommittee to get
direct input from State and local ombudsmen and make sure that
title VII promotes a strong environment of autonomy for
ombudsmen.
Specifically the strategy to a stronger title VII is
providing it with realistic funding levels to allow it to
achieve the goal of enhancing the capacity of the aging network
to develop and implement a comprehensive elder rights system
over the coming years.
The proposals put forth by the Leadership Council of Aging
Organizations whose chair and a number of other members are
here related to title VII deserve the very serious
consideration. It is critical to set authorization levels high
enough to send the proper signal to the Appropriations
Committees of the importance of all of the title VII programs.
In particular I would note their call for $10 million in
funding for elder abuse prevention activities under title VII,
$45.5 million in funding for the Long Term Care Ombudsman
program which would take this program a long way to meeting a
critical recommendation of the Institute on Medicine which
recommended there be one ombudsman per 2,000 nursing home
residents--$10 million in funding for the Native American
Organization provisions and $10 million in funding for the
Legal Services Developer program.
There will be guaranteed returns on this investment of
Federal money. These funds will lead to clear outcomes--better
training of law enforcement and medical personnel and others
who come in regular contact with the elderly to be able to
detect possible elder abuse. These funds will lead to the
bolstering in some cases and the establishment in other cases
of local-based multidisciplinary teams formed to help combat
elder abuse in the community. They will lead to the hiring of
more ombudsmen and can lead to better reporting of elder abuse,
which is so crucial.
I remember presenting testimony to this committee back in
September of 2003 and noting that a new commitment to elder
justice--the right of older Americans to be free from abuse,
neglect and exploitation is as important as any initiative that
has been undertaken to improve the quality of life for seniors
in need.
A good first step would be to accomplish the
reauthorization of the Older Americans Act with a commitment to
a stronger title VII. It should be about taking those steps to
allow a comprehensive elder rights system to be developed and
advanced at the State and local level through the aging
network. Also under title II we need to continue the National
Center on Elder Abuse and hope it too can receive a modest
increase in its authorization. This call for a prompt and
purposeful reauthorization of the Older Americans Act was the
top vote getting resolution at the recent 2005 WHCOA.
The Elder Justice Coalition also hopes that this committee
will again move forward and adopt its version of the Elder
Justice Act either in conjunction with the Older Americans Act
reauthorization or separately.
This committee in 2004 reported out S. 2940 the Act for
Elder Justice unanimously.
This followed a unanimous reporting out of S. 333 the Elder
Justice Act by the Finance Committee. The 108th Congress did
adjourn before taking final action on the bills.
Our Coalition is pleased that Senators Hatch together with
Senators Lincoln, Smith and Kohl have introduced S. 2010. It is
now and always has been a bi-partisan bill which would greatly
expand and better coordinate our Federal response to the
problems of elder abuse neglect and exploitation.
When a new bill is considered by this committee related to
elder justice we hope it maintains the essential feature
supported by the administration of enhancing the existing
authority of AOA to raise awareness about elder abuse, promote
coordination and support intervention efforts. We also hope it
will take the critical step of creating a specific Office of
Elder Justice within the Department--the precise location to be
at the discretion of the Secretary.
We also hope that this legislation as well as anything done
on reauthorization of the OAA recognizes the critical role of
adult protective services in the prevention of elder abuse,
neglect and exploitation. In the previously mentioned national
Incidence and Prevalence study, it noted that 80 percent of
elder abuse occurs in home settings, not institutions; Adult
Protective Services is the entity best trained and able to work
to respond, aid in reporting and help victims of this more
common form of elder abuse.
Although not the direct jurisdiction of this committee the
Elder Justice Coalition does want to reiterate its support for
a dedicated funding stream for adult protective services in the
future. This is especially critical in light of the proposed
$500 million reduction offered in the President's budget for
the Social Services Block Grant which is the largest source of
funding of adult protective services.
The delegates to the White House Conference on Aging
actually spoke twice on the subject of elder abuse prevention.
Their top resolution as mentioned called for the prompt
reauthorization of the OAA including Title VII. They also
adopted a resolution entitled Create a National Strategy for
Promoting Elder Justice through the Prevention and Prosecution
of Elder Abuse. It ranked number 15 of the 50 resolutions
adopted.
When you combine the 1,200 delegates to the White House
Conference on Aging, the more than 430 members of the Elder
Justice Coalition and the Leadership Council of Aging
organizations you get quite a powerful and bi-partisan group of
American constituencies calling for the same end: more
resources to address elder abuse in this country.
There is a finding in the opening pages of S. 2010 which to
me says with chilling simplicity the ultimate consequence of
elder abuse. It states ``that victims of elder abuse, neglect
and exploitation are 3.1 times more likely to die at an earlier
age than expected than elders who were not victims of elder
abuse, neglect and exploitation.''
This compels us to move forward on the Older Americans Act
and the Elder Justice Act.
Thank you.
Chairman DeWine. Mr. Lacayo.
STATEMENT OF CARMELA G. LACAYO, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, NATIONAL ASSOCIATION FOR HISPANIC ELDERLY, PASADENA,
CALIFORNIA
Ms. Lacayo. Buenes tardes. I am Carmela Lacayo, President,
CEO, and founder of the National Association for Hispanic
Elderly. Thank you, Senator Mikulski and Senator DeWine, for
inviting me to present testimony on the reauthorization of the
Older Americans Act. For the last 35 years, I have been through
the process of reauthorizations, and believe me, it is a
process many years.
My comments are expanded in the written testimony we have
submitted for the record. I am going to be very brief in
summarizing some of the key important issues that our
organization is concerned with.
Congress, in our view, has wisely included targeting
language historically in the Older Americans Act to direct
services to those seniors with the greatest economic and social
needs, with particular attention to low-income aged minorities.
This language recognizes that there are not sufficient Older
Americans Act moneys to reach all older Americans. The
targeting language has helped to focus Older Americans Act
services on those seniors with the greatest needs.
Additionally, the targeting language has improved minority
participation in Older Americans Act programs. This language is
extremely important to our organization and we urge that it be
retained.
Because of limitations of time, I am going to direct my
remarks to the Senior Community Service Employment Program.
There are four points that I wish to bring to the attention of
the committee.
First, the value and worth of title V has been amply
demonstrated for low-income senior workers, the communities
they serve, and our Nation. The Senior Community Service
Employment Program has been independently evaluated on numerous
occasions and it has always received high marks. The existing
State sponsor partnership has worked extraordinarily well and
Congress should continue this winning approach.
Second, there is an old adage that one should not attempt
to fix what is not broken. This clearly applies to the SCSEP
and especially the proposal to de-nationalize title V and turn
the program over to the States. We oppose this proposal. There
is no authoritative research to support this change. Quite to
the contrary, independent evaluations have given high marks to
the existing SCSEP. We urge Congress to maintain the existing
State-national organization partnership.
Third, Congress should continue the longstanding basic
principles that have contributed to title V success. These
bedrock principles include targeting older Americans with poor
employment prospects, serving minorities, limited English
speaking, and other individuals with the greatest economic and
social needs, at least in proportion to their numbers in each
State, retaining and enhancing the community service aspect of
the SCSEP.
Fourth, we urge Congress to avoid taking specific actions
which would be harmful to the SCSEP. Title V should not be
folded or forced into the Workforce Investment Act, WIA. The
Association is aware that some people will argue that it is
better to have all employment and training activities under one
roof. Congress tackled that very issue more than 30 years ago
and wisely decided that a Senior Community Service Employment
Program was needed to serve low-income persons 55 or older with
poor employment prospects. General job training programs
enacted after the passage of the Older Americans Community
Service Employment Act, such as JTPA, CETA, and now WIA, do not
have a good record of reaching out and serving older workers,
particularly low-income disadvantaged older Americans.
Just 2 seconds. Title V differs from the conventional
training programs under the direction of the Department of
Labor, such as WIA. The SCSEP combines community service with
employment and training for low-income seniors. DOL wants to
model the title V after WIA. We think the opposite should
occur. WIA should model itself after the SCSEP and its success
with older workers.
Our view is that SCSEP has been a far more effective
program in achieving its objectives than WIA has. We urge
Congress not to further the WIA-fication of the SCSEP.
[Laughter.]
Ms. Lacayo. In conclusion, the value and worth of the SCSEP
and other Older Americans Act programs have been amply
demonstrated throughout the history of the Older Americans Act,
and I believe in my--well, I am young--Hispanics age
gracefully--that the Older Americans Act, next to the Medicare
Act and the Social Security Act, are the preeminent legislation
that really allow older Americans to live their life with a
little bit of dignity, and I say a little bit because we see
the cutbacks and the problems facing so many of our service
providers.
Thank you very much, Senators.
Chairman DeWine. Thank you.
[The prepared statement of Ms. Lacayo follows:]
Prepared Statement of Carmela G. Lacayo
Mr. Chairman and members of the Health, Education, Labor and
Pensions Committee, the National Association for Hispanic Elderly
(Asociation Nacional Pro Personas Mayores) appreciates the opportunity
to participate in the roundtable discussion concerning the
reauthorization of the Older Americans Act (OAA).
A. OAA SERVICES BENEFIT SENIORS IN MANY WAYS
At the outset, we wish to express our strong support for the OAA
and the vital services that it provides to seniors throughout our
Nation. The OAA continues to be the primary source for funding
supportive and nutrition services for people 60 years of age or older.
These services--such as homemaker or home health care--have enabled
seniors to live independently in their communities, rather than being
placed prematurely, and sometimes unnecessarily, in a nursing home at a
much higher public cost.
Similarly, the national elderly nutrition program, which is
probably the most visible title III services program, provides millions
of home-delivered and congregate meals to older Americans each year.
Quite often, this program delivers the only nutritious meals that
seniors will receive on a particular day.
Participants in the Senior Community Service Employment Program
(SCSEP) have been enormously helpful in contributing to the noteworthy
achievements of the OAA congregate meals and home-delivered meals
programs. These nutrition programs, which have helped millions of older
Americans over the years, could not have achieved their current success
without the exceptional assistance from title V participants.
The OAA also helps seniors access needed services. Routine tasks
for most Americans--such as shopping, visiting friends or going to the
doctor--can become formidable challenges for aged individuals without a
car or suitable public transportation. Unfortunately, far too many
older Americans live under a form of ``house arrest'' because public
transportation is often unavailable, inaccessible, or too expensive.
OAA transportation services have helped elderly people in numerous ways
and have made it easier for these individuals to cope with the
challenges related to advancing age.
B. SERVING MINORITIES MORE EFFECTIVELY THROUGH TARGETING LANGUAGE
Congress, in our view, has wisely included targeting language in
the OAA to direct services to those seniors with the greatest economic
need and greatest social need, with particular attention to low-income
aged minorities. This language recognizes that there are not sufficient
OAA resources to reach all older Americans. The targeting language has
helped to focus OAA services on those seniors with the greatest needs.
Additionally, the targeting language has improved minority
participation in OAA programs. A good example is the SCSEP which had
nearly a 45 percent minority participation rate for the program year
ending June 30, 2004--the most recent year that official public
information is available.
We urge the Congress to retain the existing targeting language
because it has directed additional services to those seniors who are
truly needy. Earlier equity studies conducted for the Administration on
Aging (AOA) found that aged minorities have a much greater need for
services than non-minority seniors--oftentimes two to three times as
great as for the Anglo aged. One important reason is that older
minorities have a poverty rate that is typically two to three times as
great as for Anglo seniors. Moreover, elderly minorities have a much
lower level of educational attainment than the Anglo aged. A large
proportion of older Hispanics has limited English-speaking ability,
which exposes them to a multiple form of jeopardy because of their age,
minority status, and communications skills.
We reaffirm our support for maintaining the existing targeting
language and oppose any efforts to dilute or otherwise undercut this
essential language.
