[Senate Hearing 118-362]
[From the U.S. Government Publishing Office]
S. Hrg. 118-362
THE OLDER AMERICANS ACT:
THE LOCAL IMPACT OF THE LAW AND
THE UPCOMING REAUTHORIZATION
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
__________
WASHINGTON, DC
__________
MAY 23, 2024
__________
Serial No. 118-19
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
56-166 PDF WASHINGTON : 2024
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SPECIAL COMMITTEE ON AGING
ROBERT P. CASEY, JR., Pennsylvania, Chairman
KIRSTEN E. GILLIBRAND, New York MIKE BRAUN, Indiana
RICHARD BLUMENTHAL, Connecticut TIM SCOTT, South Carolina
ELIZABETH WARREN, Massachusetts MARCO RUBIO, Florida
MARK KELLY, Arizona RICK SCOTT, Florida
RAPHAEL WARNOCK, Georgia J.D. VANCE, Ohio
JOHN FETTERMAN, Pennsylvania PETE RICKETTS, Nebraska
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Elizabeth Letter, Majority Staff Director
Matthew Sommer, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Robert P. Casey, Jr., Chairman...... 1
Opening Statement of Senator Mike Braun, Ranking Member.......... 3
PANEL OF WITNESSES
Janet Billotte, Home-Delivered Meal Participant, West Decatur,
Pennsylvania................................................... 5
Laura Holscher, Executive Director/Assistant Vice President,
Generations, Area 13 Agency on Aging, Vincennes, Indiana....... 7
Leslie Grenfell, Executive Director, Southwestern Pennsylvania
Area Agency on Aging, Charleroi, Pennsylvania.................. 9
Mairead Painter, Connecticut State Long-Term Care Ombudsman,
State of Connecticut, Hartford, Connecticut.................... 10
APPENDIX
Prepared Witness Statements
Janet Billotte, Home-Delivered Meal Participant, West Decatur,
Pennsylvania................................................... 33
Laura Holscher, Executive Director/Assistant Vice President,
Generations, Area 13 Agency on Aging, Vincennes, Indiana....... 34
Leslie Grenfell, Executive Director, Southwestern Pennsylvania
Area Agency on Aging, Charleroi, Pennsylvania.................. 38
Mairead Painter, Connecticut State Long-Term Care Ombudsman,
State of Connecticut, Hartford, Connecticut.................... 41
Questions for the Record
Janet Billotte, Home-Delivered Meal Participant, West Decatur,
Pennsylvania................................................... 47
Laura Holscher, Executive Director/Assistant Vice President,
Generations, Area 13 Agency on Aging, Vincennes, Indiana....... 48
Leslie Grenfell, Executive Director, Southwestern Pennsylvania
Area Agency on Aging, Charleroi, Pennsylvania.................. 50
Mairead Painter, Connecticut State Long-Term Care Ombudsman,
State of Connecticut, Hartford, Connecticut.................... 53
Statements for the Record
National Council on Aging Testimony.............................. 57
American Association of Retired Persons Testimony................ 65
Meals on Wheels Testimony........................................ 70
THE OLDER AMERICANS ACT:
THE LOCAL IMPACT OF THE LAW AND
THE UPCOMING REAUTHORIZATION
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Thursday, May 23, 2024
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 9:30 a.m., Room
106, Dirksen Senate Office Building, Hon. Robert P. Casey, Jr.,
Chairman of the Committee, presiding.
Present: Senators Casey, Gillibrand, Blumenthal, Kelly,
Fetterman, Braun, Rick Scott, Vance, and Ricketts.
OPENING STATEMENT OF SENATOR
ROBERT P. CASEY, JR., CHAIRMAN
Chairman Casey. Good morning. The Senate Special Committee
on Aging will come to order. Welcome to today's hearing, which
is entitled, "The Older Americans Act: The Local Impact of the
Law and the Upcoming Reauthorization." we call it around here--
just like, everything has an acronym--OAA, that this act has on
communities all across the country.
OAA was passed into law in 1965, to establish a network of
social services to support older Americans, complementing
Medicare and Medicaid. By all measures, the Older Americans Act
has succeeded.
Since its passage, OAA has served as the foundation for
community social services for older adults, providing nutrition
services, legal support, and social networking, among other
services. The Act has a tangible impact on local communities.
Funding flows from the federal government to states and to
communities to allow programs to be delivered in a way that
works best for the locality.
This law supports countless older adults and nearly 20,000
service providers around the country, 20,000. In Pennsylvania,
an estimated 27 percent of older adults served by OAA are under
the federal poverty line. The Law's nutrition programs alone
serve approximately 85,000 older Pennsylvanians.
Today, I am releasing a brochure, which I am holding up and
you would not be able to see from the distance of your seats,
but it is a brochure that highlights the impact of the Older
Americans Act on Pennsylvanians. This brochure is entitled
"Federal Policy on a Local Level: The Impact of the Older
Americans Act Across Pennsylvania," and it just has some
examples of the individuals from different parts of our State
and the services that are provided to them. It provides
information on those eight Pennsylvanians who are receiving
services from Older Americans Act programs across nine
different counties.
Over time, the OAA has evolved to meet the unique
challenges that older adults face. In recent years, by way of
work that I have done and others, Congress added language to
expand support to grandparents raising grandchildren.
Flexibility, of course, is the key. The COVID-19 pandemic
required programs to innovate service delivery. We should be
learning from this innovation as we move forward.
This year, I am privileged once again to be the leader in
negotiations to reauthorize the Older Americans Act. I am
committed to building on my work in the last reauthorization to
bolster support for older adults throughout Pennsylvania and
throughout the Nation. I will be prioritizing both funding and
programming that helps the Older Americans Act keep pace with
our rapidly aging population.
Just to name a few of my priorities: I am working to pass
the Strategic Plan for Aging Act along with Senator Gillibrand
to incentivize states to bolster public-private partnerships
and build communities that work for the older adults of today
and for future generations.
In addition, I am dedicated to uplifting the tireless work
of long-term care ombudsmen. As the Committee has shown
throughout its history, some older adults experience tremendous
hardship in nursing homes and assisted living facilities. Long-
term care ombudsmen are advocates for residents in nursing
homes and other long-term care facilities, dealing with
everything from no-notice evictions and theft to serious
neglect.
However, the program is stretched very thin, operating on a
grossly inadequate budget, struggling to recruit and retain
staff and volunteers. In some cases, one ombudsman may be
serving 10,000 beds, well exceeding national recommendations of
one to every 2,000 beds. Today, the GAO is releasing a report,
which I requested, that shows the real impact these funding
challenges have on residents.
We will hear today from Mairead Painter, the State
Ombudsman from Connecticut, who can discuss these struggles in
much more detail. We will also hear today from two Area Agency
on Aging directors, including Leslie Grenfell representing
Washington, Greene, and Fayette Counties in Southwestern
Pennsylvania, who will discuss the very real challenges they
face in delivering services to rural communities with limited
funds. The Aging Services network deserves to be elevated and
supported by the federal government.
I am especially looking forward to hearing today from Janet
Billotte, a meal delivery recipient from Clearfield County, in
central Pennsylvania. I am so grateful she is using her voice
here today to share how OAA has helped her.
Finally, May is Older Americans Month, a time when our
Nation comes together to honor the contributions of older
Americans. I want to be clear. I will not support any attempts
to undermine vital programs that support older adults in
Pennsylvania and across the country. Our Nation's older adults
have fought our wars, raised our children and our
grandchildren, they have built our communities, and they
deserve support as they age.
I will now turn to Ranking Member Braun for his opening
comments.
OPENING STATEMENT OF SENATOR
MIKE BRAUN, RANKING MEMBER
Senator Braun. Thank you, Chairman Casey, and to all the
witnesses who have come here today.
Under the current Administration, we have seen sky-high
inflation, and probably 20 percent higher now than it was when
the Administration came in. That is an invisible but yet very
palpable tax that makes everything we are talking about here
even more difficult.
All Americans are struggling, but perhaps no one more so
than Older Americans, finding it harder and harder to stretch
their dollars to afford even basic groceries.
The spending of borrowed money, almost anything we do new
here, is 100 percent borrowed, and it is now averaging into
what we already do, 30 cents on every dollar we spend is
borrowed. It is a bad business plan for the younger Americans,
who are going to have to shoulder that burden, and especially
for older Americans, so we need to do something about that,
Republicans and Democrats guilty of it.
This reckless spending is forcing more and more seniors to
seek support to make ends meet, while simultaneously making the
programs that are there for them even harder to be effective.
The Older Americans Act provides this support, including
nutrition, transportation, health promotion, and many other
things. We need to make sure they stay vital.
As a member of the working group leading the
reauthorization of the Older Americans Act, I am committed to
preserving flexibility for localities and states, because they
generally do things with more effectiveness, and they make sure
the bills get paid without borrowing the money.
Every community is different. Seniors are best served, I
think, when providers on the ground can be entrepreneurial. You
do not want a one size fits all. You do not want it being
dictated from the top down. That does not work anywhere. I was
an entrepreneur for 37 years, and I can tell you in the real
world, in a business, that never works. You want choice, you
want transparency, you want new ideas to accomplish the same
old thing.
Every community is different, like I said. The Biden
Administration, though, has put rules out there that want to
try to make everyone adhere to the same guidelines. Some of the
final rules are being looked at and litigated currently. All I
can tell you is when it happens, it removes flexibility from
local area agencies, adds administrative burden, more cost,
changes the definition of greatest social need to prioritize
certain social groups for OAA's nutrition programs. That just
does not make sense to me.
I am working to push back against some of these things they
want to do. This includes ensuring that any senior in need of a
meal has a fair chance, regardless of which social group they
belong to. That should not be a parameter. I am also working on
new proposals to empower AAAs and senior centers to serve older
Americans without the need for additional funding. We have got
to find a way to spend less than we take in and get more bang
for our buck if this place is going to be around and be part of
the solution.
We should allow states and local service providers to
innovate to meet growing nutrition needs, encourage business
acumen in the aging network, and invest in cost-effective,
evidence-informed programs.
I would like to bring much needed transparency by requiring
the Administration to summarize state ombudsman long-term care
annual reports for Congress and publish a list of all resource
centers that it funds. This will allow Congress to have better
oversight over long-term care facilities and ensure that tax
dollars are being stewarded effectively.
Finally, a recurring theme I hear when traveling throughout
Indiana--I visit all 92 counties every year; they all are
trying to find those best practices, that right mix--is the
lack of broadband access in rural communities, and Indiana, for
example, is a state that is putting a high priority on it,
investing in state funds, not waiting for the Feds to do it,
and we are now getting that into every nook and cranny. Other
states need to be enabled in the same way. They ought to
probably look to see how they do that themselves rather than
the cumbersome way of maybe involving this place.
I hope that we can address this issue by doing more to
connect existing resources to these communities.
I look forward to working with my colleagues and
stakeholders to advance these priorities in the Older Americans
Act.
I yield back.
Chairman Casey. Thank you, Ranking Member Braun, and I want
to thank the Ranking Member for his work on the reauthorization
that we are working together on.
I will introduce our witnesses now. I will introduce each
of our witnesses before their testimony. I will start with our
first witness, Janet Billotte. Janet, thank you for being here.
She is from West Decatur, in Clearfield County in the middle of
our State, kind of the northcentral part of our State, and she
receives meal deliveries and other services from her Area
Agency on Aging. She will share how meaningful the meals and
services she receives have been for her.
I want to thank you, Janet, for being here today and for
making the trip from Clearfield County. It is not an easy ride.
I will turn to Ranking Member Braun to introduce our second
witness.
Senator Braun. It is my pleasure to introduce Laura
Holscher. She is the Executive Director and Assistant VP of
Generations, which is an Indiana's Area 13 Agency on Aging,
located in Vincennes, Indiana, very near where I live. In fact,
we are rivals, I think, in a lot of sporting events and so
forth, so it is that close.
She has served with Generations for almost 30 years,
including the past 14 years as Executive Director. Under her
supervision, her team has received the highest level of
accreditation through the National Committee on Quality
Assurance. Kudos to you for that. She has served as a Board
President of the Indiana Association of Area Agencies on Aging,
and now serves as the Chairman of the Public Policy Committee.
Thank you for making the trip to D.C. to be here today.
Chairman Casey. Thank you, Ranking Member Braun. Our third
witness is Leslie Grenfell. Leslie is the Executive Director of
the Southwestern Pennsylvania Area Agency on Aging, or AAA as
we call them. She will share her experience as the AAA's
Executive Director, the challenges they face, and the
innovative ways that AAAs handled service delivery during the
COVID-19 pandemic.
Ms. Grenfell, thank you for being here and thanks for your
service to older Pennsylvanians and sharing your experiences
with us today.
Our fourth and final witness, I will turn to my colleague
from Connecticut, Senator Blumenthal, to introduce that
witness.
Senator Blumenthal. Thanks, Mr. Chairman, and thank you for
having this hearing on this very important topic. I am very
honored to introduce Mairead Painter, of Connecticut. She is
Connecticut's Long-Term Care Ombudsman, and she has done really
magnificent work in that job. I am very proud to be here with
you.
Ms. Painter was appointed to this position of Connecticut
Long-Term Care Ombudsman in 2018. She has had this position
during some of the worst times in our long-term care
facilities, during COVID. She promotes and protects the quality
of life for older adults and individuals with disabilities
across the State. She serves more than 30,000 Connecticut
residents in skilled, long-term care nursing facilities,
residential care homes, and assisted living and managed care
residential communities. She also oversees the program's
advocacy work and is committed to furthering person-centered
care and informed choice for all individuals.
Recently, she received the Administration for Community
Living's first Community Living Director Care Award,
highlighting the work that she and her team have done in
advocating and protecting the rights and well-being of
individuals in long-term care facilities.
I want to thank Ms. Painter for all you have done to
protect those 30,000 people in facilities across the State of
Connecticut, and especially you making the trip down here to
D.C. and sharing your thoughts on this very important topic
with us. I know you have a lot of experience, a lot of insight,
and we really welcome and express our thanks to you. Thank you.
Chairman Casey. Thank you, Senator Blumenthal. We will turn
to our first witness, Ms. Billotte.
STATEMENT OF JANET BILLOTTE, HOME-DELIVERED MEAL
PARTICIPANT, WEST DECATUR, PENNSYLVANIA
Ms. Billotte. Chairman Casey, Ranking Member Braun, and
members of the Committee, thank you for having me here today at
your Older Americans Act hearing. My name is Janet Billotte. I
live at the Village of Hope. I am 78 years old, and I live in
West Decatur, Pennsylvania, which is a rural town in Clearfield
County. Before retiring, I worked as a nursing aide. I am here
to share my experiences as a recipient of Meals on Wheels and
other services from the Clearfield County Area Agency on Aging.
I have been receiving Meals on Wheels for four years. My
husband Richard and I started receiving meals in August 2020,
when he had five stents placed in his heart and two years later
open-heart surgery, during the pandemic. I was very happy to
receive these meals. Every time I received a meal, it always
feels like I am getting a present each meal. I would like to
invite you to have lunch with me today. The meal is kielbasa,
mashed potatoes, sauerkraut, a fruit cup, brown bread, and it
is a special day--we get strawberry shortcake.
Last year, I was diagnosed with Stage three colon cancer,
and I was also caring for my husband Richard, who had been sick
with many issues for a long time. I also just had an operation
for my cancer and had chemotherapy three times every other
week. Many days, I did not feel well, and it was very helpful
to have these meals delivered to us.
I love talking to Fred. Fred is my meal delivery person.
Every day he comes he asks me how I am. Lots of times I don't
see anyone except Fred to see or talk to each day, so I am
thankful when he checks in on me. If he doesn't hear from
someone, he calls the Area Agency on Aging and asks to make
sure we are okay. A lot of older people don't have family. I
don't have family. I have a son, Clint, who is autistic, a
daughter, Sarah, who passed away, and my husband recently
passed away. Now the Area Agency on Aging has become my family.
Today, my cancer is in remission. I am still receiving
deliveries from Meals on Wheels and other services from the
Area Agency on Aging. I am very glad that they give us vouchers
through the Senior Farmers Market Nutrition Program run by the
Agriculture Department so that we can go to the farmer's
market, and I can get fresh produce. I can get tomatoes,
lettuce, and all kinds of fresh foods from the market. It is
good nutrition, and it is helpful in preventing cancer.
During bad weather, they also receive "blizzard boxes",
where they send us a box of frozen and shelf-stable food so we
have something to eat when we are stuck in bad weather to
prepare. I am thankful for these services, and I'm not sure
what I would do without them.
Beyond meal deliveries, I also participated in events at
the senior center. They took us on a field trip to a mushroom
farm, where we learned about all the different types of
mushrooms and how to prepare them, how bees pollinate herbs,
and we went to a flower garden. I love flower gardens and
gardens.
The Area Agency on Aging also helped coordinate
transportation for me when I had to go to the clinic to get
chemotherapy. I had to get chemotherapy and blood work every
week, and this was not good, because I live in a rural area, it
was very hard to find transportation to the clinic, but Adam
was very kind to help drive me to my doctor's appointment and
to chemotherapy.