C. COST SHARING
The 2000 OAA Amendments authorized cost-sharing for certain
services under certain conditions. We opposed this measure because it
can discourage minority participation in OAA services programs, despite
some of the safeguards written into the law. We want to make certain
that the existing cost-sharing language does not, in any way,
discourage or reduce minority participation in supportive services
programs. Furthermore, we want to assure that waivers from cost-sharing
are granted when a significant percentage of older Americans in the
planning and service area have incomes below the cost-sharing
threshold, and cost-sharing would be an unreasonable administrative or
financial burden upon the area agency on aging (AAA).
Existing law requires States and AAAs to develop plans prior to
implementing cost-sharing to ensure that participation of low-income
older individuals, with particular attention to low-income minorities,
will not decrease because of the cost-sharing. AOA must enforce this
measure fully and vigorously. Similarly, AOA must be vigilant in taking
corrective action to provide services without cost upon a finding that
cost-sharing is having a disparate impact upon the participation by
low-income and minority older individuals. In short, we call upon AOA,
State offices on aging, and AAAs to enforce the safeguards in the law
to prevent a reduction in minority participation in OAA supportive and
nutrition services programs.
D. SCSEP: FINE TUNING RATHER THAN RADICAL OVERHAUL
It appears now that the future direction for the SCSEP will be the
most likely contentious issue for the reauthorization of the OAA.
Title V, in our view, is the most successful employment and
training program ever enacted for older Americans, especially for low-
income seniors with poor employment prospects. The SCSEP has been
enormously effective for our Nation, low-income senior participants,
and the numerous communities served by the SCSEP. It has been evaluated
on numerous occasions and has always received positive marks, whether
from independent evaluators, elderly participants, host agencies, or
others.
Title V has enabled low-income seniors to improve their economic
well-being by helping others in their communities through the provision
of much-needed services at libraries, hospitals, senior centers,
nutrition sites and numerous other locations. Congress carefully
crafted this program to address two crucial objectives:
1. Self-help through employment and training opportunities for low-
income seniors who typically have poor employment prospects;
2. The provision of vital community services that would normally
not be available without the SCSEP.
One of the hallmarks of title V is that it has given low-income
seniors an opportunity to help themselves while helping others in their
communities, rather than be dependent upon public assistance. It has
taken some of the more disadvantaged older Americans in the United
States in terms of limited educational attainment, outmoded work
skills, or a long-term detachment from the labor force and helped to
place them in gainful employment in our economy.
1. AVOID DISRUPTIVE AND HARMFUL CHANGES
We favor a fine-tuning approach for continuing the SCSEP, rather
than proposing major changes. Congress made fundamental and far-
reaching changes for title V with the enactment of the 2000 OAA
Amendments. The result has produced four new national sponsors, new
regulations governing the program, a different and much more complex
reporting system, more stringent performance standards, and a shifting
of numerous older participants from one national sponsor to another
national sponsor. People who work with the program on a day-to-day
basis and those who participate in community service employment need to
reach a comfort level with the substantially revised SCSEP. They do not
need more fundamental changes or a radical overhaul. This action would
be harmful for the program, the low-income senior participants, and the
communities that they serve. A fine-tuning approach is necessary to
minimize disruption and to prevent title V's achievements from slipping
or falling precipitously.
In approaching this task, it is important to consider not only what
should be done for the SCSEP but also what should not be done to the
SCSEP. One important lesson is that what you do not do can be as
important as what you do, and sometimes even more important.
2. OPPOSITION TO ``DE-NATIONALIZING'' THE SCSEP
There is an old adage that one should not attempt to fix something
when it is not broken. This clearly applies for the SCSEP, and
especially the proposal to ``de-nationalize'' title V and to turn the
program over to the States. States would conduct periodic competitions
under this approach.
We oppose this proposal for several reasons:
There is no authoritative research to support this
proposal. Quite to the contrary, prior independent evaluations have
given high marks to the existing SCSEP, which operates successfully now
as a national program with a national sponsor-state partnership.
Performance levels certainly do not justify this
recommendation, primarily because national sponsors have consistently
outperformed the States by most meaningful performance measurements.
This is not meant to criticize States because they have a solid record
in administering SCSEPs. National sponsors, though, have outperformed
States according to key important standards. For example, national
sponsors had a 30.6 percent unsubsidized placement rate for the program
year ending June 30, 2004, compared to 26.8 percent for the States.
National sponsors achieved this higher unsubsidized placement rate
while serving more hard-to-place individuals on the basis of poverty
status, lower levels of educational attainment, minority status, and a
higher percentage of older participants.
A ``de-nationalized'' title V would become a balkanized
program. It would lead to greater chaos and more disruption. The SCSEP
has functioned well as a national program. It has operated as a
successful partnership with national sponsors and States. Each party
has something to offer to make the program operate more efficiently,
effectively and successfully as well as to respond to the diverse
population groups served by the SCSEP while meeting community service
needs. For these reasons, the Asociacion urges Congress to maintain (1)
the existing partnership between national sponsors and States and (2)
the existing ratio of funding between national sponsors and States.
3. OPPOSITION TO INCORPORATING SCSEP IN THE WORKFORCE INVESTMENT ACT
The Asociacion urges the Congress to avoid taking two specific
actions, which would be harmful for the SCSEP, the participants served
by the program, and host agencies working with the program. First,
title V should not be folded into the Workforce Investment Act (WIA).
The Asociacion is fully aware that some people will argue that it is
better to have all employment and training activities under one roof.
They further maintain that there should not be separate programs for
special groups. Congress tackled that issue more than 30 years ago and
wisely decided that a SCSEP was needed for low-income people 55 or
older with poor employment prospects because of their limited
education, outmoded work skills, long-term detachment from the work
force, and other limitations. Congress wisely opted for this approach
when it became readily apparent that general employment and training
programs oftentimes overlooked or ignored people 55 years of age or
older. Congress realized that older workers were historically
underserved by general employment and training programs. Congress was
pragmatic in recognizing that employment service and national manpower
activities placed a premium on serving younger workers because there is
a mindset that these programs will receive ``more bang for the buck''
by focusing on youth and younger populations. General work and training
programs enacted after passage of the Older American Community Service
Employment Act--such as the Comprehensive Employment and Training Act
(CETA), the Job Training Partnership Act (JTPA), and now WIA--do not
have a good record of reaching out and serving older workers, and
particularly low-income, disadvantaged older Americans with poor
employment prospects. In fact, the unacceptably low participation rate
for older workers in these programs following creation of the SCSEP is
a powerful reason to continue the SCSEP in its current form, rather
than have it subsumed in a comprehensive employment and training
program. Unfortunately, the record is all too clear that older workers
lose under comprehensive employment and training programs because their
participation rates are unacceptably low. The harsh reality is that
older workers will effectively be swimming upstream because of the
employment service and manpower network's preoccupation with serving
younger workers first and foremost. Low-income aged minorities,
especially those with limited English-speaking ability, can be
particularly disadvantaged when seeking assistance from general work
and training programs.
4. CONTINUE THE LONGSTANDING UNDERLYING PRINCIPLES
Title V does not need a radical overhaul. A much sounder approach
is to continue underlying core principles that have made the program
successful. For example, the SCSEP should continue to target older
Americans who have poor employment prospects. These individuals
typically have the greatest need for training, employment or additional
income. Quite often these people are simply not good candidates for
employment in the private sector because they have outmoded work
skills, a long-term detachment from the workforce, limited English-
speaking ability or other disadvantages. It is important to target the
SCSEP's resources in the most cost effective manner because title V
cannot possibly reach all the potentially eligible persons with
existing funds now or those that will be available in the future. An
emphasis on targeting those with poor employment prospects will help to
assure that the SCSEP's funds are utilized effectively, efficiently,
and in a cost-effective manner.
Congress should continue the existing language directing SCSEP
sponsors, to the extent feasible, to serve the needs of minority,
limited English speaking people, and individuals with the greatest
economic need at least in proportion to their numbers in the State
where the project is located.
One of the hallmarks of the SCSEP is the community service aspect
through which title V SCSEP participants provide valuable services for
aged community residents as well as the community at large. The
Asociacion supports retention of the community service aspect for the
SCSEP. We are opposed to any attempt to deemphasize community service
under title V. Many important programs flourish or are helped
significantly by the services provided by SCSEP participants. Congress
should encourage community service activities under title V, rather
than discourage them.
Title V has been a very successful program for numerous important
reasons. Congress targeted the program in a way to reach those with the
greatest employment, training and income needs. Congress was also
realistic in developing a pragmatic program that was responsive to the
needs of the SCSEP's clientele. Congress created a program that merged
two important concepts: (1) community service employment to make more
community services available and (2) self-help for those who performed
these services. Another key principle is to encourage people to move
from the SCSEP to employment in the private or public sectors. This not
only enables more low-income older Americans to participate in the
SCSEP; it also permits them to earn more as full-time employees in the
private or public sectors. Title V provides part-time community service
employment as an incentive for participants to move into full-time
employment in the private or public sectors. On the other hand,
legislators who established the SCSEP recognized that there would
probably be many participants who would not have a realistic prospect
to find employment in the private or public sectors for a variety of
reasons. Consequently, the leading sponsors of the SCSEP did not want
the program to apply undue pressure to force these people out of the
program. Thus, there was a reasonable and realistic balance established
to be responsive to the program's goals and the participants' needs in
the real world. These principles have worked well.
5. AOA SHOULD ADMINISTER THE SCSEP
Title V differs from the conventional training programs under the
direction of the Department of Labor (DOL), such as the Workforce
Investment Act (WIA). The SCSEP combines community service with
employment and training for low-income seniors with poor employment
prospects. DOL wants to model Title V after WIA. We think the opposite
should occur: WIA should attempt to be modeled more after title V.
Moreover, general training programs, such as WIA, have had a poor
record in serving older workers, and especially low-income seniors with
poor employment prospects. Our view is that the SCSEP has been a far
more effective program in achieving its objectives than WIA has.
In addition, there seems to be a more natural bonding between the
way title V operates, with its emphasis on community service, and AOA/
OAA programs under the direction of the aging services network at the
State and local levels. This has been an extraordinarily effective
partnership that has been a ``win-win'' proposition for all concerned.
Title III Supportive and Nutrition Services programs have been able to
reach out and serve many more older Americans, and more effectively.
SCSEP participants have been able to improve their economic well-being
while providing rewarding and valuable services in their communities.
For these reasons, we recommend that the administration of the
SCSEP be transferred from DOL to AOA. We strongly believe that this
action would improve the administration of the program as well as its
performance. Moreover, there is a more natural affinity between the
objectives of the supportive and nutrition services activities of the
AOA administered OAA programs and the SCSEP than there is between title
V and WIA.
E. CONCLUSION
In conclusion, the value and worth of the SCSEP and other OAA
programs have been amply demonstrated throughout the history of the
OAA. These programs deserve to be continued and expanded. The OAA
should be extended for at least 4 years, and ideally for 5 years.
We reaffirm that the SCSEP should be continued without major or
fundamental changes to prevent disruption for the participants, the
host agencies and the sponsors administering the program. All parties
connected with title V have already made significant adjustments and
sacrifices to conform to the 2000 OAA Amendments. Every effort should
be made now to permit a comfort level to be reached for those
participating in the SCSEP as well as those administering the program.
Chairman DeWine. Mr. Fong.
STATEMENT OF CLAYTON S. FONG, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, NATIONAL ASIAN PACIFIC CENTER ON AGING, SEATTLE,
WASHINGTON
Mr. Fong. Thank you, Mr. Chairman, Senator Mikulski. I want
to begin by thanking you both for your leadership the last time
we had the reauthorization. It was tough for a long time, and I
think it was your joint bipartisan approach that really
unplugged it and got it done quickly, on a timely basis, and we
look forward to that happening again with the same players at
the helm.