I was very grateful to receive these services, and grateful
for the friendship I have with my Area Agency on Aging. Kathy
Gillespie, who is with the Area Agency on Aging, is like family
to me. I know many older adults receive Meals on Wheels are
thankful like I am. I also understand that there are many more
older adults on the waiting list for these services. I ask you
to please help more people get into the program and be able to
receive these great services.
Thank you again for the opportunity to share my story.
Chairman Casey. Ms. Billotte, thanks so much for your
testimony and for sharing your own personal experience. We are
grateful.
Ms. Holscher, you may begin.
STATEMENT OF LAURA HOLSCHER, EXECUTIVE
DIRECTOR/ASSISTANT VICE PRESIDENT, GENERATIONS,
AREA 13 AGENCY ON AGING, VINCENNES, INDIANA
Ms. Holscher. Senator Braun, Chairman Casey, and members of
the Senate Special Committee on Aging, I am Laura Holscher. For
30 years it has been my honor to serve older adults at
Generations Area Agency on Aging. Generations is a program of
Vincennes University and is designated by the Indiana Division
of Aging's Commission on Aging as the Area 13 Agency on Aging
and as the Aging and Disability Resource Center. I want to
thank Senator Braun for inviting me today.
Under the Older American Act, Generations' role is to
develop, fund, and implement a broad range of programs and
services to meet the needs of older adults and caregivers. We
serve six counties in southwestern Indiana--Daviess, Dubois,
Greene, Knox, Martin, and Pike Counties. We impacted the lives
of more than 35,000 individuals last year. Our entire planning
and service area is considered rural. We have four hospitals,
but in some of our cities there is not even one primary care
physician and 22.7 percent of the population in our service
area is living below 150 percent of the federal poverty level.
Some of the challenges we face as a rural community include
lack of broadband internet and limited access to
transportation, both of which limit access to health care and
social opportunities. Under Title III-B of the Act, our AAA
offers in-home services for frail older adults, senior
transportation, information and referral/assistance, options
counseling, home modification and repair, legal services, the
Long-Term Care Ombudsman Program, and other person-centered
approaches.
The flexibility of this funding stream gives AAA the means
to meet the needs of older adults in the community, eliminating
the need for expensive nursing home care.
Our Older Americans Act clients inform our work. Since many
have cognitive impairments, we pulled together a dedicated
action team to help form partnerships like the one with Mi
Patio, a local restaurant, to provide dementia-friendly dining
hours. This was achieved by using some of our Title III-B
funding and supplementing it through our University of Southern
Indiana Geriatric Workforce Enhancement Program workforce
development grant. I am proud to say this county was recently
designated as a Dementia Friendly Community by Dementia
Friendly America.
Another essential part of Older Americans Act is Title--C
nutrition services. In the past, Generations has provided daily
hot and home-delivered meals to homebound older adults. As the
economy shifted, gas prices rose, and the cost of food
increased, it became apparent that our operations would need to
shift from daily hot, home-delivered meals to frozen meals. As
we made the shift to frozen meal providers we searched locally
for partners who would be willing to contract with us to
provide hot meals. We now have partnership with a nursing home
and two senior centers to provide hot meals in their
surrounding area.
Today, we operate a hybrid program. A client can choose
from up to six different frozen, home-delivered meal service
providers or from a hot meal if they live in a covered area.
Last year we provided over 106,000 meals to nearly 1,000 older
adults.
Our hope was to expand these local partnerships for hot
meal delivery, but the funding is not sufficient. Need is
growing in our community. Over the past two years, we have seen
a 20 percent increase in calls for meals and have more people
accessing our services because they just cannot afford
groceries or other necessities. Due to the continued rising
cost of food, freight, delivery, and labor costs, the same
amount of money simply cannot stretch to meet higher costs.
In addition, donations, grant support, and community
support are down as donors themselves are tightening up their
purse strings and prioritizing their own budgets. This has
forced us to triage calls and provide meals only to the most
at-risk individuals and put others on a waiting list. In the
meantime, our trained counselors work with clients to provide
alternatives, such as enrollment assistance for Supplemental
Nutrition Assistance Program, referrals to food banks, food
pantries, and local churches.
Under Older Americans Act Title III-D we run several
evidence-based health and wellness programs, such as A Matter
of Balance, Bingocize, and the Chronic Disease Self-Management
Program. Through additional partnerships we have more than
doubled in what we were able to offer.
There are also ways to make these dollars go further.
Generations and other rural AAAs around the country would
benefit from flexibility to use Title III-D moneys to fund
evidence-informed programs, which are lower in cost and more
adaptable.
Generations was created as a result of the Older Americans
Act. These are just a few examples of how we innovate and adapt
to meet the needs of older adults in our rural area. Please
keep the Act's inherent flexibility and locally driven
structure in mind as you update the law this year.
I have four recommendations for the reauthorization.
First, increase Older Americans Act funding, which has not
kept pace with the growing number of older adults or inflation.
Second, continue some of the nutrition flexibilities that
were extended to AAAs during COVID or allow for the flexibility
to fund innovative ideas in the nutrition program.
Third, allow Title III-D health and wellness programs to be
evidence-informed, and finally, we support USAging's
recommendations for reauthorization.
Thank you for the opportunity to testify today.
Chairman Casey. Ms. Holscher, thanks for your testimony and
for being here today.
Ms. Grenfell. Thank you.
STATEMENT OF LESLIE GRENFELL, EXECUTIVE DIRECTOR,
SOUTHWESTERN PENNSYLVANIA AREA
AGENCY ON AGING, CHARLEROI, PENNSYLVANIA
Ms. Grenfell. Chairman Casey, Ranking Member Braun, and
members of the Senate Special Committee on Aging, thank you for
the opportunity to testify before you today to discuss the
Older Americans Act.
My name is Leslie Grenfell. I am the Executive Director of
Southwestern Pennsylvania Area Agency on Aging, serving older
adults residing in Fayette, Greene, and Washington Counties. It
has been an honor for me to serve as the Executive Director for
the past 23 years.
In terms of population, our agency is the largest rural
Area Agency on Aging in the Commonwealth. Its service and
planning area encompasses 2,223 square miles. The agency acts
as a community focal point, providing information and
assistance, protecting vulnerable older adults, assisting
caregivers and their families, reducing food insecurity, and
empowering older adults to live independently and to age well.
The Nutrition Program is the cornerstone of the Older
American's Act, and includes congregate, home-delivered, and
grab-and-go meals, which were introduced during the COVID-19
pandemic. The flexibility of the grab-and-go meal option, where
older adults can pick up a meal to take home, has been well-
received by our consumers.
Our home-delivered meal providers, however, are struggling.
High costs, long distances between homes, and traveling on
winding back-country roads, can make delivery difficult. One of
our most demanding routes is in the Laurel Highlands of Fayette
County, which requires travel through State Game lands and is
32 miles long.
Although challenging, providers have successfully developed
and sustained a service delivery system using volunteers who
not only deliver hot, well-balanced nutritious meals five days
a week, but also provide wellness checks to each older adult,
ensuring their safety and well-being. Last fiscal year,
approximately 700 dedicated volunteers delivered over 400,000
in-home meals to at-risk consumers.
The challenges identified by our 34 home and community-
based agencies who provide personal care services in rural
communities are the costs associated with transportation due to
the distance between consumer homes, the recruitment and
retention of direct care workers, and the need for increased
reimbursement.
Last fiscal year, our agency received $591,073 in American
Rescue Plan Act funds, which provided a necessary infusion of
financial support, permitting us to help a growing number of
older adults.
Despite the growing number of older adults and the
corresponding need for services projected to increase, no
appreciable amount of additional Older Americans Act funding
has occurred for over a decade.
Increasing Older Americans Act funding and increasing its
flexibility is a cost-effective financial investment which
would enable older adults to stay healthy longer, living in
their own homes and communities where they want to be, whereby
reducing the need for more costly long-term care interventions,
such as skilled nursing care.
In 2023, the Pennsylvania Department of Aging began
development of a 10-year Multisector Plan for Aging called
Aging Our Way, PA. It is a state-led and stakeholder-driven
strategic plan designed to help transform the infrastructure
and coordination of services for older Pennsylvanians and
persons with disabilities. The network of AAAs was essential to
the stakeholder process, which yielded over 20,000 responses
from across the State. Each AAA engaged their local
communities, encouraged community participation, and
facilitated listening sessions, at least one in each of the 67
counties and over 200 sessions in total.
The AAAs are integral to many of the recommendations
developed through this process, and we are looking forward to
working with the Pennsylvania Department of Aging in
implementation.
In conclusion, I would like to especially thank Senator
Casey for inviting me to provide testimony today. On August
5th, I will be retiring after 48 years in the Aging Network. It
has been an honor and a privilege for me to share my insights
with you and it is truly a wonderful capstone of my career.
Thank you.
Chairman Casey. Well, Ms. Grenfell, thank you, and thanks
for those--you said 48 years?
Ms. Grenfell. Yes, sir.
Chairman Casey. You started in second grade.
Ms. Grenfell. Thank you.
Chairman Casey. You have dedicated your life to this work.
Thanks so much for that.
Ms. Grenfell. You are welcome.
Chairman Casey. Ms. Painter, you may begin.
STATEMENT OF MAIREAD PAINTER, CONNECTICUT STATE
LONG-TERM CARE OMBUDSMAN, STATE OF
CONNECTICUT, HARTFORD, CONNECTICUT
Ms. Painter. Thank you, Chairman Casey, Ranking Member
Braun, and distinguished members of the Senate Special
Committee on Aging for inviting me here today, and Senator
Blumenthal for that welcome.
My name is Mairead Painter, and I am honored to serve as
the State Long-Term Care Ombudsman in Connecticut. As long-term
care ombudsman, we serve as independent advocates for older
adults and individuals who reside in residential care settings.
The Long-Term Care Ombudsman Program was established in the
1970's by President Nixon in response to widespread concerns
over pervasive abuse, neglect, and mismanagement of nursing
homes. Over the following years, the program was statutorily
formalized as part of the Older Americans Act, or the OAA.
My team in Connecticut, although small, is dedicated and
strong. It is comprised of 12 staff members, including myself,
and we serve approximately 30,000 residents in about 400 long-
term care facilities. The ombudsman's activities are performed
on behalf of, and at the direction of, residents, and is
strictly confidential. We provide direction for services,
information about residents' rights, including consultation,
investigation, and complaint resolution.
Our non-mandated reporter status reassures residents that
their communication with us is confidential. This is
encouraging to them because they can speak to us and get our
guidance without fear of reprisal.
Our office frequently receives complaints concerning
general care issues. These complaints can be adversely
affecting to them, about their basic care needs. For example,
in some cases residents are informed that they must choose what
days they can get out of bed because they lack available staff
to assist them. Other complaints might pertain to involuntary
discharges, where residents receive notices that they are being
discharged from the facility or instructed that they might have
to leave immediately, and that they are being sent to a
homeless shelter or a hotel. In these cases, our team works
closely with the residents to try to ensure that their rights
are upheld and that proper procedures are followed.
Despite an increase in care settings over the years,
ombudsman programs have not seen the corresponding increase in
funding. Many programs receive minimal state funding, and some
programs, like in Tennessee, only receive enough funding to pay
for the state ombudsman's salary. This lack of investment in
the state funding, coupled with stagnant funding at a federal
level, hampers our ability to meet increased demand.
Half of the states do not have adequate staff to meet the
1995 Institute of Medicine staffing ratio, which recommends one
ombudsman for every 2,000 long-term care beds. This report,
while outdated, provides the most reliable staffing standard
for the program to date. Connecticut's program currently
operates with one regional ombudsman to almost every 3,800
long-term care beds. Additionally, the increased number of
residents with complex care needs who depend on our advocacy
underscores the necessity for ombudsmen to be able to
responsive.
The original program relied heavily on volunteers, but
today demands often exceed what volunteers feel equipped to
handle. We need to reevaluate our reliance on volunteers while
adding more trained and paid ombudsmen across the Nation.
Most critical is funding limitations impede our ability to
educate individuals, respond promptly to complaints, and
monitor facilities before crisis happens. This critical funding
would also result in cost savings to the greater health care
system. Although ombudsmen may work as state employees, our
roles require independence.
In addition to monitoring and responding to complaints, our
program engages in education and outreach, both at a facility
level and in the broader community. We also undertake rigorous
systemic and legislative advocacy.
Once I got to know other state ombudsmen I began to realize
that in Connecticut, while federally mandated under the Older
Americans Act to have autonomy, it is not upheld in all the
other states. Many of my peers cannot speak out about the
interference that they experience as it might jeopardize their
jobs. This is unsettling because ombudsmen must have the
autonomy to advocate in a bipartisan way in order to advocate
on behalf of the people that we serve.
This leads me to one of the reasons that it is essential
that the National Director position for Long-Term Care
Ombudsman be refilled. It is necessary to have that independent
voice advocating for our role. As a representative of the state
ombudsmen across the country, I strongly urge you to reinstate
the National Director for the Ombudsman Program.
I want to thank you for allowing me to offer you this
testimony today, as many individuals are still unaware of our
role, their rights, and the standards of care that they should
expect when receiving long-term services and supports. As
ombudsmen our goal is to continue to protect the health,
safety, welfare, and rights of all individuals receiving long-
term services and supports. Thank you.
Chairman Casey. Ms. Painter, thanks very much for your
testimony and for your good work.
We will turn next to questions, and I often say at this
point in the hearing how challenging Thursdays can be around
here with a lot of conflicting hearings. That challenge applies
to me today, so I am going to have to step out to get to a
hearing and then come back, but the Committee will be in the
capable hands of the Ranking Member, and I think we will start
with, in my place for questions, we will start with Senator
Blumenthal, and then we will turn to Ranking Member Braun.
Thank you.
Senator Blumenthal. Thank you, Mr. Chairman, and I
appreciate your yielding to me, and I want to thank all the
witness for your excellent, insightful testimony.
Ms. Painter, I am particularly interested in your comments
about the need for autonomy and independence, and also adequate
funding. Connecticut may be doing better than other states, but
still your point about needing additional resources I think is
extremely important, and perhaps you can tell us how those
resources would be used in Connecticut and by other similar
ombudsmen or offices around the country.
Ms. Painter. Yes. Thank you, so the staffing that we need
is trained, paid staff in order to meet the demand when the
calls come in. We do not want to have to triage calls. We want
to be able to answer the calls when individuals say that there
is a need. We want to be able to go out and meet with them
directly. It is important that they have the confidentiality
and the ability to meet with us face to face.
When you are talking about having to choose or only being
able to represent some of the residents, my team right now is
almost double the amount of individuals that they serve. We try
to get out to everybody within two to three days, but sometimes
that is taking up to a week, and like I said, we have one of
the better staffing ratios in the country. For some I think it
was, Senator Braun brought up, it was almost 10,000. We are
almost 4,000; some are 10,000, so that is a major difference
there.
Senator Blumenthal. I understand your point about the need
for independence so you can speak out.
Ms. Painter. Yes.
Senator Blumenthal. At the same time, it is important, is
it not, that ombudsman offices be supported by the
Administration in Connecticut and around the country. Do you
find that support less robust than it should be?
Ms. Painter. I have the support at a state level, so
different ombudsmen offices are set up differently. They are
either housed within a state agency, which is centralized, or
decentralized, which is outside of a state agency, so I am
within a state agency. However, I am independent, so I have
autonomy. They support me in the ways of a fiscal office and
HR. However, I can advocate on behalf of the residents in the
way that the residents or family members direct me to do so.
It is challenging for my peers because when something, for
instance staffing levels or other issues, come up at a federal
level for them to be able to testify either at a state or
federal level. They do not always have the ability, or there
may be a manager if they are decentralized, or someone that
tells them they are either not able to speak out against that
or to speak to a reporter. I am able to independently speak to
reporters, the media, anyone who contacts me, and I do not have
interference at a state or federal level.
Senator Blumenthal. Do you have authority to go to court,
to take action in court?
Ms. Painter. If I see necessary, yes, I do.
Senator Blumenthal. Do you do that commonly, or is it a
rare instance?
Ms. Painter. It is a rare instance.
Senator Blumenthal. Would you do more of it if you had more
resources?
Ms. Painter. Potentially. If there was a need and I felt I
needed to, yes.
Senator Blumenthal. That would provide a stronger deterrent
as well as remedies for the individuals who may be suffering
unfairly or painfully in facilities that are not doing their
job right.
Ms. Painter. Potentially, if we had the ability to work on
the cases and to have the staff out there to work the cases in
those ways, we may have the ability to get the information
necessary to move cases forward.
Senator Blumenthal. You mentioned a couple of instances
that you found where perhaps residents or patients were not
treated well, being unable to get out of bed when they wanted
to do so, involuntary discharge. Are those the two most common
kinds of complaints? What are the most common kinds of
complaints that you receive?
Ms. Painter. I believe the two highest complaints that we
heard this past year were related to individuals' care plans
being honored, some of them having a say in their individual
plans of care and those being honored, and that was directly
linked back to staffing. When we really looked at why their
care plans were not being honored it was because they did not
have the staff to be able to do that. It was not that the staff
did not want to. They were not able to complete those things
that the residents wanted done because the staff were not there
to do that and the other highest area is involuntary discharge.
Senator Blumenthal. Thank you. My time has expired. This
area is of great interest to me and very important in the State
of Connecticut. Again, I appreciate your very significant work
and the need for more resources. Thank you.
Senator Braun. Thank you, Senator Blumenthal. We will go
next to Senator Ricketts.
Senator Ricketts. Great. Thank you, Ranking Member.
As the Nation's population ages, communities face
increasing demand and challenges in providing comprehensive
systems for the care of older Americans. The Older Americans
Act funds programs and services that enable older adults to
enjoy healthy, productive, and independent lives in their homes
and communities.
Services authorized by the OAA include, but are not limited
to, family caregiver support, health and wellness promotion,
job training, nutrition programs, transportation, and programs
to prevent and address elder abuse, neglect, and exploitation.
The OAA provides states not only to target services to people
with the greatest social or economic need but also to make
programs available to all people in the community.
The Older Americans Act has been the primary federal
legislative source supporting social and nutrition services to
Americans aged 60 and older since 1965. OAA programs are vital
for seniors who are at significant risk of hunger, isolation,
and losing their ability to live independently. We have heard
about the Meals on Wheels and the great work they do providing
home-delivered nutrition services to older Americans, and the
Older Americans Act helps fund this critically important
program.
When considering care for older Americans, loneliness if
often overlooked. Studies undertaken during the COVID-19
pandemic demonstrated significant increase in reported
loneliness among older adults. A study conducted at the
University of Nebraska Omaha found that 39 percent of older
Nebraskans reported feelings of loneliness, and 35 percent
reported feeling lonelier due to the impacts of the pandemic.
That was my experience as Governor of Nebraska. One of my
concerns was in our skilled nursing facilities and assisted
living facilities due to the restrictions that were placed on
those facilities. There was concern about the folks in those
facilities being isolated and the loneliness that goes along
with that, not being able to get access to their families, and
that sort of thing.
As a result, last November I introduced the Improving
Measures for Loneliness and Isolation Act with my First
District Congressman Mike Flood. This would direct the
Secretary of Health and Human Services to establish a working
group to formulate recommendations for standardizing the
measurements for loneliness and isolation.
Ms. Holscher, you mentioned in part of your remarks that
lack of broadband actually limited social interactions. In
general, what are your thoughts with regard to loneliness and
finding a way to come up with uniform measurements for
loneliness? Would this be something potentially beneficial? I
mean, everybody, I think, mentioned about the wellness checks
that the Meals on Wheels do.
Tell me a little bit, what are kind of your thoughts on
this?
Ms. Holscher. During COVID obviously we did the wellness
checks, as you mentioned. Some of the other activities that we
engaged in during COVID included porch drop of activities. We
created a manual, so to speak, that had activities and games
and trivia, and we were able to porch-drop those to individuals
that we were concerned about, that we knew were at high risk of
social isolation and loneliness. We continued that for a while
with the COVID relief funding, but since that money is gone we
are struggling to be able to continue that.
We have done some other things to get folks out of their
houses since COVID kind of opened back up. We are providing
Coffee and Canvas programs. They are art programs, and we
provide those in senior centers, and they are a more relaxed
activity than an evidence-based program, because you can come,
you can participate in the activity, and it is just a lot more
relaxed than a classroom type activity.
We have done some of that. Again, funding is an issue, and
we would like to be able to continue that.
One of the other things that we think is very important is
we would like to see the National Resource Center for Engaging
Older Adults codified in the Act. This is a valuable resource
for AAAs. It provides training and technical assistance on
social engagement.
Senator Ricketts. Would you think it would be helpful,
because you mentioned the evidence-based programs and
flexibility to use that, would it be helpful then to have some
way to measure loneliness, for example, to be able to determine
who is most at risk, establish baselines, who would be the
folks that you would need to focus on, as a first priority for
some of the programs you talked about?
Ms. Holscher. I think that it would definitely be helpful,
but I would not want to add an additional mandate to what we
are already doing. We have been doing this for 50 years, and we
are able to recognize those individuals that we think are most
at risk. That does not mean that we will not miss some, but I
think what would be helpful--I would not want an additional
mandate, because when you add a mandate, it increases our
costs.
Senator Ricketts. Finding a way to be able to maybe
establish a baseline but do it in a way that is not going to
impact, or mandate you do extra stuff without actually
providing the funding to be able to do it.
Ms. Holscher. Right.
Senator Ricketts. Right. We tend to do that a lot in
government. Okay, great.
Hey, well, my time is up but thank you very much, Ms.
Holscher. I appreciate your insights on it.
Ms. Holscher. Thank you.
Senator Braun. Thank you, Senator Ricketts. Senator
Gillibrand.
Senator Gillibrand. Thank you, Mr. Chairman.
State and local governments need resources and planning
assistance to comprehensively address the needs of our aging
loved ones. I am proud to lead the Strategic Plan for Aging
Act, with Chair Casey, which would establish a grant program
for states, territories, and Tribes to create or continue
developing a Multisector Plan to transform the infrastructure
and coordination of services for their aging population.
Ms. Grenfell, thank you for your testimony and your 48
years of work in the aging network. Could you please describe
the ways in which legislation like the Strategic Plan for Aging
help a state like Pennsylvania with continuing to develop its
10-year Multisector Plan for Aging?
Ms. Grenfell. Thank you, Senator. That is an excellent
question. Regarding Pennsylvania's work, there was considerable
effort to ensure that we received input from a multiple number
of stakeholders. There was effort made also to have a vast
majority of older people, as I mentioned.
I think that legislation that you are referring to would be
extremely helpful, not only to the work that we are continuing
to do in Pennsylvania but to incentivize other states to
possibly move into a direction of a Multisector Plan. I think
it would be extremely helpful. I think what we are hearing
today is that states and local Area Agencies on Aging are
struggling, and if there would be a way to incentivize such
planning on a national level. We already know that other states
have implemented such plans, and Pennsylvania is in the
implementation stage. I think it would go a long way to
ensuring that older adults across the Nation receive that same
type of respect in terms of the planning process, so I thank
you for that question.
Senator Gillibrand. What, Ms. Grenfell, do you think is
most misunderstood or overlooked as part of the Older Americans
Act, and what does Congress need to know about it?
Ms. Grenfell. Well, I think what is most misunderstood is
the provision about the state units on aging having oversight
over contracting that local Area Agencies on Aging are involved
in to help ensure that the constituents that live in their
geographic area are able to receive a number of services. There
seems to be some confusion on whether or not the state units
are to have oversight over all types of contracting or just the
contracting that would leverage potentially Older Americans Act
funds, as opposed to non-Older Americans Act funds.
In Pennsylvania, we are very involved in the level of care
determinations, so that contract, for us, the Southwest Area
Agency on Aging, allows us to bring over $1 million. That
funding then helps to reduce other funding that we might need
but allows us to use more services and programs, provide more
services and programs, if you will, to the population that we
serve.
Senator Gillibrand. Great. Since 1972, the Older Americans
Act Nutrition Program has been successfully meeting its purpose
to reduce hunger, promote socialization, and support health
amongst older adults. During Fiscal Year 2025 appropriations
process I am proud to have called for $1.8 billion in funding
for this vital program to fund congregate and home-delivered
food services for older adults.
Ms. Billotte, thank you for sharing your story. It is vital
that older Americans can age in place. Could you please explain
the ways in which home delivery food services impacts your
ability to live in the setting of your choice?
Ms. Billotte. It is helpful for me to receive services at
home because that way I don't have to go to the nearest grocery
store, which would be eight miles to Philipsburg, 10 miles to
Clearfield for my doctor's appointments. It helps me to be in
my home and be secure that I can have Fred, my deliveryman,
deliver Meals on Wheels to me, and also that I can receive
someone to take me to my doctor's appointments, and for the
nutrition part, I believe that through the Senior Farmers
Nutrition Act that also is very helpful for my cancer.
Senator Gillibrand. What would happen to you if you were
unable to receive home-delivered meals?
Ms. Billotte. I would have to go to someone and hire them
to take me to the grocery store, and then to learn how to cook
all over again.
Senator Gillibrand. Yes. It is a lot. Well, I just want to
thank all of our panelists for their dedication and their
strong support for our older Americans. Thank you for all the
hard work you have done and thank you for your testimony.
Chairman Casey. Thank you, Senator Gillibrand. We will turn
next to Ranking Member Braun.
Senator Braun. Thank you, Mr. Chairman. I want to start
with Ms. Holscher. In the OAA Final Rule the Administration
expanded the definition of "greatest social need." These
criteria are used to determine which seniors should get
priority for meals. With waiting lists and challenges in food
delivery is it justified to expand the definition of greatest
social need?
Ms. Holscher. I think the definition needs to remain broad
and allow the local AAA to determine who is in the greatest
need through their local area plans and their needs assessment.
My area does not look like Juneau, Alaska, or Indianapolis,
Indiana, for that matter, and we need the flexibility to plan
for and meet the needs of the older adults at the local level.
Senator Braun. We have heard about how partnering with
other aging service providers can magnify your reach while
making each dollar go further. I applaud this local
entrepreneurship. Our national debt, as I said earlier in my
opening statement, is ballooning to the tune of a trillion
dollars every six months. To put that in perspective, that was
just, well, it is a lot of zeroes after a one. It was a
trillion dollars annually just five and a half years ago. We
are now $35 trillion in debt, and five and a half years ago,
18, which was approaching a record.
What steps should we take to support entrepreneurship in
the aging network, and do you think this will bring costs down
and yet still be more effective?
Ms. Holscher. We would ask that the flexibility and control
of business arrangements, such as contracting with health care
entities to deliver home and community-based services under
Medicaid be restored to the local AAA level. We have been
charged with building comprehensive systems of services by
leveraging local and private funding, and we need to be nimble
to do that without delay.
We have a long history of preventing conflict of interest
and managing multiple funding sources, and it is important that
we maintain our independent status without the restrictions or
barriers.
Senator Braun. One more question for you. In your testimony
you called for more flexibility in the Older American Act's
Health and Wellness Programs. Currently, and by the way, health
and wellness and prevention and all that is what I wove into my
health care plan, back many years ago, in my company, and
pretty well, when you do that right you can halt your health
care costs and insurance costs, so it can be done, and I know
that it hurts in places where you have got communities that are
already strapped for resources.
Can you explain how allowing evidence-informed programs
would expand the reach and effectiveness of services?
Ms. Holscher. The flexibility in Title III-D to incorporate
evidence-based programs would allow the network to reach older
adults with emerging innovations and enhance our ability to
stretch the limit on Title III dollars and reach more people.
In my area we would like the opportunity to try a program
called Building Better Caregivers. It is a six-week, online
workshop for caregivers of veterans, and this flexibility would
allow us to do that. Right now that is not a program we would
be able to offer because we do not have the funding.
Senator Braun. Thank you. Ms. Painter, the Long-Term Care
Ombudsman Program exists to identify, investigate, and resolve
complaints made at long-term care facilities. State ombudsmen
submit reports to the Administration on the cases they handled
each year. However, it is unclear how this information is being
utilized. How would summarizing this data and making it public
improve transparency at long-term care facilities?
Ms. Painter. We agree that this information should be
available to the public and to policymakers. We think that it
is important that transparency is available to everyone.
There are millions, billions of dollars going out to long-
term care facilities, and that in many cases individuals are
spending down their private dollars and going on Medicaid, and
if it is federal dollars that are being spent in these
facilities that there should be good policies for oversight and
transparency about how those dollars are being spent, and if it
is our programs that are looking at those cases and doing those
investigations, and by you all having access to that
information and what we are seeing would give you better
ability to make policies, then that should be available.
Senator Braun. Yeah, an ombudsman service is a portal of
feedback, and I think any business, any entity ought to welcome
it. In your experience, do you get a lot of it, and do you
learn a lot from it?
Ms. Painter. Yes, we do have a lot of information. We
would, of course, want to make sure that it remains
confidential--people's names, information in that way--so that
they continue to feel confident in giving us that information,
but the actual data related to cases of mistreatment, abuse,
neglect, the amount of times that people go to the hospital,
involuntary transfers and discharges, because I do believe that
that directly impacts cost savings, and when individuals are
not given information about informed choice, to return a less
restrictive setting or encouraged to stay in the nursing home
versus go to a less restrictive setting, I think that is very
costly to our long-term care system.
Senator Braun. It makes sense. Thank you. I yield back.
Chairman Casey. Thank you, Ranking Member Braun. I will do
my questions now that I am back.
I wanted to start with Ms. Billotte. Janet, I am noting in
your testimony you shared how not only that you have enjoyed
receiving a meal but you also have enjoyed seeing your meal
delivery driver, Fred, and you have become friends, and that is
just such an important part of the services, as you made
reference to.
A critical piece of the home-delivered meals, the program
itself and OAA programs, in general, not only are you receiving
important services but you are able to make friends and build
relationships. In fact, toward the end of the first page of
your testimony you say, "The Area Agency in Aging is my
family," which I think speaks volumes of what we are talking
about.
In this brochure that I made reference to earlier about
these Pennsylvanians, one of them is from Erie, Pennsylvania,
Doris Philhower, and she talks about her experience, and I am
quoting her here from the brochure, she says, "It has filled my
life with new friends over the years. It's my home away from
home." I think that says it all, so this is obviously an
important part of the benefit that you derive from these
services. Can you share more about the social connections you
have been able to build through the Clearfield County AAA?
Ms. Billotte. With the AAA services I have been able to
receive doctor's appointments, and we become friends with many
people that deliver the Meals on Wheels and also that we can
depend on those people checking in on us each day, so that we
have someone to support us and that will know how we are and
what we are doing that day, so I think it is very important to
do that.
Chairman Casey. It is obviously part of life that we have
relationships and we are able to see people. I think one of the
more remarkable pieces of evidence the last number of years,
especially during COVID, was sometimes when someone was
receiving a meal, that person delivering the meal was the only
person they saw----
Ms. Billotte. Right.
Chairman Casey [continuing]. for days at a time, if not to
include, as well, the Postal Service worker, but I think we all
understand what you are talking about.
Ms. Grenfell, I wanted to make reference to your testimony,
as well, that Pennsylvania is currently working to develop and
implement a so-called Multisector Plan for Aging. These plans
help states and localities come together to collaborate on ways
to make communities work for older adults. The response
throughout our commonwealth from community stakeholders is
really impressive. You have lived this, and I want you to know
how important it is for us to try to pass the Strategic Plan
for Aging Act, Senator Gillibrand and I and others, to
incentivize states to start their own planning processes. How
can we ensure that state governments are hearing the voices of
older adults and nontraditional aging partners across the
state?
Ms. Grenfell. Thank you, Senator. The process that
Pennsylvania undertook involved multisector planning, as I
mentioned, so what we attempted to do was to reseed the
nontraditional type of input from departments, state
departments, as well as local planning areas, as well as the
elected officials that were local, the American Legions, all
the infrastructures that were available locally, so the plan
that we are developing will entail the opportunity to have
diverse input and will allow Pennsylvanians to have the breadth
of a larger plan that takes all of their considerations and
their input into practice, so we are really excited about
moving forward on this plan.
It is very transparent. That is the other important part of
the plan, and as I said, we are looking forward to its
implementation stage, which is coming up.
In terms of having any incentives to do that, if that is an
opportunity for other states, I think it would be well
received. Pennsylvania could certainly use additional funding
if it was available and thank you for presenting that
opportunity as a legislation attempt. We appreciate it.
Chairman Casey. Well, I think funding is a big part of this
equation. We appreciate you making reference to that.
I will turn next to Senator Kelly.
Senator Kelly. Thank you, Mr. Chairman, and thank you for
having this hearing today.
Since I have been in the Senate three and a half years now
I have been very grateful for my senior advisories, my seniors
advisory group that I meet with often to discuss issues
impacting Arizona seniors, and most of the group is made up by
representatives of the Arizona Area Agencies on Aging, and
because of that I have gotten to understand the essential role
that the Area Agencies on Aging play in their communities, from
providing meals to helping somebody find a direct care aide, to
connecting older adults to benefit programs, to make the most
out of a fixed income.
These organizations are, in many areas of my State, the
backbone of the aging services community, and they call
themselves the best-kept secret in Arizona until folks turn 60,
so I want to make sure we all understand why it is so important
that we successfully reauthorize and fund programming in the
Older Americans Act.
Ms. Painter, your role is authorized under the OAA, but you
are also deeply immersed in the rest of the aging network.
Could you speak to how the OAA and Area Agencies on Aging fit
into the aging ecosystem and why they are so important, not
only to Arizonans but to all Americans?
Ms. Painter. Thank you. That is a great question. I think
working in partnership in order to support individuals at the
lowest level of need, so that they are able to age in a healthy
way, and to support them before they have the highest level of
need. That way we are giving them--we spoke about good
nutrition, access to programming, information about health and
wellness, and we want to encourage individuals to be a part of
their communities.