I want to say, though, I think what we have seen is a
demonstration of how 99.9 percent of this act, we all agree on,
and it is Republican and Democrat, it is from different States,
and it is from different parts of the country. We all agree on
it 99.9 percent. So I won't talk about the 99.9 percent. We at
the National Asian Pacific Center on Aging clearly support
LCAO's principles and we have submitted that as part of our
testimony, and I want to also point out that we have also
submitted, 13 members of national organizations have also
supported the Vision for America's Low-Income Senior Workers in
their Communities, and I want to submit those as part of my
testimony.
I want to, though, focus on just a couple simple things,
and that is, one, we all talk a lot about the aging of the baby
boomers and the tremendous numbers that are coming about. Few
of us talk about the changing face of that baby boom
population. And a good example of that would be the Hispanic
and the Asian community. At the same time as the plus-65
population is going to grow, is going to double in size, the
Asian and Hispanic elders are going to grow seven times faster
and that is an astonishing number.
So what are we going to do to be able to meet the needs of
a different and more diverse population, as well? Probably the
most key and fundamental issue is going to be language, so I
want to talk a little bit about language and language capacity.
In our communities, the Hispanic and Asian communities,
fully 60 percent of elders do not speak English well, and one-
third live in a household where no adult speaks English, and
those are astonishing numbers in terms of figuring out how to
reach them and serving a population that is most vulnerable and
not getting service.
But it isn't just new immigrants. I want to use my dad as
an example. He currently has Alzheimer's and is in a nursing
home. He came here in 1949. He came here for the simple reason
that he wanted his kids to have a better life, and I am a
testament to that fact. However, because he came here as an
adult, English will always be his second language, and now that
he has got Alzheimer's, there are many times when he just goes
back to his Chinese language and you can't treat him. It is
literally veterinary medicine if you don't have the language
capacity.
But beyond that, I think that it is an example of how we
have got to figure out how we best serve those most vulnerable
and target those resources to those that have the greatest
needs.
I want to also mention the other area that I want to
reemphasize and that is the Senior Community Service Employment
Program. For us, the Older Americans Act and especially the
Senior Community Service Employment Program have been, in the
Asian community, an emerging community, a critical component to
building an infrastructure for reaching and serving seniors who
otherwise would not have been served. In our communities, we
have not only language barriers, but most seniors in our
community actually also don't have pensions and so they have to
work longer. So the Senior Community Service Employment Program
is absolutely critical to that.
I will merely close with a couple of quick points. It is
really important that we have a critical mass, and you all have
seen wisely to make sure that there is a minimum critical mass
available for the National Asian Pacific Center on Aging--well,
for Asian and for Native American Indian elders, because there
is a critical mass to language in serving a national program,
so you have got to have big enough critical mass to figure out
how to do that. You have got to have a big enough critical mass
to figure out, how do you reach employers that will hire people
that speak other than English.
I also want to merely say that there is an economy of scale
that exists for limited English-speaking elders, but it also
exists for serving elders altogether, because there really is
literally a disincentive to serve, I think, elders in the
overall employment training programs because just placement,
elders aren't going to be as easy a placement. And then if you
speak limited English, it is even harder.
The last point I will merely say is that the community
service component and the placement of jobs are not mutually
exclusive. SCSEP is a good example of how you can literally
marry the two. The seniors get jobs where they can make a
difference in their communities, and that is very simply what
SCSEP is all about. Thank you.
[The prepared statement of Mr. Fong follows:]
Prepared Statement of Clayton Fong
National Asian Pacific Center on Aging,
Seattle, WA 98101,
February 14, 2006.
Hon. Michael B. Enzi,
Chairman,
Committee on Health, Education, Labor, and Pensions,
U.S. Senate,
Washington, D.C. 20510.
Mr. Chairman, members of the committee, and fellow aging advocacy
colleagues. My name is Clayton Fong and I have the distinct honor
serving as the Executive Director of the National Asian Pacific Center
on Aging (NAPCA). I appreciate the opportunity to offer comments on the
reauthorization of the Older Americans Act from the perspective of the
seniors I serve--Asian and Pacific Island Americans.
NAPCA is dedicated to the needs and concerns of Asian and Pacific
Island seniors in the United States. As an organization, we have long
held ``improved access to eligible services'' as the focal point for
our mission. NAPCA serves as one of the 13 national SCSEP sponsors. The
SCSEP is critically important for our seniors and we would like to see
it continue to serve this growing and diverse segment of senior
Americans.
NAPCA supports the basic reauthorization principles articulated by
the Leadership Council on Aging (LCAO) of which we are a member. Rather
than going into these principles, I attach them for the record and
focus my comments on a single component of the Older Americans Act--
Title V, the Senior Community Service Employment Program (SCSEP). This
particular program illustrates the nature of work of organizations such
as ours who are committed to serving elders. SCSEP is directed to a
particularly difficult to serve segment of senior Americans--low-income
seniors. While all low-income seniors are difficult to serve, Asian
Pacific Islanders are especially difficult to serve.
Presently there are approximately 1,100,000 API elders 65 and over
that live and work in the United States. This population is expected to
grow faster than any other minority group over the next decade. This
increase in population is likely to include increasing diversity among
API ethnic groups, languages, and nationalities. This diversity is
magnified by differences in immigration history, citizenship status,
English proficiency and by life-span experiences. These experiences
impact life chances and influence how APIs enter and experience old age
and aging.
These differences also make it difficult to serve this community.
Over 70 percent of all APIs are foreign born, 80 percent of API elders
speak a language other than English and a third live in a household
where no adult speaks English. Language proficiency has a significant
impact on an API elder's experiences. According to the Census Bureau 60
percent of all API elders are limited English proficient (LEP). That
percentage is higher for certain ethnic groups especially SE Asians,
and Koreans. Not surprisingly, an API elder survey conducted in 1998-
1999 by NAPCA in five urban areas found that language barriers ranked
highest among many unmet needs.
These elders, who tend to be the most vulnerable, will face
daunting challenges in understanding what changes are being made to the
social and health-related programs on which they depend. While
mainstream seniors might be aware of such services through mailings,
news media, and television, Asian Pacific elders can seldom be reached
through these vehicles. This segment of older Americans requires more
direct and continuous attention than those in the mainstream. NAPCA is
committed to improving Asian and Pacific Islander Americans' access to
the benefits for which they are eligible.
NAPCA is one of the national sponsors actively participating in
SCSEP. We have chosen to operate our efforts by collaborating with
existing community-based organizations rather than having stand-alone,
NAPCA-staffed SCSEP programs in those communities with large Asian and
Pacific Islander senior populations. We feel this approach is not only
cost effective but also enhances the capacity of community-based
organizations to serve seniors.
NAPCA along with the National Indian Council on Aging (NICOA) are
the two smallest national sponsors in terms of allocation of enrollees.
Because both programs have a national focus and literally operate in
locations across the United States, these programs can only be cost
effective if there are a sufficient number of enrollees over which to
spread fixed costs of administration and management. If the number of
enrollees allocated to these smaller programs fall below this
``critical mass'' level, program costs per enrollee would make the
program impractical.
We aggressively defend the need for a national sponsor, such as
NAPCA, dedicated to serving Asian and Pacific Islander Americans since
just the language barriers for this segment of seniors make it
impractical, if not impossible, for mainstream organizations to serve
our constituents. Clearly, there are economies of scale in having a
national organization such as ours serve as a clearing house of
information and regulatory requirements so that our constituents have
an understanding of options and can make more informed choices. NAPCA
operates as a clearing house in the sense that we translate difficult-
to-understand information and regulations into forms that are easily
understood and used by senior Asian and Pacific Islander Americans.
I submit that without a national sponsor focusing on the API
seniors, this segment of the senior population would be underserved.
This is not because States and other sponsors do not want to serve our
constituents; it is simply because the prominent language and cultural
diversity of API seniors make them a difficult group to serve.
Replacing the national sponsors with a block grant to the States
would inevitably displace many low-income seniors, and particularly
aged minorities. States will simply not be able to locate projects in
areas where there are high concentrations of minorities to the same
extent that national minority aging organizations currently do.
Additionally, States would be unable to duplicate the language capacity
of the existing minority networks at a level that would sustain the
existing 1,000 API seniors that are served every year.
Simply put, national minority aging contractors are more effective
than States in representing the interests of minority enrollees and
involving minority host agencies in the SCSEP. We have a better track
record. We have the respect and confidence of the minority community.
In short, minority seniors will not be adequately served without the
continued levels of support for the national organizations that are
dedicated to the needs and concerns of minority seniors.
Finally, why block grant this program when national sponsors have
outperformed the States by virtually every single important measurable
barometer, including unsubsidized placements, fully utilizing allocated
funds, and serving older Americans with the greatest needs in terms of
poverty status, limited education, and advancing age?
In the reauthorization of the Older Americans Act, NAPCA urges the
committee to retain Sections 506(a)(2) and 506(a)(3) relating to
Reservations for Territories and Organizations. Without this section of
the law, low-income Asian and Pacific Islander Americans will be less
likely to be served. Second, we also urge the committee to require that
the Federal agency administering SCSEP take into account the specific
economic and cultural environment of seniors in assessing and
evaluating placement in unsubsidized employment. Placement rates tend
to move in concert with employment rates in a community; and, community
differences must be accounted for in program evaluation and assessment.
Finally, we cannot overemphasize the importance of the dual nature of
SCSEP. Community service and employment training are a powerful
combination.
NAPCA recently participated in discussions of SCSEP with other
aging organizations on ways to improve how we serve low-income seniors.
The outcome of this self-evaluation and forward looking discussion is
contained in a statement entitled ``A Vision for America's Low-Income
Senior Workers and Their Communities'' which I endorse and include for
the record.
Mr. Chairman and members of the committee, I thank you for the
opportunity to offer my views on behalf of Asian and Pacific Islander
seniors.
a vision for america's low-income senior workers and their communities
The following statement was adopted at a meeting held January 10,
2006, of the 13 national grantees funded by the U.S. Department of
Labor.
For 40 years, the Senior Community Service Employment Program
(SCSEP) has provided part-time employment in a wide range of nonprofit
and public agencies to low-income adults 55 and over. Every year, more
than 100,000 older adults with poor employment prospects and the
greatest need are able to re-enter the labor force. As extra help,
SCSEP participants enable thousands of community and faith-based
organizations to provide vital public services that would not otherwise
be available to other needy seniors, children, and the general public.
The 2000 reauthorization of the Older Americans Act kept SCSEP
intact while strengthening program accountability and the role of State
Governments. Congress concluded that SCSEP is an efficient and cost-
effective program, serving practically every county in the Nation,
including hard-to-serve rural and urban communities.
The 2005 White House Conference on Aging recognized that SCSEP
ensures that ``the oldest, poorest and least skilled older workers do
not fall through the cracks.'' Across the aging network, there is broad
support for continuing SCSEP--with minor refinements--as our Nation's
most effective workforce program serving the most vulnerable older
Americans.
PRINCIPLES TO GUIDE SCSEP REAUTHORIZATION (TITLE V, OLDER AMERICANS
ACT)
1. Target services to older persons with the greatest economic and
social need--including those from minority, rural, and urban hard-to-
serve communities--by keeping the current age and income eligibility
requirements.
2. Maintain and enhance the community service employment aspect of
the program in addition to promoting economic self-sufficiency among
participating seniors.
3. Maximize expenditures on participant wages and benefits and
minimize administrative costs by retaining current policy on program
budgets.
4. Support best practice and avoid disruption in the program by
continuing to fund both national and State/territorial grants to
operate SCSEP.