Senator Kelly. Would those be examples of the lowest level
of need?
Ms. Painter. Those are the lowest level of need, and doing
that on an individual level, so the Area Agencies on Agencies--
I can speak for Connecticut, that I know--they meet with their
communities and they talk to the individuals that they serve
about the programs that they want in their areas, and so it is
really about ensuring that they are meeting the needs of the
individuals that they serve, because it could be different
district to district, and so we want to make sure that if it is
an ombudsman program that is decentralized they may also house
some ombudsmen within the Area Agency on Aging, so they could
be having information about what services are needed from the
Ombudsman's Office, they could be speaking about what they are
seeing related to long-term care, home and community-based
services, as well as meal delivery services or even
transportation services. We know that comes up a lot for
individuals and how they are reaching doctor appointments or
access to food and other resources.
I think if we are not able to do that we would see people
needing higher levels of care, which is more expensive, more
quickly.
Senator Kelly. All right. That is true, I think, in a lot
of areas of health care, as well, is trying to tackle the
problem earlier can be less costly.
Ms. Billotte, thank you for being here today and thank you
for sharing your story, and I am sorry for your loss. Your
testimony about your local Area Agency on Aging, about how they
made sure you were fed and looked after during your illness was
very powerful. You mentioned your interaction with Fred, who
delivers your meals.
As we work to reauthorize the OAA, Arizona's Area Agencies
on Aging have requested that we allow them one unified
nutrition program so they can determine how best to split the
congregate meals and home-delivered meals to folks who qualify,
and the Arizona agencies have said that that would make it
easier to fill the needs of their local communities. Nearly all
of them have a waitlist for home-delivered meals, but they are
not seeing the same demand for in-person congregate meals.
I think some folks up here are a bit hesitant to create one
single nutrition program because socialization is such an
important part of the meal program within the OAA.
Ms. Billotte, do you feel like your home-delivered meals
were the right fit for you when you needed them, both for your
physical and mental health?
Ms. Billotte. They were. It was very helpful when my
husband was sick and I also was sick that we received these
meals and we were able to understand that they were nutritional
and that they did help us, that we were able to receive them.
I also understand that there were many more Americans that
are on this waiting list for the Meals on Wheels and would
appreciate that you would speak to people that would be able to
put this program into service so that we could receive
services, and I think that it is very helpful to us, as
American citizens.
Senator Kelly. Right. Well, thank you, Ms. Billotte, and
thank you, Mr. Chairman.
Chairman Casey. Thank you, Senator Kelly. We turn next to
Senator Fetterman.
Oh, I am sorry. Senator Vance.
Senator Vance. Thank you, Mr. Chairman. I appreciate
Senator Fetterman for pushing back against your Pennsylvania
bias there, but thanks to both of you, and thanks to you and
the Ranking Member for hosting this hearing, and thanks to all
of you for being here and giving us some sense of what you are
working on and how we can make things a little bit easier for
people.
You know, I come at this with some personal experience with
Meals on Wheels program. My grandmother, who I lived with for a
very long time, benefited from the program. It was a very, I
think, critical part of keeping her healthy and happy during a
pretty tough time for our family.
I want to sort of direct my questions to Ms. Holscher--am I
pronouncing that right? Okay, great. I am sort of interested in
the two sort of meal programs in the Older Americans Act and
how they sort of can provide flexibility or take some away if
we do not do this right way, so maybe, Ms. Holscher, given your
extensive work in Indiana, what factors inform seniors when
they are choosing between congregate meals, going to a place
for a meal, versus things like Meals on Wheels?
Ms. Holscher. Well, some of it has to do with
transportation and if they have access to a senior center. In
some of our very rural areas there are not senior centers, so
there is no choice. They would have to access home-delivered
meals.
Some of it has to do with some of our senior centers have
been around for 50 years, and they are in older buildings, in
basements, and they are outdated, and the seniors today want
choices, and they want places that they can go that will engage
them in activities. We have one senior center that is in the
basement, and I personally feel like it is haunted, and I have
heard that from other older adults.
They want choices, not just, "Here is the senior center."
They want places that they can go where they can engage in
today's activities, such as like our Coffee and Canvas project
that we do, and sometimes it is about, just because you are
isolated does not mean you are lonely, and some older adults
prefer to eat at home, alone, but we still try to find ways to
engage them in other activities.
I hope that answered your question. Thank you.
Senator Vance. It does, and I guess on this, if I
understand it correctly, and please correct me if I am wrong,
is that you saw, understandably, during COVID especially, in
that summer of 2020 time period, a really massive increase in
demand for things like Meals on Wheels. We are now close to,
well, it is exactly four years after that. Where do you think
we stand? Has demand fallen? Has it stayed the same? Are we
seeing seniors less interested or more interested in that
service?
Ms. Holscher. In our area we have seen a 20 percent
increase in requests for services, nutrition services, so while
I think it has stabilized a little bit after COVID, the
increase is definitely there in the last two years, a 20
percent increase that probably has more to do with they can't
afford their basic necessities and so they are reaching out to
us for help with nutrition to offset some of those other costs.
Senator Vance. Got it, and could you just explain to me,
when the money is coming to an agency like yours, that I
believe you have worked with for close to 30 years, right, does
it come in as--are there separate buckets?
Ms. Holscher. Yes.
Senator Vance. There is money for congregate, there is
money for Meals on Wheels, and am I correct, you have
flexibility in moving them between the two programs, depending
on the demand for seniors in your area?
Ms. Holscher. We do not. We had that flexibility during
COVID and it was very helpful, obviously because most of our
congregate sites were closed during COVID, but since the public
health emergency has ended we no longer have that flexibility.
Senator Vance. I see, and so I guess I am probably asking
the obvious here, but am I right that you would prefer to have
more flexibility in how you actually provide these services?
Ms. Holscher. We would definitely prefer to have more
flexibility at the local level. We want to meet the needs in
our area, and we can only do that with flexibility between
funding sources.
Senator Vance. Yes, and I can imagine, too, just between
rural and urban areas, you could have a small town that might
have one set of preferences, you could have a bigger city that
might have a different set of preferences. Obviously, maybe a
little easier to get to a senior center if you are in
Indianapolis or Columbus or Cincinnati.
I appreciate your testimony here and I certainly share your
view that flexibility would be a good thing here, and maybe we
can work on that. Thank you.
Ms. Holscher. Thank you.
Chairman Casey. Thank you, Senator Vance. I am sorry about
the mess-up in the order. I will now turn to my colleague from
Pennsylvania, Senator Fetterman, with that long buildup.
Senator Fetterman. Thank you, Mr. Chairman. Ms. Grenfell,
can you speak to the barriers that exist to the LGBTQ+ older
adults and aging individuals with HIV in accessing programming
established through the OAA?
Ms. Grenfell. Thank you for that question, Senator. As we
know, the LGBTQ+ community has faced many barriers over the
years--discrimination, difficulty accessing health care. The
Older Americans Act programs are based on need, and so our job
is to ensure that we are creating an inclusive environment that
is welcoming to all communities. Our agency is certified
platinum, stays informed, and so our staff has made sure that
we are all in the position to be able to understand exactly
what their history has been, how we can ensure that we have
welcoming senior centers, how we can ensure that we have
services and programs that meet their particular needs and are
sensitive and inclusive of their needs.
Senator Fetterman. You are able to confirm that the special
kinds of needs and other issues to those kinds of communities
are being fully addressed?
Ms. Grenfell. Well, Senator, to the extent that we are able
to include, and are welcoming----
Senator Fetterman. Sure, so that language seems specific.
What are you referencing then?
Ms. Grenfell. Well, I am specifically referencing the
training that our staff has undergone, and that there are
particular questions that are part of the assessment process
that are identifying if the individual is willing to self-
identify. That is not necessarily everybody is willing to do
that, but those that will, then we are able----
Senator Fetterman. In other words, somebody might be--they
might not be--not comfortable to identify as a member of that
community. They would be actually missing those kinds of
critical services then, right?
Ms. Grenfell. They could, yes. Yes, they could. Yes, they
could. However, I think that, in general, it is important that
there be adequate training for staff and that Area Agencies on
Aging are well-informed of the need to be inclusive, to have
environments, have policies in place, which allow for all types
of individuals to receive the services at that level.
Senator Fetterman. Okay.
Ms. Grenfell. Thank you, Senator.
Senator Fetterman. Okay and now, currently the OAA is up to
serve Americans 60 and older. Other federal programs do not
kick in until 65. There are a lot of Pennsylvanians between 60
and 65 who rely on these critical programs. OAA bridges this
gap.
Ms. Painter, can you speak about the importance of offering
these programs before the eligibility kicks in on the other
federal programs?
Ms. Painter. Thank you. Yes, I believe, again, the earlier
we can intervene and support individuals and offer them the
ability to stay healthy, have access to supports, the better we
will be able to maintain their health and well-being and
enhance their wellness in order to prevent them from needing
higher levels of care at earlier ages and stages of their life.
Senator Fetterman. Finally, ensuring Pennsylvanians can
have food on the table, I mean, that is a top priority,
personally for me, but of course, for the commonwealth as well,
and about five percent of older Pennsylvanians are food
insecure. Recipients of OAA-provided meals report that this is
half or more of the food for that day.
Ms. Billotte--is that correct? How important are these
kinds of home-delivered meals for overall, and for your
nutritional meals?
Ms. Billotte. I believe that our Area Agency of Clearfield
County has obtained a chef that will help each individual meal
be characterized, like what the need is. We all have a menu we
go through each day, and they provide meals to us. The
nutrition meal, for me, for my cancer, was very helpful to help
me get through cancer.
Senator Fetterman. Mr. Chairman, about 30 more seconds?
Chairman Casey. Sure.
Senator Fetterman. It is also another point of contact for
some seniors that may not have any other kinds of contact,
essentially a well check on there, like making sure everything
is still okay.
Ms. Billotte. That is very correct, because my meal
deliveryman, Fred, is my only contact during the day many times
to talk to and to see each day, so that is very helpful that he
checks in on me to see how things are.
Senator Fetterman. Yes, and also my own grandmother, she
fell, and she did not have a situation like this, and she was
not able to get contact for several days, so the horror of all
of that, so only the critical food but just also just kind of
that interaction, but also like it is a well check, just how
critical it is to make sure that everyone is going to still be
okay.
Ms. Billotte. That is correct, and with my transportation
issue it was for my cancer, to go to the chemotherapy and to my
doctor, and it was very critical because there is no Ubers, no
taxis, and no transportation in my area because we live in a
rural county, so that is very helpful if I can have
transportation to and from my doctors.
Senator Fetterman. That seems almost beyond helpful. I
mean, that is critical to maintain your health and your way of
life.
Ms. Billotte. At that time, I did not drive while I had
cancer for the year, so not driving for a year it is critical
in finding someone to help.
Senator Fetterman. Thank you, all of you. Thank you. Mr.
Chairman.
Ms. Billotte. Thank you.
Chairman Casey. Thank you, Senator Fetterman.
I just have maybe two more questions and then we will have
to wrap up. I wanted to ask a question of Ms. Painter. In your
testimony you spoke about the Long-Term Care Ombudsman Program
desperately needs more federal funding to account for the sheer
number of older adults who are now residing in long-term care
settings, especially assisted living facilities. Many of these
residents may worry about retaliation if they raise issues
themselves. Others may not have the ability to self-advocate.
That is why the Long-Term Care Ombudsman Program is so
important in your voice for older adults who may be both
uncomfortable or unable to advocate for themselves.
However, you cannot do this essential job without the
funding. I released a report last year entitled "Uninspected
and Neglected." The report revealed that lack of investment in
ombudsmen and nursing home surveyors leave nursing home
residents at risk. Today, at my request, the GAO is releasing
new findings on the increased complexity of cases and the
impact that limited budgets have on ombudsmen. In fact,
Connecticut is one of five states highlighted by GAO. Based on
this data, I am advocating to triple the amount of funding for
Long-Term Care Ombudsmen Programs in the Older Americans Act
reauthorization, so here is the question. If it is clear that
additional funding would help ombudsmen stay afloat, can you
describe how additional funding would directly impact and
improve the lives of older adults living in long-term care
facilities?
Ms. Painter. Yes. Well, thank you for advocating for us to
have that increased stable funding. We so appreciated the
funding that we received during COVID, and realized how much we
could do. Even though we were not able to access the buildings
initially, once we had that funding and we were able to do more
outreach that we were seeing an increase in cases, and we have
seen a steady increase in cases.
I think with additional funding that would continue,
because when we were able to meet that mandate of being in
long-term care facilities on a regular basis it is not
necessarily that individuals know to reach out to us. As I said
in my testimony, individuals do not know what their rights are
always related to quality of care, and so when you have the
access to regular ombudsman who is in the building, on at least
a quarterly basis, going around, introducing themselves to
people, explaining their rights, and ensuring that they know
what quality of care looks like, talking with them, explaining
to them the grievance process, explaining to them that they
have the right to transfer to a less restrictive environment,
to attend a care plan meeting with them and talk to them about
what their plan of care can look like and what they should be
expecting, that they do not have to just decide to get out of
bed every other day. The expectation should be that they get
out of bed when they want to get out of bed. They should be
able to get to the bathroom or have nutritional support when
needed.
I think that is when we will see those changes, and I think
that will impact cost savings as well, because we will not have
those visits to the hospital, where people have wounds or
infections and those types of things, because the interventions
that the ombudsmen are able to provide one-to-one with the
nursing homes, when residents allow us to, and sometimes it
means multiple visits. When you have that rapport with a
resident, sometimes initially they do not want us to do
anything. We just have to go back a few times and reassure them
that we can have that conversation with the long-term care
community, and when we talk with them they put those
interventions in place, and the resident sees that benefit, and
I think that is where we will see the biggest change in care.
Chairman Casey. Ms. Painter, thanks for that response.
The last question I have is really for the panel, but I may
ask Ms. Grenfell and Ms. Holscher to address it first, but if
anyone else wants to add to the conversation.
As I mentioned earlier we have got a bipartisan group of
Senate colleagues that are leading the effort to reauthorize
the Older Americans Act. We are not only working to reauthorize
the Act, we are also working to modernize it, to make sure that
we are meeting the needs of today's older adults and the needs
of future generations of older adults.
The reauthorization provides us with an opportunity to look
at what has changed in the last four years since the 2020
reauthorization, what innovations were critical throughout the
COVID-19 pandemic, and what needs are still not being met.
How have you seen the needs of older adults evolve over
your careers, and where is modernization needed most within the
Older Americans Act? Maybe Ms. Holscher, and then we can go
from there.
Ms. Holscher. The needs have changed, I guess over the
years, is today's older adults want choices. They want to be
able to choose from a list of meals. They do not want, here is
a cookie-cutter meal, everybody gets it, and that is true in
all six counties that we serve, so what the folks in Pike
County might want is different than what the folks in Dubois
County, and they want those choices, and we need the
flexibility to be able to provide those choices to them.
As well as we need the flexibility to come up with new
ideas. We need to be able to pilot programs, and the funding
right now does not really allow for us to get out of our box,
so to speak, so we would really like to see more flexibility so
that we can implement new ideas, emerging innovations, and be
more entrepreneurial.
Chairman Casey. That is great. Thank you. I might reframe
the question a little bit for Ms. Grenfell because of her
impending retirement, so I guess the question for you would be
what is your hope for the Older Americans Act moving forward?
Ms. Grenfell. Well, I certainly agree with my colleague,
Laura, from Indiana, because those are critical issues for the
Older Americans Act.
I would also say that our national USAging organization has
really spent a lot of time and effort with the Older Americans
Act and has excellent recommendations for moving forward and I
think for modernizing it.
It is not always just about money either. I mean, money is
important, and we have all mentioned that, but it also, as
Laura mentioned, it is really important that we are able to do
some innovation. Southwestern Pennsylvania has certain meals
that they love, and they do not necessarily meet the
nutritional requirements exactly.
I think we have to update a lot of that in terms of the
whole nutrition program to make it more available. The COVID-19
grab-and-go meals have been extremely successful. We are
finding that our population likes the fact that they are
available, and they are flexible, and they can come to the
center when they have time, or if they are caring for somebody
at home then they can pick up a meal for their loved one and
them and get a little bit of respite.
We are also looking at trying to do some innovation,
because of the ruralness of our service area, of a cafe, a pop-
up cafe, where we would be able to take the meals in more rural
parts of our service area and have them available as opposed to
an infrastructure like a senior center that is a lot more
costly, so we are looking for innovation and cost-efficient
ways to provide the program. That type of innovation is what I
think both Laura and I are looking for, and that would be
something I would hope for.
Thank you, Senator.
Chairman Casey. We are grateful for that, and I think that
innovation is going to be important, and obviously giving
seniors choices is also important. Who wants to be locked into
one choice for a meal? That should be part of the opportunities
we provide.
I will move to our closing statement. I will have a closing
statement and then I will turn to Ranking Member Braun, and
then we will have to wrap up.