5. Strengthen the role of the Administration on Aging in SCSEP.
POSSIBLE REFINEMENTS TO SCSEP
1. Amend section 502(e) to remove disincentives for private
business concerns, community colleges, and other training providers to
participate in innovative training and placement activities for SCSEP
participants.
2. Fully implement a ``balanced scorecard'' to measuring SCSEP
grantee performance that reflects Congressional intent, including
service level to most-in-need, unsubsidized placement, and community
service.
3. Streamline performance data collection.
4. Provide sufficient funds to respond to the projected increase in
SCSEP-eligible persons.
This approach would respect Congressional intent in 2000 to update
SCSEP without disrupting a proven program has evolved to meet changing
needs since its inception. Adopting these principles and refinements
will enable SCSEP to serve the most vulnerable and hardest-to-serve
older adults in a cost-effective, research-validated, and high-quality
manner for the remainder of this decade.
RATIONALE
1. The number of older adults in poverty and at risk will increase
significantly, according to the Census. By 2008 there will be 6.7
million persons aged 55 or over below poverty, a 22 percent increase
from 5.5 million in 2000; by 2015, this number will increase to 9
million low-income older Americans. Clearly the need for SCSEP is
growing.
2. Current research about productive aging, employment, and civic
engagement supports the validity of paid community service employment
to assist older adults at risk. Working in bona fide part-time jobs
provides not only needed financial aid but also contributes to
participants' physical and mental well being, helping them avoid
becoming increasingly dependent on others.
3. SCSEP does more than help older job seekers find employment--it
directly supports the day-to-day operation of thousands of community
and faith-based organizations and Government agencies. According to
USDOL, 70 percent of these agencies reported that they would not have
been able to provide the same level of services without SCSEP. Last
year alone, SCSEP participants provided these agencies close to 46
million hours of paid community service. For instance, SCSEP
participants and staff work as the primary older worker specialists at
many WIA One Stops and have helped meet the increased demand for social
services as a result of Hurricane Katrina.
4. SCSEP serves over 100,000 persons 55 and over each year, over
twice as many as those served by WIA. Further, SCSEP serves a more
needy population: about over 70 percent of all SCSEP participants are
women; over 80 percent are 60 and older; over 80 percent are at or
below poverty, about one-third have less than a high school education;
and over 40 percent are from a minority group. In contrast, WIA
nationally serves less than 4,000 persons 65 and over of any income and
education level (likely due to performance disincentives currently
built into WIA, according to GAO Report 03-350). In fiscal year 2004,
national and State/territorial SCSEP grantees achieved ACSI customer
satisfaction scores that were ``substantially higher'' than scores for
WIA, and better than most organizations in the private sector.
5. The 13 national grantees (selected by USDOL through a national
competition in 2003) add significant value to the total SCSEP program
and delivery system. They develop and replicate successful program
models by partnering with national-level corporations, employer
associations, social service agencies, and other providers. These
national nonprofit organizations strengthen SCSEP at the State and
local level by sharing best practices on serving hard-to-reach rural
and urban communities, including minority and immigrant groups;
collaborating with WIA One Stops, area agencies on aging, etc.; and
leveraging local resources to support SCSEP. National SCSEP grantees
represent unmatched expertise and experience that would be difficult to
replace.
6. Since USDOL did not issue final regulations for SCSEP until
2004, many of the initiatives and improvements embodied in the 2000
reauthorization are only starting to take effect. For instance, the
reauthorization requires stronger national and State grantee
coordination, but the improved State planning process has been in place
for only 1 year. At the request of the Senate Special Committee on
Aging, GAO is conducting a review of SCSEP since the 2000 Amendments.
It would be premature to make major changes without full implementation
of Congressional intent from the last reauthorization in 2000.
[Editors Note--LCAO Older Americans Act Reauthorization
Recommendations can be found with the statement of Barbara B.
Kennelly.]
Chairman DeWine. Mr. Kourpias.
STATEMENT OF GEORGE J. KOURPIAS, PRESIDENT, ALLIANCE FOR
RETIRED AMERICANS, WASHINGTON, DC.
Mr. Kourpias. Thank you very much for this opportunity, and
let me say that the Alliance for Retired Americans will submit
further testimony here.
The Alliance for Retired Americans is a nationwide
grassroots organization that advocates on behalf of older
Americans. The Alliance represents some three million retired
workers and our mission is to support public policy that
protects the health and economic security of this country's
senior citizens. We teach seniors they can and should make a
difference in their lives through activism, and it is this
activism that we harness to help preserve and protect that
which makes a difference in the lives of older Americans.
I am here today to say that the Older Americans Act, from
which the Alliance receives no money nor do we administer OAA
programs, is a perfect example of legislation that has made an
enormous positive difference in the lives of millions of
seniors. Designed to promote the dignity and the independence
of older people, this landmark legislation has resulted in the
creation of a broad range of indispensable and, some would say,
life-saving services for older adults and their caregivers.
Thanks to the Older Americans Act, American seniors can today
live independent and dignified lives as members of their
communities for as long as possible.
I hear time and time again what a difference the program
made possible by the Older Americans Act has made in the lives
of our Alliance members. Food arrives with a knock at the door
from Meals On Wheels. Doctor visits are possible, and
prescription drugs can be picked up at the pharmacy thanks to
transportation. And if you or your family member are in a long-
term care facility and have a problem, thanks to the Older
Americans Act, you today have legal recourse to resolve their
issue.
I can't imagine what would happen if these folks didn't
have these services to count on. Programs and services funded
by the Older Americans Act are not only life savers for
seniors, but they save the Federal Government and taxpayers the
high costs of institutional care. This cost savings is destined
to deliver an even better return in the not-too-distant future
because home- and community-based support services will become
even more essential as the baby boomers start to age.
Just last month, there was a great fanfare when the first
of 77 million baby boomers turned 60. This huge increase in the
aging population will have a direct and dramatic impact on
every community, county, and city in this country for decades
to come.
What this should be telling us is that now is the time to
plan for expansion in the adequate health and support services.
We should not be debating cutting or curtailing these essential
programs. The reauthorization of the Older Americans Act
provides Congress the opportunity to do what is right for
today's aging population, as well as for tomorrow's new
seniors. It is my hope that as Congress debates measures
designed to reduce the deficit, it resists the temptation to
cut or eliminate programs that help millions of needy older
Americans.
I am especially concerned that the Senior Community Service
Employment Program remain intact. Thanks to this program, more
than 100,000 of the country's neediest seniors are given part-
time jobs, and last year alone, seniors in this program
provided close to 46 million hours of paid community service.
The Older Americans Act created vital programs and services
that millions of Americans count on daily to survive. It, too,
deserves to survive. Thank you very much.
[The prepared statement of Mr. Kourpias follows:]
Prepared Statement of George J. Kourpias
Good afternoon Senators. I am George Kourpias, President of the
Alliance for Retired Americans. We are a nationwide, grassroots
organization that advocates on behalf of older Americans. The Alliance
represents more than 3 million retired workers, and our mission is to
support public policy that protects the health and economic security of
this country's senior citizens.
We teach seniors they can and should make a difference in their
lives through activism. And it is this activism that we harness to help
preserve and protect that which makes a difference in the lives of
older Americans.
I am here today to say that the Older Americans Act is a perfect
example of something that has made an enormously positive difference in
the lives of millions of seniors. Designed to promote the dignity and
independence of older people, this landmark law has resulted in the
creation of a broad range of indispensable, some would say life saving,
services for older adults and their caregivers.
The Alliance does not receive funding, nor do we administer
programs, through the Older Americans Act. Many of our members receive
the benefits of this law in their everyday lives. And many of our
members volunteer in Older Americans Act programs as well.
Thanks to the Older Americans Act, American seniors can today live
independent and dignified lives as members of their communities for as
long as possible. I hear time and time again what a difference the
programs made possible by the Older Americans Act have made in the
lives of our Alliance members.
Food arrives with a knock at the door from the ``Meals on Wheels''
programs. Older Americans Act transportation programs provide visits to
the doctors or prescription pick-ups at pharmacies. Ombudsman programs
for long-term care provide the peace and comfort that family members
need when a loved one is in a long-term care facility.
This past December, delegates to the White House Conference on
Aging, which several dozen Alliance members attended as delegates,
voted as their number one resolution that the Older Americans Act be
reauthorized within the first 6 months following the Conference.
But what the Older Americans Act makes possible is more than just
health and supportive services. It is, for millions of American
seniors, the very reason they can continue to live their independent
lifestyles. It allows them to remain part of their communities.
Without the programs funded by the Older Americans Act, far too
many elderly citizens would have little choice but to pack up their
homes and lives and move to hospitals or nursing homes. Programs and
services funded by the Older Americans Act are not only lifesavers for
seniors, but they save the Federal Government and taxpayers the high
cost of institutional care. This cost savings is destined to deliver an
even better return in the not too distant future. Home- and community-
based support services will become even more essential as the baby
boomers start to age.
The Older Americans Act also supports the Senior Community Service
Employment Program (SCSEP), which provides part-time jobs to 100,000 of
the most needy seniors each year. Participants in this program work
directly for thousands of community and faith-based organizations and
Government agencies. According to the United States Department of
Labor, 70 percent of these agencies reported that they would not have
been able to provide the same level of services without SCSEP. Last
year alone, SCSEP participants provided these agencies close to 46
million hours of paid community service. This cost-effective program
needs to be continued without any major changes.
Also, the number of older adults in poverty and at risk will
increase significantly, according to the Census. By 2008 there will be
6.7 million persons aged 55 or over below poverty, a 22 percent
increase from 5.5 million in 2000; by 2015, this number will increase
to 9 million low-income older Americans. Clearly the need for SCSEP is
growing.
Just last month there was great fan fare when the first of the 77
million baby boomers turned 60. This seismic increase in the aging
population will have a direct and dramatic impact on every community,
county, city, and State in this country for decades to come. Everything
from transportation to health, from recreation to workforce development
and housing will be impacted.
What this should be telling us today is that NOW is the time to
plan for a dramatic expansion in adequate health and support services.
We should NOT be debating cutting or curtailing these essential
programs. The reauthorization of the Older Americans Act provides
Congress the opportunity to do what is right for today's aging
population as well for tomorrow's ``new seniors.''
The baby boomers are real, but we cannot ignore the fact that the
fastest growing segment of our population today is people over 85.
Congress must provide for adequate funding to keep seniors independent
and productive. And it must ensure that the necessary system of
services is in place to meet both current and future needs.
I have seen what programs created by the Older Americans Act do to
improve the quality of living for today's older Americans. And it is my
hope that as Congress debates measures designed to reduce the deficit,
it resists the temptation to cut or eliminate programs that help
millions of older Americans.
The Older Americans Act created vital programs and services that
millions of Americans count on daily to survive. It deserves--and the
Alliance for Retired Americans supports--a prompt reauthorization.
Thank you for allowing me to testify before the committee today.
Chairman DeWine. This has been very good, very, very
helpful. We have got just a couple minutes left. I think it
could be helpful if we could just kind of open it up, if
anyone--Barbara, if you have any questions, but I thought we
would just kind of open it up if anybody wants to react in any
way to anything anyone said or if anyone wants to jump in here
very quickly with any additional comments. Barbara?
Senator Mikulski. Senator, first of all, I think it is
wonderful that everybody stuck to the 3 minute rule. There are
lessons to be learned here.
[Laughter.]
But I agree with you. I would like to hear if anyone would
like to say more.
Chairman DeWine. Don't be bashful. Come on now.
Senator Mikulski. Howard has got a comment, Senator.
Mr. Bedlin. I would just like to associate myself with
Clayton's comments that 99.9 percent of the issues that you
have heard, there is consensus, and I am very grateful that
both of you were so much involved 5 years ago when it took us--
actually 6 years ago when it took us 5 years to do this. I
think if we all work together, which I know we can, on a
bipartisan basis, we can do this. Even though the White House
Conference resolution said, do it within 6 months, the
delegates didn't have the opportunity to change that language.
I think there was consensus that we want to do it this year.
But I really am very enthusiastic about the very broad
consensus that is here and that is reflected in all the
comments that we have heard today.
Senator Mikulski. I would like to ask a question of Jo
Reed, if I could.
Ms. Reed. Yes.
Senator Mikulski. It goes more to the livable communities.
Are you familiar with the concept of NORCs?
Ms. Reed. Yes.
Senator Mikulski. I would like to know what you think about
them. Senator DeWine has a demonstration project in Ohio. I
have two in Maryland and we are contemplating a hearing on
NORCs. Also what you think about reverse mortgages, which also
offers seniors the income and opportunity to remain at home.
How would we protect against fraud and gouging? Because as you
know, where there is a need, there is often a greed and gouging
that goes with it.
Ms. Reed. Right. Well, with regard to Naturally Occurring
Retirement Communities.
Senator Mikulski. NORCs, not narcs.
[Laughter.]
Ms. Reed. This is kind of an evolving awareness that these
exist already and that we need to get out there and recognize
this is an opportunity to achieve economies of scale in
providing services to people where they live, where they want
to remain, and we are really interested in the demonstration
projects that you are working on there.
We also have been engaged as an association for a long time
in monitoring what is happening with the development of reverse
mortgages. It is a real option for people who are house rich
but cash poor, but it is subject to all kinds of dangerous
marketing behaviors if we are not very careful in keeping track
of this developing industry. AARP has been a very strong
proponent of the FHA insurance program for home equity
conversion mortgages, which requires independent third-party
counseling for people who are considering getting a reverse
mortgage to make sure that they are clear on what their
alternatives are and whether this is truly the best choice for
them.
So that is the thing that we have worked very hard to
ensure was passed, first of all, that FHA insurance program,
and then expanded and the cap raised on how many could be
insured, and now we are hoping to see the cap removed
altogether because this is really taking off.
Chairman DeWine. Who else?
Senator Mikulski. Suzanne, we need to have the microphone.
Ms. Mintz. I think one of the things that we need to
consider as people age in place and we see more and more of
that coming, and I certainly believe in it, is that if people
are living in homes that they have lived in for a very long
time, more likely than not, they are not particularly
disability friendly, and as people age, obviously, they tend to
require more aids.
There is not a whole lot of money around to help people
make adjustments to their homes so that they can stay in them
safely and healthfully. Certainly Medicare does not cover even
grab bars or something as minimal as that. So I think to
support people staying in their homes, we need to look at that
entire package of what does that mean and making their home
capable of housing them in a safe way as they age and become
more disabled is something that needs to be part of the entire
package.
Senator Mikulski. Ms. Mintz, could I ask a question,
because I was touched by the story of the lady in Potomac,
Maryland, which is not a poor community----
Ms. Mintz. Right.
Senator Mikulski [continuing]. But nevertheless shows the
level of desperation. How do you see this? She called for help
even in terms of changing the light bulb, the leaky roof,
essentially what we would call the basic household maintenance,
which can cost a bundle, again seniors are subject to great
consumer fraud. Do you think this should be done through
volunteers? Do you think there should be ways of adding
flexibility in the law to essentially encourage extreme
makeovers in caregiving, a version of the way Habitat for
Humanity, which I am a big believer in, builds new housing, but
kind of a retrofit as well as maintenance.
Ms. Mintz. I think there is a combination of things that
are needed. I think there will never be enough money around to
solve everything.
Senator Mikulski. Right.
Ms. Mintz. I think that we need to come back together as
communities, the old concept of barn building. I think help in
mowing the lawn and changing a light bulb and all of that is
definitely something that can be done on the community level by
volunteers, by just putting together networks of friends and
neighbors to support efforts of that nature. We need to build
more on that.
But in terms of the larger issues of programs, I do think
we need to look at the concept of things, what is it, Christmas
in April is a group that comes in and helps people with homes.
I think we need to be thinking about those kinds of programs in
terms of rehabilitating housing so that people can stay there
as they age or as they become disabled for whatever reason. So
I think it is a combination of both programs and reeducating
all of us to watch out for our neighbors.
Senator Mikulski. But, you know, in Potomac, Maryland, you
can find a lot more lawyers than you can find plumbers and God
love them, we appreciate that, or social workers and so on.
Again, I am not saying anything about Potomac, but when you
look at the rural community or other communities, a neighbor
can watch out but might not be able to because they themselves
might be poor.
Ms. Mintz. Right.
Senator Mikulski. Therefore they don't have either the
skills or can't run to Home Depot to help Miss Mabel. That is
why I am wondering, the use of AmeriCorps, others where there
is actually even more reliability and sustainability available
to the Offices on Aging.
Ms. Mintz. Yes, I think we definitely need to look at the
various programs that are out there and pull them together so
that we can build on the value. Somebody talked about baby
boomers and volunteering, and in fact, baby boomers as a
generation have the largest number of people who volunteer. I
think we need to work on those initiatives and get more people
involved in things, whether it is the young people or older
people who are retiring. And I think it needs to be built
around the community.
Senator Mikulski. Yes.
Ms. Mintz. There are any number of Web sites and systems
out there to help people develop networks of support and I
think we need to find out more about them, make them more
available to a wide range of people. I believe people want to
help. I think they don't necessarily know how. And I think
people are afraid of being sucked into something that is long-
term. We need to find ways to help people give in the ways that
are easiest for them.
In DC., there is a program called DC. Cares, which actually
got started, oh, it has got to be a dozen years ago, I think,
to give professionals opportunities to volunteer, recognizing
that they had crazy, overworked schedules as it is, and it is
that concept.
Senator Mikulski. I appreciate that. Senator DeWine is
going to have to go, and if I could put that in our information
bank. Senator, before you go, if you want me to continue, I do
want to follow up with Meals On Wheels and the Offices on Aging
and the changing nature of the volunteer in the new century and
the new demography, if I could.
Chairman DeWine. I do have to go. I have a 4 o'clock
meeting in the Leader's office. But I want to thank all of you
very much. Senator Mikulski is--are you going to continue,
Barbara?
Senator Mikulski. Just for a little bit more, if I could,
on this issue of volunteerism.
Chairman DeWine. My staff will remain and listen. It has
been very, very helpful. We look forward to working with all of
you. It worked last time. We got a bill. We all worked
together. We got it done. Senator Mikulski and I are dedicated
to getting it done again with your help, and so we are going to
make it happen. Thank you very much.
Senator Mikulski. [Presiding]. We will work together. We
are going to get this done, and I think what Senator DeWine was
saying, the way you have said it to each other is, we are not
going to make the perfect the enemy of the good, but we are
going to have a good bill that we all have a sense of pride in,
consensus in.
First of all, I do want to ask about volunteers, like in
the delivery of Meals On Wheels, the nature of this program has
been changing since it was created in 1965, but know my
position is that private philanthropy is never a substitute for
public policy nor for public funding. So we are not looking for
cheap labor to be a substitute, and I mean that quote not that
that is cheap labor, but let us go to Meals On Wheels.
Ms. Borden, thank you for your testimony, but here is my
question. The very nature of the need is expanding because
people are staying at home and also even now the issue of
chronic often equals infirmity and therefore are shut-ins. We
are also hearing there are not enough volunteers to do Meals On
Wheels. Are you finding that? Would you tell me the impact of
that on the delivery of your services, and also, could you
share with the committee the impact of rising energy costs,
because if you have a meal and you need a wheel, you need gas--
--
Ms. Borden. That is right.
Senator Mikulski [continuing]. To both cook, prepare, as
well as to deliver.
Ms. Borden. That is right. Thank you for bringing this up.
It is one of the issues that is actually the most significant
to us today.
I mentioned in my testimony that we have four out of ten
programs that have waiting lists. When we poll our programs to
find out why we have those waiting lists, one of the top two
answers is a lack of volunteers. The face, the changing
demographic shows us that the face of the current volunteer are
those people who are seniors themselves. Those are the people
who have the time during that portion of the day to actually go
out and volunteer, so that is becoming increasingly a more
difficult problem for us.
And the second issue that we are facing today is the rising
cost of gas. More and more of our programs are finding all
sorts of problems getting people to volunteer because they
can't afford the price of the gas.
So any help that you can give us along those lines will be
most appreciated. It is a huge problem for us. We cannot--our
programs cannot exist without volunteers. We are a volunteer
program, for the most part. When we lose our volunteers because
of age and because of gas prices, we are in deep trouble, and
we are finding that it is a major, major problem today.
Senator Mikulski. I am going to ask the leadership council
really to ponder this because I think it is an issue in each
and every one of the program areas, and in certain communities,
it is even more exacerbated, and also in those parts of our
country or even in our own States where particularly the
delivery is very long distances, the rural parts of our State.
We were talking about Appalachia. That is very rugged terrain,
as you know. You spent a lot of time in Maryland.
Ms. Borden. Absolutely.
Senator Mikulski. You know what I am talking about. So we
really would like the leadership council, to look at this tax
break for volunteers. I don't have the answers, but I am
concerned, and you shouldn't be penalized. It is one thing to
do it on your own time and do it on your own dime, but it is
another thing to do it on Exxon's dime. So if we could get some
ideas on that.
Ms. Kennelly. Senator, I would like to speak to that----
Senator Mikulski. If you have ideas now, this is a good
place to hear them.
Ms. Kennelly. But I think we have to continue to have some
group thinking is what we have all said. I mean, I travel the
country. I go to senior centers all the time. The
sophistication of the senior centers is limited. It is
absolutely limited. I think that so many of us who have so much
knowledge and talent have to be forward-thinking about that we
are all going to work longer, much longer, and that we have got
to update how we think about ourselves from 70 to 80.
And I think the leadership council could be--I listened to
this whole thing. It was wonderful, but there is so much talent
here. We can't just protect what we have got. We have got to do
much better.
Senator Mikulski. That is what I am saying.
Ms. Kennelly. We have got to do much better, and I can't
think of any better group, and I thank you for your leadership,
but I don't think we can be self-congratulatory. I really
don't. I don't think we have moved into who we are and where we
are going and how long we are going to live.
Senator Mikulski. I think we have a couple of crises. One,
of course, is in this budget, so that is one thing. This budget
is a crisis, and I will leave it to you all to figure out how
you are going to be advocates. You can count on me certainly to
be speaking up.
The second is the terrible thing that happened in disaster
planning with Katrina. Hello, we are Americans, too. Who got
left behind?
Ms. Kennelly. Seventy percent.
Senator Mikulski. Who died? Who were vulnerable? Who ended
up holding children, it was the grandparents. So one is the
role in disaster planning. This might not be in the Older
Americans Act, but this is a good time for us to have a
conversation. Do you all have a kind of a generalized position
or a white paper?
The third is the gas crisis, the energy crisis, of being a
volunteer and a variety of other things associated with that.
Then there is the usual and customary things that we are
facing. I know Mr. Flood raised them and Ms. Markwood, who
represents the Area Agencies on Aging. You are up against it,
aren't you, but yet you have got the solutions.
Ms. Markwood. Well, in saying that, I think that there are
solutions out there and a lot of the solutions exist at the
local level and we need to cull that out and we need to support
those best practices.
Senator Mikulski. Which, of course, is what Ms. Mintz was
saying.
Ms. Mintz. But in addition to that, Senator Mikulski,
speaking to the disaster preparedness that you raised, I think
what we are proposing as part of our community preparedness is
really that, is helping communities look at preparing and
planning for the aging of the population, helping people plan
to prepare and modify houses, but also to develop new housing
options, helping them to develop new transportation options.
Disaster preparedness for older adults is to really look across
the services that exist at the community level and look at how
they are going to be impacted by an aging population.