As we heard today from our witnesses, the Older Americans
Act is a landmark piece of legislation that has been providing
lifesaving services to older adults for nearly 60 years. To put
it simply, these programs authorized through the Older
Americans Act are working well. The Area Agencies on Aging,
senior centers, Meals on Wheels programs, and other provide
services tailored to the unique needs of their communities.
The individuals who make up the aging network are dedicated
to this work, with many having devoted their entire careers to
improving the quality of life for many older adults. Ms.
Grenfell, I am making reference to you here. They are the
trusted partners in our communities.
I think everyone on both sides of the aisle can recognize
the importance of the Older Americans Act in preventing chronic
diseases and reducing social isolation and loneliness, and
enabling older adults to remain at their home, in their
communities, where they would like to be.
However, we cannot expect the aging network to continue to
work for older Americans and their communities if we are not
willing to provide the programs with adequate funding. As we
heard today, due to funding limitations there are thousands of
older adults waiting--waiting--for services across the country,
from meal services to ombudsman assistance. Waitlists and wait
times will only grow of Congress fails to act.
Folks like Janet should not be forced to wait for needed
meals and services, and that is why, through the
reauthorization I will be pushing for increased funding for
Older Americans Act programs, and I encourage my colleagues to
join me. I will also continue to advocate for changes to the
statute that will better enable AAAs and local service
providers to do their work.
The Older Americans Act plays a critical role in the health
and success of older adults in local communities from
Pennsylvania to Connecticut to Indiana, and everywhere in
between. It is critically important the Senate invest the
necessary resources to fulfill the intent of the Act.
I will now turn to Ranking Member Braun for his closing
remarks.
Senator Braun. Thank you, Mr. Chairman. We always have
prepared remarks that we can default to. Since I have been
here, I like to listen, hear what everybody says, and then
sometimes just chuck the prepared remarks.
This is a Committee that I had to be recruited to get onto,
back when I came to the Senate, and it is one that we cannot
legislate out of, but for the time I have been here we have had
more pertinent discussions in this Committee that other
committees end up legislating off of, and in this place it is
always frustrating in that we have all heard what we need. We
have got future older Americans that have to pay all the bills
and shoulder the debt, so we are kind of between that rock and
hard place, and it is not only here. It is across our
government. You know, sure, we need more funding. Everybody
needs more funding, but when you are borrowing 100 percent of
it, remember, we are asking our kids and grandkids to pay for
it. We have got to get smarter than that. No other place does
that work, and that is why being entrepreneurial, maybe turning
more of the responsibility over to all the places that have to
live within their means.
It was refreshing to hear from Ms. Grenfell that maybe it
is not all about money. Federal level, that is what this place
is about. That is okay if you have it. If we are borrowing it
from our future older Americans, our kids and grandkids, we
have to step back and figure out how to be smarter and better,
because then we are defeating the whole purpose of what this is
about in this discussion.
Thank you all for coming in. It is food for thought. Maybe
we will find a way to have our cake and eat it too, be smarter
about it in the long run. Thank you.
Chairman Casey. Well, thanks everyone for being here today.
We are grateful for the witnesses, for your testimony, and for
bringing your own life experience as well as your professional
experience to bear.
If any Senators have additional questions for the witnesses
or statements to be added, the hearing record will be kept open
until May 30th.
Thank you all for participating today. Have a great rest of
your day.
[Whereupon, at 11:10 a.m., the hearing was adjourned.]
APPENDIX
=======================================================================
Prepared Witness Statements
=======================================================================
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Prepared Witness Testimony
Janet Billotte
Chairman Casey, Ranking Member Braun, and Members of the
Committee, thank you for having me here today at your Older
Americans Act hearing. My name is Janet Billotte, I am 78 years
old. I live in West Decatur, Pennsylvania, which is a rural
town in Clearfield County. Before retiring, I worked as a
nursing aide. I am here to share my experiences as a recipient
of Meals on Wheels and other services from the Clearfield
County Area Agency on Aging.
I have been receiving Meals on Wheels for four years. My
husband, Richard, and I started receiving meals in August of
2020, during the pandemic. Let me tell you, it is so nice to
receive these meals. Every time I get a box, it always feels
like I get a little present. You always get milk, sometimes
cookies, and if it was summer, sometimes we get a strawberry
shortcake. Last year, I was diagnosed with Stage three colon
cancer and I was also caring for my husband who had been sick
with many issues for a long time. I also just had an operation
for my cancer and had chemotherapy three times a week. Many
days, I didn't feel well and it was very helpful to have these
meals delivered to us.
I love talking to Fred, the meal delivery person. Every day he
comes in and always asks me how I am. Everywhere he delivers,
he checks on everyone it is wonderful that he does these check
ins. If he doesn't hear from someone, he calls the Area Agency
on Aging and they make sure we are okay. A lot of older people
don't have family around. I don t have family around. I had two
brothers, but they passed away and my husband just passed
recently. The Area Agency on Aging is my family.
Today, my cancer is in remission. I am still receiving
deliveries from Meals on Wheels and also use other services
from the Area Agency on Aging. They do this very nice thing
where they give us vouchers through the Senior Farmers Market
Nutrition Program run by the Agriculture Department so that we
can go to the farmer's market and I can get fresh produce. I
get tomatoes, lettuce, and all kinds of fresh foods from the
market. It is good nutrition, and it's good for preventing
cancer. During bad weather, they also do a blizzard box, where
they send you a box of frozen and shelf-stable food so we have
something to eat when we are stuck in bad weather. I really am
thankful for these services because I'm not sure what I would
do without them.
Beyond meal deliveries, I also participated in events at the
senior center. One time, I went on a field trip to a mushroom
farm, where we learned about all the different types of
mushrooms. We also went to a flower farm. I love flowers and
have always had a flower garden. The Area Agency on Aging also
helped coordinate transportation for me when I had to go to the
clinic to get chemotherapy. I had to get chemo and blood work
every week, and that was terrible, because I live in a rural
area, it was very hard to find transportation to the clinic but
they were very kind to help drive me to my doctor's
appointment.
I'm very grateful to be receiving these services, and grateful
for the friendship I have with my Area Agency on Aging. Kathy
Gillespie, who is with the Area Agency on Aging, is like family
to me. I know many older adults who receive Meals on Wheel are
thankful like I am. I also understand that there are many more
older adults on the waiting list for these services. I ask you
to please help more people get into the program and be able to
receive these great services. Thank you again for the
opportunity to share my story.
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Prepared Witness Testimony
Laura Holscher
I am Laura Holscher. For 30 years it has been my honor to serve
older adults at Generations Area Agency on Aging, the past 14
years as the Executive Director. Generations is a program of
Vincennes University and is designated by the Indiana Division
of Aging's Commission on Aging as the Area 13 Agency on Aging
serving Daviess, Dubois, Greene, Knox, Martin and Pike counties
in southwestern Indiana. Generations is also designated as the
Aging and Disability Resource Center (ADRC). I want to thank
Senator Braun for inviting me to speak with you today on a
topic that I am very passionate about, the Older Americans Act
(OAA) programs and services that support older adults and
caregivers in Indiana and nationwide.
As an Area Agency on Aging, Generations' role is to develop,
fund and implement a broad range of programs and services to
meet the needs of older adults and caregivers, all of which are
based on demonstrated need in the communities we serve. We
develop an area plan that is based on those identified needs,
the changing preferences of older adults and the input of local
stakeholders, such as our provider partners. As a AAA, we also
leverage additional local dollars to support the Act's efforts,
operate an information and referral/assistance system so that
consumers can access resources, select community providers to
deliver services and then provide oversight, and much more.
Generations serves six counties in southwestern Indiana. Our
entire planning and service area is considered rural. We have
four hospitals, but in some of our cities, there is not even
one primary care physician. Our public transportation system
runs Monday through Friday between the hours of 6:00 a.m. and
6:00 p.m. with reservations requiring at least 24-hour advance
notice. Additionally, 22.7% of the population in the
Generations planning and service area is living below 150% of
the federal poverty level.
Some of the challenges we face as a rural community include
lack of broadband internet and limited access to
transportation, both of which lead to increased risk of social
isolation. Broadband internet is nonexistent in some rural
areas or unaffordable. This limits access to online
opportunities that our AAA offers such as social engagement
activities or virtual evidence-based classes on healthy aging.
Through our work with community partners and contracted
providers Generations staff and volunteers impacted the lives
of more than 35,000 individuals last year. To respond to the
needs of older adults and caregivers in our planning and
service area, we offer all the core OAA services.
Under Title III B of the Act, our AAA is able to offer in-home
services for frail older adults, senior transportation
programs, information and referral/assistance services, options
counseling, home modification and repair, legal services, the
Long-Term Care Ombudsman Program and other person-centered
approaches to helping older adults age well at home. Services
provided through Title III B are a lifeline for older adults
living in the community, and they also connect older adults to
other OAA services-for example, transportation services funded
by Title III B ensure older adults can reach congregate meal
sites funded by OAA Title III C.
The critical flexibility of this funding stream gives AAAs
greater means to meet the needs of older adults at home and in
the community, thereby eliminating the need for more expensive
nursing home care-which usually leads to impoverishment and a
subsequent need to rely on Medicaid to meet critical health
care needs.
Many of our OAA clients have cognitive impairments, including
those living with dementia, and so this informs our OAA work as
well as other projects we take on. Recently one of our counties
was designated as a Dementia Friendly Community by Dementia
Friendly America. This was achieved by using some of our Title
III B funding and supplemented through our University of
Southern Indiana (USI) Geriatric Workforce Enhancement Program
(GWEP) workforce development grant. A dedicated action team was
pulled together that consists of a diverse group of community
members who volunteer their time and energy to create an
inclusive community that is welcoming, mindful and
inspirational for people living with dementia (PLWD) and their
caregivers through education and action. Our action team
membership includes representation from the faith community,
local nursing facilities, local United Way, Chamber of
Commerce, several local nursing facilities and, most
importantly, Genevieve and Carmen (someone who is living with
dementia and her caregiver daughter). A few of the highlights
from our team's dementia friendly work include partnering with
Mi Patio, a local restaurant, to provide dementia friendly
dining hours. These hours are set aside specifically for people
living with dementia and their care partners; a special menu
was created for these dining hours which includes a limited
menu, to make decision making less stressful, and pictures of
each food item so that these customers can see what they are
ordering. Other events/activities include Coffee and Crafting
activities for PLWD and their caregivers; these activities
provide opportunity for fun quality time for the person living
with dementia and their caregiver.
In the near future we will be reaching out to first responders
in our service area in an effort to provide dementia education
and awareness to these individuals who are often first on the
scene in the event of an emergency. By educating this group to
be able to recognize the signs and symptoms of dementia and
instructing them on techniques to interact with someone living
with dementia, we hope to reduce stress in an already stressful
situation for both the person living with dementia and the
first responder.
The flexibility of OAA Title III B also allows AAAs to meet new
and emerging needs in their communities. During the COVID-19
pandemic, we were able to transition to new and modified
programs such as wellness checks for homebound older adults,
activity packets that we were able to porch drop to help older
adults stay socially engaged, and a new virtual version of our
evidence-based programs. This was in addition to our work
supporting vaccine outreach and assistance. To further support
older adults' access to social engagement and healthy aging
opportunities, we have also started offering basic technology
classes geared toward older adults. However, years of eroded
funding prior to COVID-19 have resulted in local rural AAAs
like my own losing ground in their ability to provide critical
Title III B Supportive Services. Without bold investment in FY
2025, the expiration of the COVID-relief funding will create
gaps and elimination across a range of OAA programs, but
especially Title III B and Title III C.
Another essential part of the OAA is Title III C Nutrition
Services. In the past, Generations had provided daily hot home
delivered meals to homebound older adults for many years. Under
our old model of services, meals were prepared out of our
centralized kitchen, plated, packaged and delivered on hot or
cold trucks door to door to nearly 1,000 older adults five days
a week. Generations prioritized this service by diversifying
funding with local donors to ensure that all individuals who
met qualifications were provided a daily hot meal. As the
economy shifted, gas prices rose and the cost of food
increased, it became apparent that our day-to-day operations
were going to have to change. We slowly made minor changes such
as reducing routes, reducing delivery days, reducing food costs
by changing vendors, and closing some of our sites. Ultimately
by 2016, we had to make the very difficult decision to shut
down local meal production and secure partnerships with home
delivered meal providers for frozen/cold meals. We could no
longer support the cost of providing daily, hot meals to all
the rural communities in our six-county area due to stagnant
federal funding that hasn't kept up with inflation-nor the
growing need as our country's aging population has grown.
As we were progressing to the shift to frozen meal providers
and Fed Ex/UPS meal delivery, we searched locally for partners
who would be willing to contract with us to continue to provide
hot meal preparation and delivery, even if we couldn't cover
all of our planning and service area. We looked at hospitals,
community centers, senior centers, long-term care providers,
and restaurants. We were fortunate that three local
organizations shared our passion for serving older adults in
their community. We now have partnerships with a nursing home
and two senior centers to provide hot meals in their
surrounding area. All three of these sites offer home cooked,
hot meals prepared daily to local residents who are homebound
and over age 60.
Today we operate a hybrid program that is person centered and
designed to meet the needs of the individual. A client can
choose from up to six different frozen/cold home-delivered
service providers, or, if they live in an area covered by a hot
meal provider, they have that option as well. Last year, we
provided over 106,000 nutritious meals to nearly 1,000 older
adults in our planning and service area.
Our hope was to expand these local partnerships for hot meal
delivery, but the funding isn't sufficient. This is even though
need is growing in our community: over the past two years, we
have seen a 20% increase in calls for meals and have more
people accessing our services because they just can't afford
groceries or other necessities.
Due to the continued rising cost of food, freight, delivery,
and labor cost, it became apparent that we would need to
increase reimbursement to our providers by 30% if they were
going to continue to provide meals to our current clients.
Increasing the reimbursement rate to keep qualified providers
decreases our overall budget for the number of clients we can
serve. The same amount of money simply cannot stretch to meet
higher, necessary costs without reducing the numbers of people
served, and it certainly cannot meet the increased need.
In addition, donations, grant support, and community support is
down as donors themselves are tightening up their purse strings
and prioritizing their own budgets. This has forced us to
triage calls and provide meals only to the most at-risk
individuals and put others on a waiting list, which is not
something we have had to do historically. When older adults sit
on a waiting list for nutrition services, it increases the risk
of malnutrition, health deterioration and social isolation, in
addition to the continued pain of hunger.
In the meantime, our trained and skilled AAA options counselors
work with callers to provide alternatives to OAA home delivered
or congregate meals, such as offering enrollment assistance for
Supplemental Nutrition Assistance Program, or SNAP, benefits
and referrals to food banks, food pantries, and local churches
and other charities. However, those latter community resources
are also under financial strain given increased need, leaving
few options for the older adults in our area.
As a way to supplement the work we were doing with evidence-
based health and wellness programs under Title III D we entered
a partnership with USI on a GWEP grant which covers 12 counties
in southern Indiana designated as a Health Profession Shortage
area, rural and medically underserved. Other partners included
three Deaconess primary care clinics, a family medicine
residency program, two AAAs and two chapters of the Alzheimer's
Association. Goals included to improve health outcomes for
older adults through information, education, support and
medical services. Falls, chronic illness, increasing incidence
of dementia with longer longevity, nutrition, and mobility
issues majorly affect this population.
As a result of the partnership, we have expanded our outreach
for evidence-based programs under OAA Title III D. Programs
such as A Matter of Balance (MOB) and the Chronic Disease Self-
Management Program (CDSMP) have more than doubled in what were
able to offer prior to the partnerships. We have increased the
number of master trainers for both programs to five and lay
leaders to almost 70. This has allowed us to provide education
to more than 500 participants in the last five years. Outcomes
from MOB analyzed in May 2023 show significant improvements,
with individuals stating they are steadier, are walking more
and have decreased fear of falling, which is in alignment with
national statistics. CDSMP outcomes from post surveys indicated
that all individuals had increased knowledge from the program
and would refer a friend.
We also added another evidence-based fall prevention program,
Bingocizer, which successfully reaches a different older adult
audience. While we are proud to be able to offer these
evidence-based programs through Title III D, the partnership
with USI has allowed us to increase the scope of the
programming. As the grant with USI comes to an end though, we
are concerned that we will not be able to continue all the
programs with the very limited funds we receive through Title
III D. Generations and other rural AAAs around the country
would benefit from new flexibility to also use Title III D
monies to fund evidence-informed programs, which have the
benefit of being lower in cost to operate and more adaptable to
community needs or cultural factors.
Generations was created as a result of the Older Americans Act
for the purpose of planning, pooling resources and coordinating
services at the grassroots level. These are just a few examples
of how we innovate and adapt to meet the needs of older adults
in our rural area. As an organization, we encourage active
participation in our communities. We live where we work and
that makes a real difference in terms of local access and
networking abilities, and that's true of our fellow AAAs and
our service providers nationwide. Please keep the Act's
inherent flexibility and locally driven structure in mind as
you update the law this year.