And at this point, our concern is that is really not
happening, and somehow or another, we need to be proactive as
the aging community to help cities and counties across the
country make this happen.
Senator Mikulski. Do you feel that these recommendations
you are making for the Older Americans Act, if adopted, would
strengthen your ability to do that?
Ms. Markwood. I think having the aging network play the
role as the community liaison with the existing community
agencies would go a long way toward increasing the awareness of
various county, city agencies on what an aging population is
going to mean for their service areas.
Senator Mikulski. See, I worry about these things, and
maybe we need a new title. I am going to ask you to ponder that
and really welcome your recommendations. I don't want to break
new ground, because we need your recommendations and in some
ways consent. Senator DeWine and I have both the will, the
relationship, and I think a framework to move ahead and move
the bill.
At the same time, I worry about the disasters plan. Every
one of our States has a disaster. If we are hit by a pandemic
like avian flu, well, who is going to get sick first? Is it the
Olympic team? I don't think so. So it is the vulnerable. What
are you going to do, quarantine? I mean, all of these issues
which you have to go to and organize systematic, skilled,
experienced professionals with the networks, and that is your
point. So they should be included in that, as well as any kind
of event that could affect the community that we can't even
anticipate, if there is a bio attack in Baltimore or in
Bethesda or something along those lines. Hartford was hit by a
snowstorm, Congresswoman Kennelly's town.
Should we actually have a title that says that all
governors, mayors, or county executives and so on should
include as part of disaster planning consultation with the
Office on Aging or something like that? So that is something
else for us to think about.
Then there is the changing nature of demography. I think
Ms. Mintz said it. People are reluctant to volunteer because
they don't want to sign up forever. They will sign up for an
event. It is the new style, and then how do we use these
volunteers? But if you are delivering Meals On Wheels, that
can't be a Christmas in April model, or it can't be a Saturday
afternoon model. This is where we wonder, is this where
AmeriCorps, ExperienceCorps, all these others could be some
other form? I don't know. What do you think?
Ms. Markwood. I think that there are various models that we
can use, but I think with the idea of civic engagement, it is
being able to capitalize on those individuals for these short
periods of time. I think the thing is that the nature of civic
engagement and volunteerism has changed, but the models that we
use at the local level unfortunately haven't changed to be able
to engage those people.
Senator Mikulski. Which would also pick up on language, you
see.
Ms. Markwood. Because the face of volunteers have changed.
Senator Mikulski. This, then, comes back to, though, the
national framework and the local flexibility. We have one
county in Maryland that has a significant Korean population.
That is Howard County. Montgomery County, where Ms. Mintz
lives, has a significant Chinese population. So you have to
keep that flexibility, because in Maryland, one size wouldn't
fit all.
But I think these have been just terrific ideas and if you
want to amplify based on our questions or Senator DeWine's
questions, we would like to hear from you. And if you think you
have good ideas but don't want to put them in the Older
Americans Act, consider something else, also let us think in
those ways. But the Older Americans Act framework and the
network from State to the local senior centers, I think was the
genius of the program.
Senator Mikulski.Yes, Mr. Fong.
Mr. Fong. I wanted to catch on that point and emphasize an
interesting area that was mentioned by Mr. Bedlin, and that is
the area of--if you look at what is happening with the Medicare
outreach right now, the whole aging network is really working
with, n4a, the State units, we are all working together, and it
was mentioned by a couple of folks. It is really a good
example, or for lack of a better word, a demonstration of how
this network is being utilized and mobilized.
However, the key to it was under the last few years of
diminishing resources, we have not really been able to think
outside of the box. We see a little bit of resource coming
about for this Medicare Act and you are seeing the potential of
it. I suspect if there is a message in that, it is very simply
there is tremendous potential for reaching the most vulnerable
population.
On the disaster preparedness side, absolutely key. It could
fall within a demonstration act. It could also amplify, I think
it was a benefits outreach demonstration or title that I think
Howard was talking about.
I also wanted to say that there are a number of things
that--one of the other areas that five national sponsors
recently did was we collaborated with the lead of SSA on a
guide for providing and engaging immigrant seniors, which I
wanted to amplify on parts of your community. It is an example
of something that happens at the national level because we have
an ability to kind of collaborate and think outside of the box
and have some economies of scale and work together.
And I guess to go back to a point, I guess my biggest fear
as we go forward here is we will see separate Senior Community
Service Employment Programs or some proposals within that kind
of bog this thing down, and I hope not.
Senator Mikulski. That has always been the prickly. That
has always been the prickly. But I think we can deal with that
and go from there.
Ms. Kennelly. You have got that one under control.
Senator Mikulski. Well, we don't have it under control, but
I think we have a will to do that and we do believe in give and
take with each other. I think we came up with a very good
approach last time.
Mr. Fong. There is a rumor about a, quote-unquote,
``formula grant,'' or actually now in the administration's
budget something that would move funding to the States, and I
suspect that would really--if you think about a formula change
that created a five year logjam, imagine what happens if you
try to create a literal elimination of the national groups.
And I want to emphasize that the reason we care so much
about this program is the nature of the folks that we serve
with it. It is not a matter of turf, I think it is a matter of
the folks that we serve and the tremendous needs within that
community. Thank you.
Senator Mikulski. Well, I am surprised there hasn't been a
revolution over the prescription drugs. I remember--I am from
the generation, and Congresswoman Kennelly was in the House, as
well, when we did the catastrophic care under President Reagan,
and I remember, Jo, the Anne Arundel County AARP came, and it
is a very polite group and more of almost a school marmish
style, they chased me down the Capitol steps with a broom
saying, ``Clean house! Clean house!'' over this bill, because
it has been so confusing and so disappointing.
But it is the Aging State Units and also the Area Offices
on Aging. Quite frankly, I think you bailed CMS out with your
excellent information and workshops and so on, and then not
only on Part D, but I am familiar in other parts of the
country, you have even in many instances gone a step farther,
where you have had the clinical pharmacologists come in and
they have had, bring your bag of drugs in and sort it out,
because people get drugs often, or they are very sick when they
hear about it. They have been alone in either a hospital or a
doctor's office, not because they are isolated, because their
daughter couldn't get off from work or it happened so fast.
So you have this bag of drugs. You are not sure what to
take, the sequencing. Is it with meals, without meals? Can you
have hot food or cold food or no food, and all these things,
and you are sorting all that out and bringing in resources, am
I right?
Mr. Flood. Absolutely. I want to----
Senator Mikulski. Or saying, this is 3 years old. No, this
is for an allergy, for God's sake, don't take this with----
Mr. Flood. The amount of work that the aging network is
doing to help implement Part D cannot be overstated. In my
State, our Agencies on Aging tell me that 50 percent, fully 50
percent of their organization's time is now spent on Part D
issues, answering questions, helping people sign up. I think
that is true across the country to a similar degree. It is a
phenomenal effort on the part of the aging network, and I
think, if I could, the reason that you are not experiencing a
revolution is because, A, an awful lot of seniors still have no
idea what they are supposed to be doing, and the ones that have
been paying attention are so discouraged by what they are
hearing and the first time they encounter their pharmacist or a
plan that gives them bad information, they just shut down. I
think that millions of seniors are simply not participating.
Senator Mikulski [continuing]. They are immobilized.
Mr. Flood. They haven't had the bad experiences yet.
Ms. Kennelly. That is why you voted against the bill. It
was too complicated.
Senator Mikulski. Yes. I mean, we could get----
Ms. Kennelly. It was too complicated.
Senator Mikulski [continuing]. You think it is? Well,
Clayton, you spoke very eloquently about language issues, but I
tell you, if you listen to my phones, I have heard language
spoken that I hadn't heard coming through the senior community
centers in a long time. It was a lot of, shall we say, ``Old
Bay'' words, both salty and peppery at the same time.
[Laughter.]
Well, this has been just a wonderful conversation. Let us
put our hats and thoughts together here, see if we can't move
the bill and also look at what other things that we can do,
again, to provide the maximum--because your point is maximum
flexibility and a 25 percent increase in funding would go a
long way and not allow this fungibility where you take from one
needy group to move it over to another needy group, am I
correct?
God bless you and what you do and thank you very much for
being here. This hearing is concluded and the committee will
convene subject to the call of the chair.
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of Easter Seals Disability Services
easter seals priorities for the reauthorization of the older americans
act
As a provider of services to older adults across the country,
including medical rehabilitation, in-home care, employment supports,
and as the country's largest provider of adult day services; Easter
Seals has a vested interest in the success of the aging network in
America. This history of service has given us insight into the needs of
older adults and their caregiver and how the aging network might best
be structured to meet those needs. Easter Seals urges Congress to
reauthorize the Older Americans Act (OAA) in 2006. Without the security
of the programs authorized in the Older Americans Act, many older
adults, their caregivers, and service providers will be hampered in our
efforts to reach our common goal which is to allow people to live as
independently as possible for as long as possible. Within the
reauthorization, Easter Seals recommends the following actions.
(1) Protect the title V Senior Community Service Employment Program
(SCSEP)--Easter Seals urges Congress to maintain SCSEP's historic
purpose and structure. The partnership between national programs and
State Units on Aging enables SCSEP to fully achieve its goal of
equitable distribution. It is also imperative that the historic focus
on community service, which significantly benefits the aging network,
the non-profit sector, and seniors with limited work experience, be
maintained.
(2) Increased Funding for Supportive Services--Supportive Services
under Title III of the OAA are the lynchpin of the aging network and
are a key component to supporting the independence of older adults. As
the baby boom generation ages and more seniors are seeking these
services, there will be a high demand for these already underfunded
services. Easter Seals recommends a 25 percent increase in this
program.
(3) Expand Community-Based Services--The Older Americans Act
programs should be structured to support innovative community-based
services delivery methods including consumer-directed models that
promote independence for older adults and their caregivers.
(4) Enhance the National Family Caregivers Support Program--The
National Family Caregivers Support Program, established in the last OAA
reauthorization, has been a resounding success. Easter Seals recommends
doubling the original authorization of this program to bring the
authorized funding up to $250 million. In addition to increased
funding, Easter Seals recommends that the grants for projects of
national significance be reinstated and made permanent, these 3 year
grants, given on a one-time basis under the last reauthorization,
addressed pressing issues facing caregivers nationally, including
transportation, grandparents raising grandchildren, training and other
needs. These initial grants were highly successful and need to be
expanded upon. There are also significant areas of concern that still
need to be addressed at a national level such as the needs of rural
caregivers.
(5) Make the Family Friends Program Permanent--This unique program
matches trained senior volunteers to provide support to families
include a child with a disability. Though small this program is
effective and greatly needed. Easter Seals urges Congress to include
language in the OAA making this program permanent.
Prepared Statement of William L. Minnix, Jr.
On behalf of the American Association of Homes and Services for the
Aging (AAHSA), I appreciate the opportunity to submit testimony on the
re-authorization of the Older Americans Act. AAHSA members serve 2
million people every day through mission-driven, not-for-profit
organizations dedicated to providing the services people need, when
they need them, in the place they call home. Our members offer the
continuum of aging services: assisted living residences, continuing
care retirement communities, nursing homes, home- and community-based
programs, and senior housing. AAHSA's commitment to create the future
of aging services through quality people can trust. Our ideals also
include dignity for all persons at every stage of life, advocacy for
the right public policies for the right reasons, and leadership through
shared learning.