To that end, I have several recommendations for the
reauthorization of the Older Americans Act.
1. Increase OAA funding, both authorized funding levels and
actual funding for FY 2025 and beyond. OAA funding has not kept
pace with the growing number of older adults or inflation and
funding is inadequate to meet even a fraction of the needs of
those older adults most at risk.
2. Continue some of the flexibilities that were extended to
AAAs during COVID such as flexibility between Congregate and
Home Delivered meals which allowed AAAs to use the funding
provided based on client needs. Or allow for the flexibility to
fund innovative ideas in the nutrition program that meet the
needs at the local level.
3. Allow Title III D health and wellness programs to be
evidence-informed-not just evidence-based-to expand the Aging
Network's ability to reach older adults with emerging
interventions and to extend the reach especially in rural areas
and other areas which have limited funding for this important
work.
4. We also support USAging's reauthorization recommendations.
Thank you for the opportunity to testify today.
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Prepared Witness Testimony
Leslie Grenfell
Chairman Casey, Ranking Member Braun, and members of the Senate
Special Committee on Aging, thank you for the opportunity to
testify before you today to discuss the Older Americans Act.
My name is Leslie Grenfell. I am the Executive Director of
Southwestern Pennsylvania Area Agency on Aging, Inc., serving
older adults residing in Fayette, Greene and Washington
Counties. It has been an honor for me to serve as the Executive
Director for the past twenty-three years.
In terms of population, Southwestern Pennsylvania Area Agency
on Aging is the largest rural Area Agency on Aging, or AAA, in
the Commonwealth. Its three-county service and planning area
encompasses 2,223 square miles. The Agency acts as a community
focal point providing information and assistance about services
and programs, protecting older adults who are most vulnerable,
assisting caregivers and their families, reducing food
insecurity, and empowering older adults to live independently
and age well.
Having worked in the Area Agency on Aging Network since 1976, I
have witnessed the transformation and development of the Older
Americans Act Programs and Services which have evolved from its
early days as a nutrition program into a comprehensive and
coordinated service delivery system for older adults who may be
at risk of losing their independence.
Older Americans Act Programs
The Older Americans Act Nutrition Program is the cornerstone of
the Older Americans Act and includes congregate, home-
delivered, and grab-n-go meals, which were introduced during
the COVID-19 pandemic. The flexibility of the grab-n-go meal
option, where older adults can pick up a meal to take home, has
been well-received by our consumers, especially those who are
providing caregiver services to a loved one.
Our home-delivered meal providers are struggling. High costs,
due to the increased cost of food, supplies, packaging, and
staffing, the long distances between homes, and traveling on
winding back-country roads or in mountainous areas, especially
during inclement weather, can make delivery difficult. One of
our most demanding routes is in the Laurel Highlands of Fayette
County, called Kentuck Knob, which requires travel through
State Game lands, is 32 miles long, and takes 54 minutes to
complete.
2Although challenging, the home-delivered meal providers have
successfully developed and sustained a service delivery system
utilizing dedicated volunteers who not only deliver hot, well-
balanced nutritious meals five days a week, but also provide
wellness checks to each older adult ensuring their safety and
well-being. Last fiscal year, a total of 691 volunteers
provided 97,638 hours of service and delivered 434,872 in-home
meals to at-risk consumers.
The major challenges identified by our thirty-four home and
community-based agencies who provide personal care services in
rural communities are the costs associated with transportation
due to the distance to consumer homes, the recruitment and
retention of direct care workers, and the need for increased
reimbursement.
Funding
Last fiscal year, the Southwestern Pennsylvania Area Agency on
Aging received $591,073 in American Rescue Plan Act (ARPA)
funds which provided a necessary infusion of financial support
for the OAA nutrition program and the home and community-based
program, permitting us to help a growing number of older
adults.
With the number of older adults projected to continue to
increase, there will be a corresponding growth in the need for
services, and yet, no appreciable amount of additional Older
Americans Act funding has occurred for over a decade.
Increasing Older Americans Act funding and increasing its
flexibility is a cost-effective financial investment which
would enable older adults to stay healthy longer, living in
their own homes and communities, whereby reducing the need for
more costly long-term care interventions.
Looking Ahead
In 2023, the Pennsylvania Department of Aging began development
of a 10- year Multisector Plan for Aging called Aging Our Way,
PA. It is a state-led and stakeholder-driven strategic plan
designed to help transform the infrastructure and coordination
of services for older Pennsylvanians and persons with
disabilities to reflect the needs and preferences of this
population to live where they choose and to access the supports
they need to thrive and age in place.
The network of AAAs was essential to the stakeholder process,
which yielded over 20,000 responses from across the state. Each
Area Agency on Aging engaged their local communities,
encouraged community participation, and facilitated listening
sessions at least one in each of the 67 counties and over 200
sessions in total.
From that engagement and those 20,000 responses, state
government agencies, state experts in different areas of
livability, and members of the Long-term Care Council developed
Aging Our Way, PA's five priorities, and a number of
strategies, and tactics. The AAAs are integral to many of the
recommendations developed through this process and are looking
forward to working with the Pennsylvania Department of Aging
and other stakeholders.
In conclusion, I would like to especially thank Senator Casey
for inviting me to provide testimony today. On August 5th, I
will be retiring after 48 years in the Aging Network. It has
been an honor and a privilege for me to share my insights with
you and it is truly a wonderful capstone of my career!
Attachment to Testimony:
Aging Our Way, PA is Pennsylvania's ten-year Multisector Plan
for Aging (MPA). This Plan is designed to address the needs and
preferences of older adults and their caregivers in
Pennsylvania and support the Commonwealth's preparedness as
this older adult population grows dramatically over the next 15
years.
On May 25, 2023, Governor Shapiro signed Executive Order 2023-
09, which directed the Pennsylvania Department of Aging (PDA)
and agencies under his jurisdiction to develop this 10-year
strategic plan that has been designed to help transform the
infrastructure and coordination of services for Pennsylvania's
older adults. Aging Our Way, PA defined by six key traits
including:
Necessary: The investments and improvements outlined in the
Plan are needed for Pennsylvania to grow alongside its aging
population.
Stakeholder-Driver: community members were invited from
across the state including Pennsylvanians over 60, caregivers,
families, subject-matter experts, and community members to
recommend improvements to the services and infrastructure in
their communities.
Collaborative: Drawn from stakeholder input, state agencies
and community expert partners worked together to articulate the
priorities, strategies, and tactics (initiatives) included in
the plan.
Achievable: To guarantee achievability, each Tactic has been
refined in active partnership with the agencies responsible for
its implementation.
Responsive: The Plan is designed to adapt alongside shifting
needs and resources over its ten-year timeframe.
Effective: The Plan presents an opportunity for
Pennsylvania's government to work smarter.
Pennsylvania's network of Area Agencies on Aging (AAAs) was
essential to the stakeholder process that yielded over 20,000
responses from across the state. The AAAs engaged their local
communities, encouraged community participation, and
facilitated listening sessions at least one in every county and
over 200 sessions in total. The AAAs structured these listening
sessions around the AARP's eight Domains of Community
Livability. These domains organize the holistic older adult
experience related to transportation, engaging with government,
volunteerism, employment, the need for navigation and getting
information from trusted sources, respect and having a sense of
belonging, social engagement and the challenges of social
isolation and loneliness, access to health care including
behavioral health and long-term care, and most broadly,
challenges with housing. From that engagement and those 20,000
responses, state government agencies, state experts in
different areas of livability, and members of the Long-term
Care Council drew out Aging Our Way, PA's five priorities,
strategies, and tactics. The AAAs are integral to many of the
recommendations developed through this process and are eager to
work with the PDA and other Commonwealth agencies. The Plan's
five priorities include:
Unlocking Access: Eliminate barriers preventing equitable
ability of older Pennsylvanians to live healthy, fulfilling
lives.
Aging in Community: Enable older Pennsylvanians to maintain
secure housing, active community involvement, and familiar
surroundings.
Gateways to Independence: Promote older adults unhindered
mobility and safe, convenient, and autonomous use of
transportation.
Caregiver Supports: Provide support, training, respite, and
navigation tools to paid and unpaid caregivers.
Education and Navigation: Streamline the resolution of
complex problems faced by older adults through improvements to
the connection, reach, and delivery of the services network.
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Prepared Witness Testimony
Mairead Painter
Thank you, Chairman Casey, Ranking Member Braun, and
distinguished members of the Senate Special Committee on Aging
for inviting me here today. My name is Mairead Painter, and I
am honored to serve as the State Long-Term Care Ombudsman for
Connecticut. I appreciate the opportunity to offer this
testimony to you regarding the critical role of Long-Term Care
Ombudsman programs in protecting the health, safety, welfare,
and rights of residents' in long-term care settings.
The term "ombudsman" originates from Sweden, where it means
"representative." This concept has been adopted by several
countries, including the United States, to ensure transparency
and accountability within the government and organizations. As
Long-Term Care Ombudsmen, we serve as independent advocates for
older adults and individuals with disabilities who reside in
nursing homes, assisted living facilities, and other small home
settings, such as residential care homes many of whom cannot
advocate for themselves.
My team in Connecticut, though small, is dedicated and
formidable. It includes eight Regional Ombudsmen, two Intake
Coordinators, one Administrative Assistant, and myself as the
State Ombudsman, serving approximately 30,000 residents in 209
nursing homes and about 200 board and care facilities these are
inclusive of residential care homes and assisted living
communities. Additionally, we have recently expanded our
program with state funding to serve approximately 50,000
individuals receiving home and community-based services. This
expansion includes one Manager and one Regional Ombudsman.
Looking back, the Long-Term Care Ombudsman Program was
established in the 1970s by President Nixon in response to
widespread concerns over the conditions in nursing homes. Media
reports and investigations at that time revealed pervasive
abuse, neglect, and mismanagement. President Nixon's plan aimed
to improve the quality of care in these facilities and address
systemic issues such as inadequate care, poor conditions, and
lack of accountability. From this initiative, the Long-Term
Care Ombudsman Program was born in 1972 as a demonstration
program.
In 1973, authority for the long-term care ombudsman
demonstration was transferred to the Administration on Aging
(AoA), which oversaw the project in several states, and in
1978, the long-term care ombudsman program was statutorily
formalized through amendments to the Older Americans Act. In
the following years, the ombudsman program was provided a
separate authorization of appropriations, incorporated into
Title VII of the Older Americans Act, and expanded to cover
additional long-term care facilities.
In 2016, nearly 40 years after the functions of the LTCOP were
delineated in the Older Americans Act, final regulations went
into effect, providing more clarity and additional authority to
the Long-Term Care Ombudsman Program in several areas.
All Ombudsman activities are performed on behalf of and at the
direction of residents, with strict confidentiality. We provide
direct services, including consultation, information about
residents' rights, and investigation and resolution of
complaints, contingent upon residents' consent. Additionally,
we serve as a continuous resource for support. Our non-mandated
reporter status reassures residents that their communications
with us are confidential encouraging them to seek our guidance
without fear of reprisal.
Our office frequently receives complaints concerning general
care issues arising from insufficient staffing, which adversely
affects residents' ability to have their basic needs met, such
as assistance with getting out of bed to use the bathroom. In
some cases, residents are informed that they must rotate which
days they can get out of bed at all due to the lack of
available staff to assist them daily.
Other complaints pertain to involuntary transfers and
discharges. Residents may receive notices indicating they are
being discharged from the facility or are instructed to leave
immediately and are sent to a homeless shelter or hotel.
Additionally, there are instances where residents are sent to
the hospital, and when the hospital is ready to discharge them,
the facility refuses to readmit them.
In all these cases, our team works closely with the residents
to ensure their rights are upheld and that proper procedures
are followed. We strive to ensure that any discharge is
conducted safely and appropriately. If residents wish to remain
in the facility, we attempt to resolve the issues to maintain
their facility as their home.
Despite an increase in additional care settings and models over
the years, the Ombudsman program has not seen the corresponding
increase in funding to manage this new workload. Many programs
receive minimal state funding some programs, like Tennessee s,
only receive enough state funding to pay the state ombudsman
salary. This lack of investment on the state level, coupled
with stagnant federal funding, hampers our ability to grow and
meet increased demand resulting from older adult population
growth and additional care settings. Without sufficient and
stable funding, our capacity to fulfill the program's original
intent identified as a critical need since its establishment in
1972 continues to decline.
Inadequate resources directly impact our ability to support and
protect hundreds of thousands of older adults living in our
communities and to respond to complaints. For example, half of
the states do not have adequate staffing to meet the 1995
Institute of Medicine staffing ratio, which recommended one
ombudsman per 2,000 beds. This report, while outdated, provides
the most reliable staffing standard for the program to date.
Although Connecticut is fortunate to have a relatively higher
level of state support, our team members still manage caseloads
nearly double the recommended standard. Currently, our program
operates with approximately one Regional Ombudsman for every
3,800 long-term care beds. Despite these financial constraints,
Ombudsman programs have expanded services to cover additional
settings like assisted living facilities and small homes,
further straining our resources.
Additionally, the increasing number of residents with complex
care needs who depend on our advocacy underscores the necessity
for Ombudsmen to be present and responsive. The original
program relied heavily on volunteers, but today's complex care
demands and cases often exceed what volunteers feel equipped to
handle. Consequently, many volunteer-based programs have been
diminished or eliminated. It is no longer feasible to run
Ombudsman programs using volunteers as the program's backbone.
We need to reevaluate our reliance on volunteers and how to
best utilize their skills while adding more trained, paid
Ombudsmen across the nation. Sufficient funding is required to
make these staffing changes.
Most critical: funding limitations impede our ability to
educate individuals, respond promptly to complaints, and
monitor facilities to prevent crises
To begin to properly fund Ombudsman programs, we respectfully
request the following funding for Fiscal Year 2025 for the
benefit and safety of long-term care residents across our
nation: $65 million for ombudsman services in assisted living
facilities under Title VII of the Older Americans Act and $70
million for our current core funding under Title VII of the
OAA. Increased and stable funding would enable us to hire
additional staff, enhance our education and outreach programs,
and provide stronger protections for elder justice.
This critical funding would not only improve residents' quality
of life and well-being but also results in cost savings to the
greater health care system. The Long-Term Care Ombudsman
Program reduces the risk of individuals requiring Medicaid
preemptively and reduces unnecessary trips to the hospital
emergency room. Significant data show that when individuals
feel they have a high quality of life, they report being in an
overall better medical condition.
Although Ombudsmen may work as state employees or under the
direction of a state Agency Director, our role requires
independence and autonomy to effectively advocate on behalf of
residents. This includes the ability to speak out on residents'
behalf, regardless of where the program is housed, whether
within a state agency or decentralized outside of one.
In addition to monitoring and responding to complaints, our
program engages in education and outreach both at the facility
level and within the broader community. We undertake rigorous
systemic and legislative advocacy at state and federal levels
to continuously improve and expand long-term care services and
supports for your constituents. Our goal is to empower
residents to have a direct voice in policies and legislation
that affect them. When this is not feasible, we advocate on
their behalf before governmental agencies or policymakers.
Until I became the State Ombudsman in Connecticut, I did not
realize how fortunate I was to be part of this ombudsman
program. Once I got to know other state ombudsmens, I began to
realize that I have an independence and autonomy that is not
only federally mandated under the Older Americans Act but is
not possible for some of my peers in other states. For example,
at a recent conference, as a Board Member of the National
Association of State Long-Term Care Ombudsman Programs, I
raised questions related to interference with the Ombudsman
office. This inference directly impacts state ombudsmen's
efforts to advocate for changes to state or federal laws,
comment to the media, or talk with legislators about concerns
constituents face.
I can ask these questions because in my state I have the
autonomy and support to speak freely on behalf of the
individuals I serve. However, the conference was being
livestreamed, and I know other state ombudsmens would be
concerned someone from their state might see them ask the
question; it could result in consequences when they return to
their home state. Some State ombudsmen have reported that in
their state, their comments are controlled by their managers or
senior officials, or they are told they cannot make comments to
the media or speak to legislators independently at all. This is
unsettling because Ombudsmen must have the independence and
autonomy this position was intended to have and advocate in a
bipartisan way on behalf of the people we serve and truly be
their voice. This is foundational to our position as State
Ombudsmen, which was created to represent them and inform all
of you.
This leads me to one of the reasons it is essential that the
National Director position for the Long-Term Care Ombudsman
Program be refilled. Although the current leadership at the
Administration for Community Living has been extremely
supportive of the program, it is necessary to have an
independent voice advocating for our role and needs without any
conflict of interest. At the state level, Ombudsmen are not
able to be housed within the same agency as Adult Protective
Services due to concerns over conflict of interest. However, at
the federal level, we report to the same Director. This
inherently creates a conflict when trying to advocate for the
interests of both programs related to funding and support. As
the representative of state ombudsmen across the country, we
strongly urge you to reinstate the National Director of the
Ombudsman Program. It is crucial that we have an independent
national director who can represent ombudsmen without any
potential conflicts of interest.
I want to thank you for allowing me to offer this testimony.