AAHSA'S FIVE BIG IDEAS
We are proposing a national agenda consisting of Five Big Ideas
designed to transform the field of long-term care into a more cost-
effective and efficient system that works for older adults. First,
AAHSA believes that managed care concepts should be expanded in the
field of aging services to meet consumer needs and responsibly contain
costs. Second, affordable housing should be combined with supportive
services to enable older adults to age in place. Third, the development
of new technologies and the innovative applications of existing ones
should be encouraged to improve consumer choice, quality of care,
quality of life, and cost-efficiency. Fourth, the culture of aging
services must change to focus on individual choice and direction. All
segments of aging services need to embrace a quality-of-life, resident-
focused service culture and a continuous quality improvement management
culture. Fifth, the transitions of elders between various settings--the
community, acute and long-term care--must be managed to minimize stress
to the consumer and wasteful and duplicative bureaucratic requirements
for service providers.
Now is the time to solve the problems that face the elderly, their
families and caregivers, and their aging services providers. This is
our society's obligation. The re-authorization of the Older Americans
Act should incorporate new solutions that will strengthen the aging
services network and enable service providers to continue to meet the
needs of the people they serve.
INNOVATIVE APPROACHES TO HOME AND COMMUNITY BASED SERVICES
The Older Americans Act (OAA) funds a wide variety of social and
nutrition services that enable the frail elderly to maintain their
independence, including senior centers, meals programs, in-home
services, adult day services, transportation, and family caregiver
support programs. Supporting seniors in their homes through community-
based care programs such as the OAA allows a cost-effective alternative
to premature institutional care. A recent Supreme Court decision
requiring States to consider community-based alternatives for the
mentally disabled emphasized the need for States to begin to
``rebalance'' their long-term care delivery systems from an
institutional model of care to one that includes home- and community-
based alternatives.
The current effort to reauthorize the Older Americans Act to
prepare for upcoming demographic changes should incorporate new ideas,
new solutions and creative approaches to home- and community-based
services that will modernize the aging services network and increase
choices for consumers. We must begin to explore the ways technological
innovations can impact the aging services network and improve the
quality of care and quality of life of the elderly. We must also expand
on partnerships between affordable housing programs and supportive
services that will enable the frail elderly to receive a more
comprehensive set of services in the place they call home. These
solutions offer a cost-effective approach to home- and community-based
services.
Title IV of the Older Americans Act authorizes the Assistant
Secretary of Aging to award grants for training, research and
demonstration projects designed to test innovative approaches to the
aging services network. Demonstration grants have been used to develop
successful programs such as the Aging and Disability Resource Centers
and Medicare Part D outreach activities. The Older Americans Act should
fund additional demonstration projects to study the effect of linking
affordable housing with supportive services, along with projects
studying the ways technological innovations can be used to meet the
objectives of the Older Americans Act.
TECHNOLOGICAL INNOVATION AND HCBS
Technology has great potential--across the continuum of aging
services--to help older adults maintain their independence; improve
quality of care and quality of life; support the needs of professional
and family caregivers; increase aging services provider efficiency; and
reduce our Nation's health care costs. Technological advancements will
dramatically impact the ability of the frail elderly to age in place.
Recognizing the potential of these developments in our field, AAHSA
launched the Center for Aging Services Technologies (CAST) to explore
ways in which technological developments could be applied to the field
of aging services. We have achieved an exciting collaboration with
corporations such as Intel and Sodexho, universities including MIT and
the University of Virginia, aging services providers, and other
stakeholders such as the Alzheimer's Association and the Robert Wood
Johnson Foundation.
Technological innovations such as in-home monitoring tools,
assistive technologies and advanced communication devices should be
used to improve the efficiency and effectiveness of the aging services
network. AHHSA recommends that the Older Americans Act include Title IV
demonstration projects to test the ways technological innovations can
be used to assist the frail elderly and strengthen the aging services
network. These demonstration projects should incorporate the following
objectives:
1. Develop, implement, and assess technology-based service models
and best practices to improve the aging services network for older
adults both in their homes and in settings such as adult day care
centers.
2. Develop, implement and assess the use of in-home monitoring and
assessment technologies designed to connect both family and
professional caregivers to the frail elderly.
3. Develop, implement and assess technology-based service delivery
systems designed to meet the needs of frail elderly residing in remote
or rural areas.
INNOVATIVE APPROACHES TO INTEGRATING HCBS WITH AFFORDABLE HOUSING
Subsidized housing facilities currently offer supportive services
onsite, including service coordination, health screening, education,
and activities, meals programs and more advanced health monitoring.
Virtually all of these programs link the Department of Health & Human
Services housing programs with Older Americans Act supportive services
programs. AAHSA's Institute for the Future of Aging Services is
studying ways to improve the integration of housing and services
through the development of innovative models and practices that foster
consumer choice and independence. The re-authorization of the Older
Americans Act is the right time to study and develop the linkages
between affordable housing and supportive services.
CONCLUSION
The re-authorization of the Older Americans Act provides the
opportunity to develop new ideas that will strengthen the network of
services that our aging population needs. AAHSA supports the
development of innovative approaches to the home- and community-based
service delivery system. Technological innovations will transform the
home- and community-based long-term care delivery system, and we must
develop, implement and assess this model of care. Affordable housing
must be linked to supportive services to offer a comprehensive approach
to care that will meet all of the needs of our frail elderly. We look
forward to working with these proposals.
Prepared Statement of Traci L. McClellan
National Indian Council on Aging,
Albuquerque, NM 87111,
February 24, 2006.
Hon. Michael B. Enzi,
Chairman,
Committee on Health, Education, Labor, and Pensions,
U.S. Senate,
Washington, D.C. 20510.
Mr. Chairman, members of the Health, Education, Labor, and Pensions
Committee, and fellow aging advocacy colleagues, my name is Traci L.
McClellan; and, I am Executive Director of the National Indian Council
on Aging (NICOA), the only national organization dedicated to the well
being of American Indian and Alaska Native Elders. I welcome the
opportunity to offer comments on the reauthorization of the Older
Americans Act (OAA) from the perspective of the seniors I serve since
much of the services on which our Elders depend are derived from this
legislation. Given that NICOA's mission is to bring about ``improved
comprehensive services to American Indian and Alaska Native Elders,''
the service authorities in the Older Americans Act are paramount.
As a member of the Leadership Council on Aging, NICOA supports the
reauthorization principles articulated by this coalition of aging
advocates. Rather than going into these principles, I attach them for
the record and focus my comments identifying portions of the Older
Americans Act that are especially important to the constituents I
serve. Specifically, I highlight in my testimony: the Indian specific
provisions in the OAA adopted by the 1,200 delegates at the White House
Conference on Aging (WHCOA); title V, the Senior Community Services
Employment Program (SCSEP); title VI, Nutrition and Supportive Services
for Indian Tribes, including caregiver provisions; and, title VII,
Subtitle B, the provision that addresses elder abuse prevention and
awareness in Indian Country. I also include three resolutions adopted
by the National Congress of American Indians over the past year that
relate specifically to the Older Americans Act for the record.
[Editors note--Due to the high cost of printing, previously
published materials submitted by witnesses are not reprinted and can be
found in committee files.]
OAA FUNDING LEVELS
In a year when baby boomers are turning 60, Congress must address
the needs of vulnerable older Americans who benefit greatly from
programs funded through the Older Americans Act. The reauthorization
provides an opportunity to create base funding levels and authorize
services that current seniors and those just turning 60 require to age
well in their communities. Due to this changing demographic landscape
of aging America, NICOA strongly opposes any further cuts or
rescissions to OAA programs and any other entitlement or discretionary
programs that provide a safety net for vulnerable older individuals.
With high poverty rates, geographic isolation, and low education levels
among most of our American Indian and Alaska Native Elders, further
cuts to critical programs greatly impact the ability of the
wisdomkeepers to remain healthy and contributing members in the Tribal
communities that they live in. This same reality is present for
African-American, Asian and Hispanic Elders who often face similar
challenges in their ability to access much needed services and
programs. Therefore, NICOA supports a 25 percent increase in all OAA
authorization levels to negate the downward trend in flat funding
levels and rescissions and allow for inflation, so programs can
adequately provide for the needs of the Elders they serve. For title
VI, providing nutrition and other supportive services to Native
American Elders, however, NICOA requests an authorized base funding
level at $100 million to be reached incrementally to address the lack
of funding that has plagued these programs, impeding the ability of
Tribes and Tribal organizations to provide the necessary services for
their Elders.
WHITE HOUSE CONFERENCE ON AGING (WHCOA)
Twelve hundred delegates from across the United States appointed by
Members of Congress, State Governors, the National Congress of American
Indians and the WHCOA Policy Committee through the at-large process.
This 4 day event yielded a set of resolutions and practical
implementation strategies that will inform and guide the President,
Congress, States and Tribes as they work together to address the needs
of older Americans. The number one resolution at the WHCOA receiving
the most votes was the reauthorization of the Older Americans Act.
Delegates regardless of age, income, or race ranked its importance
first among the final 50 resolutions adopted. The delegates also
provided a number of practical implementation strategies for OAA
reauthorization, focusing on provisions they wanted to see included by
Congress, which are available on the WHCOA Web site at www.whcoa.gov.
Some of the strategies adopted include:
1. Maintain the dual purpose of SCSEP program with emphasis for
program performance on community service;
2. Retain the National Indian organization as title V sponsor and
the participation of cultural and ethnically diverse organizations;
3. Provide $1 million for title VII, Part B for elder abuse
awareness grants to Tribes, Tribal organizations and Indian
organizations;
4. Provide $1.3 million for training and technical assistance to
title VI grantees;
5. Reestablish the Indian White House Conference on Aging to be
held prior to the next WHCOA to allow Tribes to present their issues
directly to the President and WHCOA Policy Committee in recognition of
the Federal trust responsibility and the Government relationship that
the Federal Government and Tribes enjoy;
6. Elevate the Director of the American Indian, Alaska Native and
Native Hawaiian Affairs with the Administration on Aging to the Deputy
Secretary level in recognition of the Government relationship;
7. Integrate delivery systems to allow Area Agencies on Aging under
title III to assist Tribal councils and title VI programs in planning
for the aging baby boomer population on reservations and how best to
provide services to them.
Again, NICOA would request that the committee members review the
resolutions and implementation strategies adopted by the WHCOA
delegates as they consider provisions to strengthen within the Older
Americans Act during reauthorization.
TITLE V--SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM (SCSEP)
On Friday, February 24, 2006, in a briefing with the national
sponsors of SCSEP, U.S. Department of Labor (DOL) Deputy Assistant
Secretary Mason Bishop stated that if the program is to be administered
by the DOL, then it needs to be employment focused with goals of
unsubsidized employment. He also stated that if Congress decides it is
primarily a human resource supplement for non-profit and community
organizations, then it should probably reside elsewhere and not within
DOL. Frankly, NICOA agrees with Mr. Bishop's statement. If the
Department is not willing to honor the intent of Congress as expressly
stated in the prior reauthorization and over the 40 year history of the
Senior Community Service Employment Program, then Congress should move
it to the Administration on Aging to be administered along with the
other aging network programs. This would mitigate the disruption in
services currently experienced in SCSEP and the overall lack of
cohesion with other programs under the OAA. The Senate Committee Report
106-399 for the 2000 reauthorization clearly states that ``It is not
the committee's intent to disrupt sections or parts of a grantee's
overall program or operation that is serving enrollees and communities
well.'' That has occurred repeatedly with the changes in income
guidelines, data collection requirements and final regulations not
being published until April 2004 since the 2000 reauthorization.
As mentioned previously, the WHCOA delegates overwhelmingly
supported maintaining the dual structure and purpose of title V, the
Senior Community Service Employment Program (SCSEP). The attached NCAI
resolution also demonstrates the intent of Tribal leaders, who value
the program, to maintain its dual structure and on and retention of a
national Indian organization as well. SCSEP is directed to a
particularly difficult to serve segment of older Americans--low-income
seniors. While all low-income seniors are difficult to serve, American
Indian Elders are especially difficult to serve because of language
barriers, cultural barriers, and geographical isolation of many
reservation Elders. This is precisely the group of Elders that NICOA
has worked hardest to serve and advocate for over our 30 year history.