Many individuals are still unaware of our role, their rights,
or the standards of care they should expect when receiving
long-term services and supports. As Ombudsmen, our goal is to
continue to protect the health, safety, welfare, and rights of
all individuals receiving long-term services and supports.
Respectfully,
/s/
Mairead Painter,
Connecticut State Long Term Care Ombudsman
Questions for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Questions for the Record
Janet Billotte
Senator Raphael Warnock
Question:
According to research from 2020, Georgia ranks in the top 10
worst states for food insecurity among seniors.\1\ However, in
the most recent government funding bill, the Older Americans
Act's (OAA) Title III nutrition programs were funded at $8.1
million less than the previous year.\2\ We owe it to our
seniors to increase funding and strengthen nutrition programs.
---------------------------------------------------------------------------
\1\ Key Statistics on Seniors Hunger, Georgia Department of Human
Services Division of Aging Services, https://aging.georgia.gov/key-
statistics-senior-hunger.
\2\ Kirsten Colello and Angela Napili, Older Americans Act:
Overview and Funding, Congressional Research Service, (May 6, 2024),
https://www.crs.gov/Reports/R43414.
Ms. Billotte, how have nutrition programs authorized under the
---------------------------------------------------------------------------
OAA, like Meals on Wheels, helped you?
Response:
I would be happy to answer questions of the nutrition balance
of the Meals on Wheels. For protein, chicken, fish, ham, pork,
and turkey are on a monthly menu. A balance of vegetables like
broccoli, brussels sprouts, carrots, green beans, potatoes and
sweet potatoes, spinach and tomatoes are delivered with meals.
Wheat bread or a muffin or a dinner roll. Fruit or pudding or
cookies. Milk of 2% is delivered with each meal.
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Questions for the Record
Laura Holscher
Chariman Robert P. Casey, Jr.
Question:
In 2021, Democrats passed the American Rescue Plan Act, which
provided significant funds and flexibility for federal
programs, including those authorized through OAA. This funding
was critical to the success of Area Agencies on Aging (AAAs)
during the pandemic. It was especially crucial because funding
through annual appropriations has not matched the levels
authorized in the 2020 reauthorization of OAA. In fact, in
Fiscal Year 2024, Older Americans Act programs should have
received $450 million more in funding than was appropriated.
Ms. Holscher, how did the American Rescue Plan funds assist
service delivery at your Area Agencies on Aging? How does the
expiration of those funds affect the older adults you serve and
the people you employ?
Response:
As a result of the American Rescue Plan funds, we were able to
provide over 18,000 additional meals ensuring no one would go
on the waiting list, and we provided 8,000 additional respite
hours for caregivers; we doubled the number of evidence-based
programs we were able to offer and provided some much-needed
one-time services such as home modifications, durable medical
equipment and pest control services allowing older adults to
remain safely in their homes. We used the funds to kick off
some new projects such as technology 101 classes, art programs
for people living with dementia and activity packets for those
that are homebound and at risk of becoming socially isolated.
We have used all the additional funds made available through
the American Rescue Plan and are now looking at scaling back
these programs. We are currently only providing meals and
respite to the most at-risk individuals, and the waiting list
is growing. We have scaled back our new initiatives and may
have to eliminate one or more of the evidence-based programs we
provide. Finally, we had to decrease our workforce by three
FTEs to accommodate the loss of funds.
Allowing AAAs to pilot new projects such as online payments to
Uber Eats or partnering with local food trucks to set up in
rural communities would enhance our ability to meet the needs
of older adults in small communities. We need the flexibility
to come up with new ideas that allow us to make the best use of
the dollars to meet the needs that best serve our communities.
It goes without saying we could use funding at the same levels
we received from the American Rescue Plan, but continuing the
flexibility in Older Americans Act TIII-C that was extended to
the AAA's during the public health emergency would increase our
ability to utilize current funding to best meet the needs in
our local communities.
Question:
The Older Americans Act is intended to target those with the
greatest social need and greatest economic need, which includes
many rural older adults. However, rural populations, while
older, poorer, and sicker, are often left out of many social
safety net programs, including OAA meal programs. This is a
population that has seen a lot of other supports in their
community move away-including hospitals, grocery stores, and
community centers. There is a need to provide targeted support,
particularly nutrition services and transportation, to rural
older adults.
Ms. Holscher, what are some of the challenges that rural
providers face when trying to reach rural older adults? What
can we do within OAA to ensure this population has access to
the same services as urban and suburban older adults?
Response:
Some of the challenges we face as a rural community include the
lack of broadband internet and limited access to
transportation, both of which limit access to healthcare and
social opportunities.
While TIII-B is the most flexible of the Titles under the Older
Americans Act, additional funding and/or increased flexibility
would go a long way to help us address the challenges of rural
communities. Increased flexibility would allow us the
opportunity to subsidize service connectivity, provide digital
literacy training and increase access to telemedicine for older
adults.
Affordable, accessible transportation has always been a
challenge in rural communities, and in many areas, public
transportation systems such as buses, subways etc. will never
be an option. We would like the flexibility to include
reimbursement for ride-share services and mileage expense for
privately owned vehicles as an eligible activity under TIII-B
services.
Additionally, we would benefit from the flexibility of using
TIII-D for evidence-informed programs which are lower in cost
and more adaptable to our local communities.
To sum it up, I would recommend an increase in OAA funding,
which has not kept pace with the growing number of older adults
or inflation. I would also strongly encourage enhanced
flexibility in transfers between Titles and allowable services
within the Titles.
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Questions for the Record
Leslie Grenfell
Chariman Robert P. Casey, Jr.
Question:
In 2021, Democrats passed the American Rescue Plan Act, which
provided significant funds and flexibility for federal
programs, including those authorized through OAA. This funding
was critical to the success of Area Agencies on Aging (AAAs)
during the pandemic. It was especially crucial because funding
through annual appropriations has not matched the levels
authorized in the 2020 reauthorization of OAA. In fact, in
Fiscal Year 2024, Older Americans Act programs should have
received $450 million more in funding than was appropriated.
Ms. Grenfell, how did the American Rescue Plan funds assist
service delivery at your Area Agencies on Aging? How does the
expiration of those funds affect the older adults you serve and
the people you employ?
Response:
The American Rescue Plan Act (ARPA) funds were critical to
meeting the needs of older adults in our planning and service
area as we began recovering from the COVID-19 pandemic. Serving
as a lifeline, the ARPA funds provided the flexibility needed
to ensure local needs such as increased requests for home-
delivered meals and community-based services were met during
those uncertain and challenging times. However, Area Agencies
on Aging continue to struggle with the recruitment and
retention of staff and providers, cost inflation and the
rapidly growing elderly population who are in need of OAA
services and programs. With the ARPA funds expiring, additional
OAA financial support is now critical to offset staff
reductions in force, long waiting lists for in-home services
and the creation of a waiting list for home-delivered meals.
While funding levels have not increased over the past two
decades, the cost of labor, food, supplies and infrastructure
has continued to escalate. Significant increases in authorized
funding levels is urgently needed to meet the rising costs of
service delivery.
Question:
The Older Americans Act is intended to target those with the
greatest social need and greatest economic need, which includes
many rural older adults. However, rural populations, while
older, poorer, and sicker, are often left out of many social
safety net programs, including OAA meal programs. This is a
population that has seen a lot of other supports in their
community move away-including hospitals, grocery stores, and
community centers. There is a need to provide targeted support,
particularly nutrition services and transportation, to rural
older adults.
Ms. Grenfell, what are some of the challenges that rural
providers face when trying to reach rural older adults? What
can we do within OAA to ensure this population has access to
the same services as urban and suburban older adults?
Response:
By highlighting the challenges that rural older adults face in
accessing necessary services in the OAA, we can work to ensure
that rural older adults have the same access as their urban and
suburban counter parts. The Older Americans Act places emphasis
on prioritizing populations with the greatest economic and/or
greatest social need. According to the Office of Policy
Development and Research, rates of poverty among rural older
adults is higher than metro and suburban areas. This
exemplifies the need for highlighting rural older adults as
part of those in greatest economic need.
The federal final rule assisted in clarifying what should be
considered for the "greatest social need", including physical
and mental disabilities, language barriers and cultural, social
or geographical isolation. Providing a definition of social
isolation as it relates to rural older adults and greatest
social need would encourage State Units on Aging to reevaluate
their intrastate funding formulas (IFF) to prioritize rural
populations that have often been forgotten. By underscoring the
importance of addressing rural older adult population in the
Older Americans Act, state units can begin to focus on some of
the disparities seen between urban and rural communities and
provide the access rural older adults need to quality services
and programs.
A significant challenge that rural providers face is difficulty
recruiting direct care workers. While challenging in any
setting, recruitment in rural communities is especially
difficult due to many direct care workers not having access to
a vehicle to reach remote areas or the inability of providers
to reimburse for mileage and other expenses, making rural
service provision cost prohibitive. As a result, many rural
elders are not receiving the care they need, leaving them
socially isolated and at increased risk of self-neglect. Others
are not obtaining consistent care, resulting in frequent and
costly emergency room visits, hospital admissions and nursing
facility stays.
Any efforts to strengthen the direct care workforce through the
OAA will increase rural older adult access to these much needed
services and also enhance support to rural caregivers of older
adults. A suggestion is to support the National Council on
Agency's Direct Care Workforce Strategies Center.
Question:
The National Family Caregiver Support Program, authorized
through Title III-E of the Older Americans Act, provides
critical support to family caregivers across the Nation. Many
of these caregivers include older adults caring for a
grandchild, great-grandchild, or other loved one-this is
especially true as a result of the COVID-19 pandemic and the
ongoing opioid crisis. In the last reauthorization of the Older
Americans Act, I ensured the resources provided through the
National Family Caregiver Support Program would reach those
families.
Ms. Grenfell, as a AAA director, what additional supports
within OAA would be most helpful for the older adults you serve
who are also raising grandchildren, other relatives, or close
family friends?
Response:
Over the last several years, our Agency has encountered, but
has not been able to serve, many elders caring for related
children who are younger than the minimum eligible age of 55. I
recommend consideration of lowering the minimum age of
eligibility in the National Family Caregiver Support Program
(NFCSP) for older adults caring for related children to 50
years old.
In our experience, some children receiving support from older
adult relatives enrolled in the NFCSP have aged out of the
program while they are still in need of assistance.
I recommend extending the age limit to twenty-one or twenty-two
years of age in extenuating circumstances such as:
If the child is enrolled in the school system with an
Individualized Education Plan (IEP) and can remain in the
school system until age 21.
If the child has an intellectual disability, is physically
disabled, or has a behavioral health diagnosis that limits
their ability to obtain employment.
Question:
Ms. Grenfell, throughout your career, you've helped tens of
thousands of older adults, maybe even more, access services
that enable them to live healthy, independent, and full lives.
You've seen the direct impact that OAA programs have on older
adults in your community. One of the defining factors of the
Older Americans Act is the age of eligibility. Older adults
ages 60 and older, and for some programs, ages 55 and older,
can receive the services they need.
Ms. Grenfell, why is it so important, especially in rural
communities like yours, that Older Americans Act programs
continue to serve those 60 years and older?
Response:
As previously noted, rural older adults face unique challenges
in accessing the same services as their urban counterparts.
Older Americans Act programs are vital to ensuring rural older
adults continue to live in their homes and communities.
With the number of rapidly growing older adults, it is
important that the OAA continues to be primarily focused on the
needs of older adults aged 60 and older especially in rural
areas where there is a lack of community resources and the OAA
funding is often necessary to fill the service gap.
Senator Raphael Warnock
Question:
According to research from 2020, Georgia ranks in the top 10
worst states for food insecurity among seniors.\1\ However, in
the most recent government funding bill, the Older Americans
Act's (OAA) Title III nutrition programs were funded at $8.1
million less than the previous year.\2\ We owe it to our
seniors to increase funding and strengthen nutrition programs.
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\1\ Key Statistics on Seniors Hunger, Georgia Department of Human
Services Division of Aging Services, https://aging.georgia.gov/key-
statistics-senior-hunger.
\2\ Kirsten Colello and Angela Napili, Older Americans Act:
Overview and Funding, Congressional Research Service, (May 6, 2024),
https://www.crs.gov/Reports/R43414.
Ms. Grenfell, how can Congress modernize the Title III C
nutrition funding stream\3\ to improve meal services for
seniors?
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\3\ See Nutrition Services, Administration for Community Living,
https://acl.gov/programs/health-wellness/nutrition-services.
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Response:
Obtaining adequate nutrition can be challenging for rural
seniors due to limited financial resources and the lack of
available transportation, as well as access and proximity to a
grocery store.
Congress has the opportunity to modernize the Title III C
Nutrition Program by consolidating the funding streams to
enable increased flexibility at the local AAA level. Such an
action would increase innovation and creativity necessary to
revitalize the nutrition program to address the requests of
current consumers for more culturally appropriate menus and to
serve the next generation of elders who are seeking more
person-centered service options such as medically tailored
meals.
One overreaching goal of the OAA is that the services for older
persons must be delivered through a comprehensive plan which is
based upon an assessment of the local planning and service area
and its resources. Toward that end, the aging network should
have the flexibility necessary to determine the programs and
supports that most effectively and efficiently address the
needs of older adults and caregivers in their communities.
Question:
Area Agencies on Aging (AAAs) offer critical services for
seniors across the country. Georgia's 12 AAAs do exceptional
work providing resources and care to older Georgians.\4\
However, the aging population is growing rapidly, and AAAs
across the country may need increased funding to meet the real
and urgent needs of their community.\5\
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\4\ Aging & Disability Resource Connection, Georgia Department of
Human Services, https://dhs.georgia.gov/aging-disability-resource-
connection.
\5\ Becky Kurtz, Request for Information - Older Americans Act
Reauthorization, Atlanta Regional Commission (Mar. 21, 2024).
Ms. Grenfell, can you explain how AAAs could benefit from
---------------------------------------------------------------------------
increased funding levels in this year's OAA reauthorization?
Response:
The fastest growing segment of the older adult population is
older adults aged 85 and older. In our planning and service
area, the number of older adults aged 85 and older is predicted
to nearly double between 2030 and 2050. These older adults are
the most likely to need the services and supports provided by
AAAs in order to continue to live independently in their own
homes and communities. Already, about 45% of the older adults
our Agency serves are aged 80 and older. Many AAAs, including
ours, are forced to maintain a waiting list for in-home
services. Increased funding levels would allow AAAs to increase
the number of older adults served and the amount of services
provided, which would allow older adults to "age in place" and
prevent or delay costly institutionalization.
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Questions for the Record
Mairead Painter
Chariman Robert P. Casey, Jr.
Question:
Ombudsmen are uniquely positioned to understand resident needs
and to get to know the residents they serve and the facilities
they monitor. This, in turn, allows ombudsmen to effectively
identify issues and to advocate for their needs.
Ms. Painter, can you explain why ombudsmen are unique in
providing this service? How does their status allow them to
identify issues more easily than other agencies?
Response:
Residents direct the actions of an Ombudsmen. All conversations
with ombudsmen are completely confidential unless the resident
grants consent to proceed with taking action. This
confidentiality allows residents to speak freely, gain
perspective on their concerns, and decide how they wish to
address issues without fear of real or perceived retaliation.
Additionally, ombudsmen regularly visit long-term care
facilities to engage with residents who may be unaware of the
program. These visits provide an opportunity to inform
residents of their rights and address issues before they
escalate and to help individuals learn how to make their needs
known and advocate for themselves. This support offered by
ombudsmen is unparalleled by any other agency. As the only
oversight agency that has a regular presence in facilities,
ombudsmen can identify systemic concerns through their
observations and resident interactions. These issues can then
be addressed directly with the facility by the ombudsman and
resolved in a timely manner. When this occurs, resident care
and satisfaction can be quickly improved, while potentially
lessening the risk of costly citations. Ombudsman intervention
and support helps to improve the quality of care and quality of
life for individuals living in long term care and can be a cost
saving on many levels of the greater health care system by
resolving care concerns before they escalate.
Question:
The Older Americans Act reauthorization process provides us
with an opportunity to look at what has changed in the last
four years since the 2020 reauthorization, what innovations
were critical throughout the COVID-19 pandemic, and what needs
are still not being met.
Ms. Painter, how have you seen the needs of older adults evolve
over your careers and where is modernization needed most within
the Older Americans Act?
Response:
Over my career, I have observed many ways in which the needs of
older adults have evolved but believe there are three
significant areas where modernization is necessary in relation
to the Older Americans Act.
First, the complexity of care needs for older adults has
increased. Advances in modern medicine have led to longer
lifespans, resulting in more complex health needs.
Additionally, there has been a rise in individuals facing
health-related conditions due to lifestyle choices, substance
use diagnosis or seeking mental wellness as they age. This
trend is evident not only in the broader community, where
issues such as loneliness and poor health are prevalent, but
also within long-term care facilities. We are also seeing an
increase in residents diagnosed with traumatic brain injuries,
cognitive related deficits, mental health diagnoses, and
physical limitations resulting in the need for staff that are
highly skilled and trained to serve a population with complex
physical and psychosocial needs.