NICOA is one of the national sponsors actively participating in SCSEP.
We are passionate about this program because we strongly believe that
if we were not conducting this program, seniors in Indian Country would
not have access to the program and the mostly rural and reservation
communities they reside in would not benefit from their service.
We aggressively defend the need for a national sponsor, such as
NICOA, dedicated to serving seniors in Indian Country since just the
language barriers for this segment of seniors make it impractical, if
not impossible, for mainstream organizations to serve our constituents.
Similarly, geographic isolation and lack of services provided to Tribal
communities by States will severely limit the number of American Indian
Elders that will be served by States operating SCSEP. The national
sponsors have a proven track record of serving the most vulnerable
older Americans, which generally include minorities and American Indian
Elders. To eliminate their participation in the program's
administration would leave these Elders underserved; and, that has
never been Congress' intent since the program was created.
In the reauthorization of the Older Americans Act, NICOA urges the
committee to retain Sections 506(a) (2) and 506(a)(3) relating to
Reservations for Territories and Organizations. Without this section of
the law, low-income Indian Elders will be less likely to be served.
Second, we also urge the committee to require that the Federal
agency administering SCSEP take into account the specific economic and
cultural environment of seniors in assessing and evaluating placement
in unsubsidized employment. Placement rates tend to move in concert
with employment rates in a community; and, community differences must
be accounted for in program evaluation and assessment. Placing
enrollees in unsubsidized employment is a monumental task in
reservation communities with unemployment rates in excess of 50
percent. With organizations like ours, which have most of our
allocations in reservation and rural areas, the ability to meet
performance standards that give disproportionate weight to unsubsidized
placement versus community service (the most prevalent form of training
opportunities for our participants) is difficult.
Third, in recognition of the unique legal and political status of
American Indians, the law allows our organization to have a separate
equitable distribution to be developed in consultation with the
Secretary. This allows our organization to serve American Indians
regardless of location where we have been assigned by the U.S.
Department of Labor. DOL, however, has never worked with us to allow
this service to occur, so we are restricted to serving in counties
assigned by DOL instead of following the law. We would urge the
committee to strengthen this language during the reauthorization, thus
allowing for greater access to SCSEP by American Indian Elders.
Fourth, income calculation changes and constant revisions to the
data collection system since the regulations were finalized in 2004
have caused more staff time to be spent on administrative tasks than on
direct service to the Elders, host agencies and prospective employers,
which is the focus of SCSEP. The SCSEP participants suffer for these
continual disruptions and changes mandated by the agency. NICOA would
strongly recommend that Congress not allow the agency to make changes
to the program that are unrelated to identified problems without first
seeking Congressional approval. Similarly, NICOA requests that Congress
require greater cooperation between DOL and the Administration on Aging
to ensure title V is meeting the needs of low-income older Americans
first and foremost. If the DOL is not committed to ensuring the program
retains its dual structure and purpose as expressly stated in the
Senate Committee Report 106-399, which accompanied S. 1536
reauthorizing the OAA on September 7, 2000. NICOA would request the
committee consider moving the program under the Administration on
Aging, which oversees all other OAA programs, in order to keep the
program's primary focus on community service. The Administration on
Aging's mission is closely aligned with serving the vulnerable, hard-
to-serve seniors we work with everyday, whereas the Department of Labor
primarily focuses on and serves the labor force under the age of 60. As
such, both agencies must work together if those low-income, hard-to-
serve Elders over age 60 will benefit from the training and community
service opportunities provided by SCSEP.
Finally, we cannot overemphasize the importance of the dual nature
of SCSEP. Community service and employment training go hand in hand.
Unfortunately, program assessment and measurement places more emphasis
on unsubsidized employment than on community service which constitutes
80 percent of the program's focus and should be assessed on a greater
scale. I am including the specific language adopted by the WHCOA
delegates about SCSEP below for the record.
``Reauthorize Title V of the Older Americans Act, (the Senior
Community Service Employment Program) which provides part-time
employment opportunities for low-income individuals over the age of 55,
to ensure the oldest, poorest and least skilled older workers do not
fall through the cracks.''
``Maintain the dual structure of State, minority, and national
[SCSEP] grantees; retain the vital, historic focus on community
services to support local community organizations and the aging
network; streamline program eligibility to promote increased
participation to meet demographic changes and the growing ethnic and
culturally diverse population to include tribal organizations.''
NICOA recently participated in discussions of SCSEP with other
aging organizations on ways to improve how we serve low-income seniors.
The outcome of this self-evaluation and forward looking discussion is
contained in a statement entitled ``A Vision for America's Low-Income
Senior Workers and Their Communities'' which NICOA endorses and I
include for the record.
[Editors note--A Vision for America's Low-Income Senior Workers and
Their Communities can be found with the statement of Clayton Fong.]
TITLE VI--GRANTS TO NATIVE AMERICANS
Since its inception in 1980, Title VI of the Older Americans Act
has been the primary vehicle for providing OAA services in Indian
Country. However, funding has been so inadequate that reservation
services have never been ``comparable to those provided under title
III,'' as the title mandates. Nevertheless, this program currently
serves 243 reservation projects and remains the cornerstone of Older
Americans Act services to Indian Elders.
While funding per project ranges from $73,000 to $180,000, two-
thirds, approximately 50 percent of projects, receive less than
$100,000. This amount is intended to provide meals and other supportive
services for a minimum of 50 Elders for an entire year! Projects funded
at the highest level ($180,000) need to serve 1,500 or more Elders!
Further, with the aging of the population in Indian Country, more
Tribes are qualifying for title VI funding but cannot be served due to
fund limitations. Thirteen programs were denied funding this year
because of the fiscal year 2005 budget shortfall.
These (primarily title VI) programs are established to provide
nutrition and other supportive services to Native American Elders
throughout the United States. Title VI service providers not only have
daily contact with Elders but are often the Elders' only contact with
services providers.
While Federal funding for substantive aspects of this program is
extremely inadequate, funding to strengthen the capacity of these
community-based organizations is practically nonexistent. A most
glaring example is the 2005 appropriation of $6.3 million for Native
American caregivers through the National Family Caregivers Support
Program, which continues to operate despite repeated requests from
Indian Elder advocates without any provisions for training service
providers to effectively provide these services. More than 100 title VI
providers struggle to operate these grant programs with little Federal
direction and technical assistance.
On behalf of the Elders in Indian Country, I ask the support of the
committee to retain all aspects of title VI as currently enacted. In
addition, I urge the committee to provide for increased training for
title VI service providers and to support demonstration of new ways to
improve Elder Indian access to social services across all of Indian
Country. Such an initiative could include but not be limited to the
following objectives:
Training to improve title VI program management and
delivery;
Title VI staff development to improve morale and
retention;
Training on information dissemination of health care,
preventative medicine, illness-coping, and caregiving strategies;
Training to improve Elder access to social services at
Federal, State, and Tribal levels;
Training to assist Native American National Family
Caregiver Support Program grantees.
Currently, the Administration on Aging takes 1 percent of title VI
funding off the top of the appropriated amount for training and
technical assistance of title VI staff. This limits meals and other
services the title VI programs can offer to the Elders and often does
not allow enough resources for adequate training for all title VI
staff. Separate funding is required to address the training needs of
title VI staff.
Concurrently, funded projects are struggling with relentless
increases in the cost of providing nutrition and other supportive
services to their clientele. These conditions dictate that current
funding of $26.4 million is grossly inadequate and an incremental
increase in funding to $100 million is in order. I ask the committee's
assistance in authorizing appropriations to this level and to also
maintain language that the level of services provided under title VI be
raised to a level comparable to those provided under title III.
In fiscal year 2005, NICOA conducted a pilot/demonstration project
in the State of Washington to assist title VI grantees to access social
and other supportive services by training Tribal members to serve as
Benefits Counselors to provide assistance to American Indian Elders. It
is NICOA's goal to implement a similar program nationwide if funding is
available once the Washington demonstration project is completed and
evaluated. Due to the outcomes experienced thus far and the large
increase in Elders accessing services they are entitled to receive,
NICOA recommends that this program be made permanent with grants
available to title VI programs across the Nation.
TITLE VII, SUBTITLE B--PREVENTION OF ELDER ABUSE AND NEGLECT
Subtitle B of Title VII of the Older Americans Act authorizes a
program for Tribes, public agencies, or nonprofit organizations serving
Indian Elders to assist in prioritizing issues relating to Elder rights
and to carry out activities in support of these priorities. Funds have
never been appropriated for this purpose.
While funds have been appropriated to States for similar purposes,
these programs seldom reach Indian Elders due to cultural,
jurisdictional, and geographic barriers. Indian Tribes have little or
no access to the agencies, departments, ombudsman, or other programs
that are available to States. Further, Tribes have no additional source
of mandated Federal funding for Elder protection activities. Anecdotal
evidence provided by those involved with Elder services in Indian
Country as well as a 2004 report produced by NICOA suggests a high
incidence of Elder abuse in Indian Country, particularly financial
abuse due to high poverty rates. To complicate matters further, it is
commonly acknowledged that ``abusers'' are often family members; and,
Elders often do not realize they are being abused. If they do know,
they are reluctant to disclose this information to the authorities.
Outreach and demonstration programs are needed to increase
awareness of Elder abuse and to help Tribes devise ways to minimize
abusive behavior. On behalf of Elders in Indian Country, I strongly
urge the committee to retain this subtitle, to authorize an
appropriation of $10 million, and to encourage an appropriation in
2007.
Mr. Chairman and members of the committee, I thank you for the
opportunity to offer my views on behalf of American Indian and Alaska
Native Elders. I would be happy to provide any additional information
that might be useful to you and your committee staff as you consider
the reauthorization this session.
______
American Dietetic Association,
Chicago, IL 60606,
August 30, 2005.
Margaret Ingraham,
Director of Policy and Legislation,
Meals on Wheels Association of America,
203 South Union Street,
Alexandria, VA 22314.
Dear Ms. Ingraham: On behalf of the American Dietetic Association
(ADA), it is my pleasure to submit this letter of support for the Meals
on Wheels Association of America's (MOWAA) efforts to establish ``line
item integrity'' in Title III of the Older Americans Act (OAA) as it is
reauthorized. ADA is the Nation's largest organization of food and
nutrition professionals, with nearly 67,000 members serving the public
through the promotion of optimal nutrition, health and well being. ADA
has made aging a top priority in its public policy and advocacy
program.
Title III C, which encompasses the OAA nutrition programs, is
currently the largest single component of the OAA, and arguably the one
that is most critical to maintaining the well-being, independence and
functionality of the older adults it serves. ADA agrees with MOWAA's
position that a strong Federal commitment to OAA must be maintained
through increased financial support to meet the program's growing
needs. ADA supports MOWAA's position that OAA, when reauthorized,
should establish ``line item integrity'' which would include the
following provisions:
General and Administrative dollars must be taken from the
line item/category in which the services are performed. For example,
title III C dollars should not be used to pay for title III B
administrative.
Transfers from one line to another cannot take place while
an unmet need still exists in the category for which dollars are
designated without, at the very least, some verification why the
transfer is necessary and justified.
ADA welcomes the opportunity to partner with MOWAA to support
proposals for the reauthorization of the Older Americans Act.
Sincerely,
Rebecca S. Reeves, DrPH, RD, FADA,
ADA, President.
______
[Editors Note--Meals on Wheels Association of America statement
presented to House Committe on Education and the Workforce,
Subcommittee on Select Education entitled ``An Examination of the Older
Americans Act'', dated May 24, 2005, may be found in House Hearing No.
109-19.]
[Whereupon, at 4:05 p.m., the subcommittee was adjourned.]