Second, the Olmstead Act has brought positive changes by
allowing individuals to choose where they receive their long-
term services and supports. Many ombudsman programs spend a
great deal of time supporting individuals working to transition
to the least restrictive environment. It is crucial to ensure
that these individuals have access to the protection of their
rights regardless of where they choose to receive their long-
term services and supports. Currently, the Older Americans Act
does not permit Ombudsman funding to support individuals who
opt for long-term services and supports in the greater
community beyond six months after transitioning from a nursing
home. Only a few states even offer this level of support
individuals, so this identifies a significant gap in rights
protections while resulting in a potential significant cost
savings to states and the federal government.
Ombudsmen oversee Residential Care Facilities for older adults,
and individuals with disabilities that are often not regulated
or licensed to the same level of Skilled Nursing Facilities. In
these facilities there are no minimum staffing requirements,
training requirements are weak, and in these communities,
ombudsmen often identify cases of significant abuse and
neglect. Examples of people who live in residential care
facilities could be individuals who want to stay in their local
community but require either financial or independent living
support but are not in need of a skilled nursing facility. They
could be a veteran or other community members, for example in
CA there are over 8,000 residential care facilities that house
over 200,000 residents and members of their community on a
daily basis.
Third, the Elder Justice Act has introduced additional
protections for older adults, including many individuals served
by Ombudsmen. However, the expansion of these protections has
increased the demands and scope of work for our program. The
OAA should be modernized by authorizing funding at levels
proportionate to the numbers of older Americans in need so that
we are able to provide services to all eligible older Americans
without delay. When we don't respond quickly to complaints and
routinely monitor resident care, residents are at risk of
dangerous outcomes.
Senator Raphael Warnock
Question:
Georgia has some of the highest rates of people living with
human immunodeficiency virus (HIV) in the country.\1\ In 2021,
nearly 32 percent of Georgians living with HIV were over the
age of 55.\2\ Because of advancements in treatment, people with
HIV are living longer.\3\ We must invest in services for the
aging population of those with HIV.
---------------------------------------------------------------------------
\1\ Sofia Gratas, Georgia Has Some of the Highest HIV Rates in the
Country, but Treatment Has Never Been Easier, Georgia Public
Broadcasting (Jul. 1, 2022), https://www.gpb.org/news/2022/07/01/
georgia-has-some-of-the-highest-hiv-rates-in-the-country-treatment-has-
never-been.
\2\ Local Data: Georgia, AIDSVu, https://aidsvu.org/local-data/
united-states/south/georgia.
\3\ Brian Altman, Older Adults with HIV/AIDS: A Growing
Population, Administration for Community Living (Sept. 18, 2021),
https://acl.gov/news-and-events/acl-blog/older-adults-hivaids-growing-
population.
Ms. Painter, can you elaborate on the unique health needs of
the aging population of people with HIV? How could new
---------------------------------------------------------------------------
investments in the OAA benefit this population?
Response:
The ombudsman program supports individuals residing in long
term care facilities, residential care homes and assisted
living communities and individuals with HIV most likely live in
these communities that we serve. HIV, like any other infectious
diseases, requires long-term care providers to be inclusive of
the person, meet their individual needs, have knowledge of and
apply good infection prevention and control practices.
I think it is important that all members of our community know
that they are welcome, that they deserve and are entitled to
high quality care, not matter where they receive it. For this
reason, I think that it is important that the OAA provide
access to programs that reduce isolation and loneliness,
keeping people connected to their greater community and
providing education and outreach. Individuals with HIV who live
in long-term care facilities or residential care communities
would benefit from ombudsmen with adequate stable funding to
hire staff ombudsmen that are highly skilled and trained to
help them achieve this. No matter what an individual's
diagnosis is, Ombudsmen need to be able to serve anyone with
complex physical and psychosocial needs, offering them support
when needed and protecting their rights.
=======================================================================
Statements for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Statement for the Record
National Council on Aging Testimony
Introduction
Chairman Casey, Ranking Member Braun, and members of the Senate
Committee, thank you for convening this hearing to highlight
the local impact of the Older Americans Act (OAA) as you engage
in this year's reauthorization process.
The National Council on Aging (NCOA) is the nation's oldest
organization focused on serving older adults. For nearly 75
years, we have worked to improve the lives of older Americans,
especially vulnerable and underserved populations. From
advocating for passage of the original Older Americans Act,
Medicare, and Medicaid, to helping end mandatory retirement,
NCOA has operated under the principle that aging well in
America should be a right for all, not a privilege for a few.
NCOA's goal is to improve the health and economic security of
40 million older adults by 2030, especially women, people of
color, LGBTQ+, low-income, and rural individuals. Working with
thousands of national and local partners, we provide resources,
tools, best practices, and advocacy to ensure every person can
age with health and financial security. Every day, our team
works to help individuals secure job training and placement,
enroll in programs that help with the cost of food and
medicine, better manage their chronic conditions like diabetes
and hypertension, and prevent falls. All our insights from our
direct service delivery inform our reauthorization
recommendations.
The OAA is integral to achieving NCOA's vision of a just and
caring society in which each of us, as we age, lives with
dignity, purpose, and security. First enacted in 1965, the OAA
establishes priorities and operations for key programs and
services that help keep our nation's adults ages 60 and older
healthy and independent.
The OAA is the designated vehicle to plan for and provide
professional assistance to older Americans and their families,
providing the many nonmedical care services that older adults
often need and complementing the support provided by Medicare,
Medicaid, and Social Security. The Act provides the blueprint
that encompasses the full range of services and supports that
address vital social determinants of health and allow all of us
to age well in community and at home as desired. Further, OAA-
funded services and supports have been shown to reduce health
care costs and delay nursing home placement.\1\ Given that
greater than 90% of older adults live in communities,\2\ we
must recognize the OAA's critical role in supporting family
caregivers who are the backbone of long-term care for older
adults.
---------------------------------------------------------------------------
\1\ https://www.liebertpub.com/doi/10.1089/pop.2017.0199
\2\ https://aspe.hhs.gov/reports/understanding-characteristics-
older-adults-
---------------------------------------------------------------------------
different-residential-settings-data-sourcestrends-0#exhibit2
Today's realities demand that we examine the OAA with fresh
eyes and with innovation at the forefront. The OAA must be
modernized to better address the needs of the diverse and
growing older adult population, which includes not only the
Silent Generation and Baby Boomers, but also Generation X,
whose members start to turn 60 in 2025.
NCOA Reauthorization Priorities
Investing in the Aging Services Network, including the
thousands of multipurpose senior centers and other community
organizations, is crucial to the Act's success now and in the
future. While demand for OAA services is growing and
diversifying, OAA funding is not keeping pace. This financial
reality has made it increasingly difficult for the Aging
Network to maintain existing services, let alone expand. The
supplemental funding Congress provided to the Aging Network
during the COVID-19 pandemic was critical to helping older
adults most at risk and in greatest need and sharply
underscored the value of and critical need for additional
investment in OAA programs. Ten leading national advocates for
the OAA have praised bipartisan efforts to reauthorize the
statute in 2024 and called for authorizing increased funding
for these critical programs at the highest possible levels to
ensure that all older people can thrive.\3\
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\3\ https://www.ncoa.org/older-americans-act-reauthorization
NCOA has several additional priorities that we believe should
be included in this year's OAA reauthorization. Our proposals
focus broadly on senior centers, healthy aging, and economic
---------------------------------------------------------------------------
security.
Seniors Centers
For more than 80 years, senior centers have provided access to
support services and opportunities for healthy aging in a
highly social setting in towns and neighborhoods across the
nation. The OAA has recognized their importance for 50 years by
including multipurpose senior centers in 1973 and by
establishing the senior nutrition program. In the establishment
of the Aging Network, senior centers were to be given special
consideration as community focal points to deliver OAA services
on a local level. Today, an estimated 11,000 senior centers
operate locally, sometimes hyper-locally, as gathering places
for generations of older adults to stay active, healthy, and
connected.
Research shows that older adults who participate in senior
center programs experience better mental health across several
measures compared to non-participants, including perceived
social and health benefits,\4\ depression,\5\ friendship,\6\
and stress levels.\7\ Compared to their peers, senior center
participants have higher levels of health, social interaction,
and life satisfaction.
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\4\ Gitelson, R., McCabe, J., Fitzpatrick, T., & Case, A. (2005).
Factors that influence perceived social and health benefits of
attendance at senior centers. Activities, Adaptation & Aging, 30, 23-
45.
\5\ Choi, N., & McDougall, G. (2007). Comparison of depressive
symptoms between homebound older adults and ambulatory older adults.
Aging Mental Health, 11, 310-322.
\6\ Aday, R., Kehoe, G., & Farney, L. (2006). The impact of senior
center friendships on aging women who live alone. Journal of Women &
Aging, 18, 57-73.
\7\ Farone, D., Fitzpatrick, T., & Tran, T. (2005). Use of senior
centers as a moderator of stress-related distress among Latino elders.
Journal of Gerontological Social Work, 46, 65-83.
Senior centers are a time-tested model to deliver on the
promise of the Older Americans Act. They provide for the -
maximum co-location of services, which differentiates them from
other community-based organizations. A visitor to a senior
center can come to exercise and also get screened for benefits,
take an art class and get a hot meal, or learn a new language
and find purpose through volunteering. At their core, senior
centers are places that foster social connection and belonging,
addressing the epidemic of loneliness\8\ identified by the U.S.
Surgeon General.
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\8\ https://www.hhs.gov/sites/default/files/surgeon-general-
social-connection-advisory.pdf
Senior centers also serve as critical lifelines for many older
adults in the community. This was never more evident as during
the pandemic that brought a disproportionately harsh impact on
older adults. Senior centers across the country sprang into
action, ensuring that older adults, especially the most
vulnerable, had credible information; access to nutrition
through meal delivery, grab-and-go meals, and grocery shopping
services; and social engagement through online programs,
parking lot parties, drive-through programs, and thousands upon
thousands of phone calls. With deep knowledge of their
communities, senior centers creatively pivoted to meet ever-
changing needs. Many moved programs from in-person to virtual.
Today, their in-person participation is rebounding, and those
with capacity continue to offer virtual options for older
adults who cannot attend the center due to transportation or
health issues. When vaccines became available, senior centers
stepped in to facilitate appointments, provide transportation,
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and host clinics.
While they provide these critical services, senior centers, in
general, are chronically underfunded. They rely on municipal
dollars, philanthropy, and fundraising. While some are operated
by Area Agencies on Aging (AAAs), especially when the AAA is
part of county government, most are not. They are part of
municipal government or nonprofit community-based
organizations. In 1978's Older Americans Act reauthorization,
senior centers were placed in the consolidated Title III-B,
Supportive Services and Senior Centers. In the allocation of
scarce resources and without a requirement that any percentage
of the appropriation for III-B be directed to senior centers,
senior centers generally are not funded by the OAA. They might
receive funding on a service unit reimbursement rate (e.g., for
meal delivery) but not for general programs, operations, or
facility needs. Senior centers that received investments from
the American Rescue Plan (ARPA) saw innovations that were not
possible before. ARPA was an infusion of funding that supported
innovations like grab-and-go meals, allowed communities to make
renovations or purchase equipment (for exercise, technology,
kitchens, etc.), and shored up the senior nutrition program.
ARPA showed us what was possible with better support. However,
once ARPA funds are expended, those innovations will not likely
be funded, and the programs that were supported will, again,
face budget shortfalls.
NCOA has been the national voice for senior centers for more
than 50 years. We have over 2,300 senior centers in our
affiliate network and, through a three-year cooperative
agreement with the U.S. Administration for Community Living
(ACL), we have established a Resource Center for the
modernization of senior centers. Through this work, we see some
senior centers that are modernizing and thriving with new or
renovated facilities that support today's technological needs,
fitness programs, evidence-based programs, meal options, and
services to address complex issues like homelessness and
behavioral health. These centers also provide support for
economic security through information and referral and benefits
enrollment. They have collaborative partnerships with
organizations and businesses in their communities, with aging
network partners like AAAs, and with community partners like
libraries, parks and recreation, and public health. New models
of senior centers, including public/private partnerships,
wellness centers, and intergenerational centers have been
developed.
2023 Programs of Excellence
Among the senior centers receiving a 2023 Programs of
Excellence award from NCOA is the Veterans Coffee Club
administered by the Muncie/Delaware County Senior Citizens
Center in Muncie, Indiana.\9\ This special military suicide
prevention program was created with support from the VA
Delaware County Indiana. The goal is not only to create and
design a program to help prevent military suicides, but to
develop, with the cooperation of the Veterans Administration, a
suicide prevention program that can be introduced to the
10,000+ senior centers across the country.
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\9\ https://www.ncoa.org/article/nisc-programs-of-excellence-
veterans-coffee-club
Initiated in response to staggering rates of suicide, the
program started out with four veterans from the center, and
currently, there are 237 registered members. A wives support
group meets at the same time for those veterans who will only
attend if their wife goes, and for Gold Star and Blue Star
wives. The program continues to grow, with a club established
in Anderson, Indiana, and two more clubs in the works one in
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Marion and one in New Castle.
All these efforts aim to find a way to reach veterans where
they are, not just reach out and hope they come get help.
Typical attendance is 80-100 veterans on the first Saturday of
every month, and several of the veterans now attend programs at
the senior center on a regular basis, but not all senior
centers are thriving. NCOA conducted an environmental scan,
which identified the successes and challenges of senior centers
today. Inadequate support, both in recognition of their value
and in the allocation of resources, is at the top of the list
of challenges.\10\ Centers do not have the funding and
direction needed to upgrade their facilities, to access
technology, and to ensure a skilled workforce. The centers that
struggle the most are those in areas of greatest need.
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\10\ https://www.ncoa.org/article/the-state-of-todays-senior-
centers-successes-
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challenges-and-opportunities
Through OAA reauthorization, Congress has an opportunity and
obligation to provide the focus and funding that will ensure
that a modern senior center one that addresses the needs of
current and future generations of older adults in a way that is
culturally meaningful is available in every ZIP code.
Senior centers are also an integral part of the OAA senior
nutrition program. The OAA created two delivery systems for
nutrition congregate meals (Title III-C1) and, for those unable
to access a congregate meal, home-delivered meals (Title III-
C2). The pandemic demonstrated the importance of elevating both
home-delivered meals and congregate meals as equally important
vehicles for fighting senior hunger and addressing social
isolation. These proven and effective community-based programs
have more than 50 years of experience, expertise, and trust to
serve those in greatest need. However, with rising costs and
increasing demand, merely maintaining current funding levels is
not enough. We need to increase the authorization level and
provide greater parity to support both approaches at scale.
Senior centers are the most common site for congregate meals.
During the pandemic, we saw innovation in meal delivery such as
grab-and-go meals and virtual options for dining with friends.
The flexibility to implement innovative solutions should be
maintained and encouraged, as should local flexibility, with
limits, to shift funds to the most-needed services. However,
the OAA should continue to recognize and prioritize them as
distinct programs and fund each one adequately. Sharing a meal
is one of the most treasured traditions of social connection.
We must support the modernization of the congregate meal, in
conjunction with senior centers, to ensure current and future
generations of older adults have this opportunity.
OAA reauthorization should:
Address lessons learned from the pandemic related to
promoting equitable access to senior center services,
addressing diverse needs, and pursuing innovation in nutrition
programs.
Ensure strong congregate settings in the community by
reinstating a separate title for senior centers and updated
language that retains the special consideration of senior
centers as designated focal points and by strengthening support
for multipurpose senior center infrastructure and services,
while allowing for the flexibility capacity for virtual
connections.
Strengthen the authorization for modernizing senior centers.
Increase the authorization level of senior nutrition
programs to allow for greater parity for both home-delivered
meals and congregate meals approaches to be equally funded at
scale.
Healthy Aging
Title III-D Health Promotion
Chronic conditions are the leading cause of frailty,
disability, and death in the United States. They lead to
declining activities of daily living (ADLs), causing affected
individuals to lose their independence, require help from
family and/or paid caregivers, and need long-term services and
supports. Yet, there are evidence-based health promotion and
disease prevention programs that we know can help and work.
NCOA has been a leader in expanding access to health promotion
and disease prevention programs, many of which have been shown
through research to reduce or delay expensive hospital or
nursing home admissions. Through education, outreach, and
community programs, NCOA provides older Americans with the
tools and resources they need to age well physically,
cognitively, and mentally. Through our ACL-funded National
Chronic Disease Self-Management Education and Falls Prevention
Resource Centers, NCOA provides broad support and technical
assistance to state agencies and community-based organizations
delivering these programs.
These health promotion and disease prevention programs result
in positive health outcomes related to managing chronic
disease, preventing falls, increasing physical activity, and
reducing symptoms of depression and social isolation. These
well-researched programs have resulted in health care cost
savings for participants:\11\
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\11\ https://www.ncoa.org/article/falls-prevention-programs-
saving-lives-
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saving-money-infographic
A Matter of Balance, a falls prevention program, reduces
total annual medical costs by $938 per participant.
The Otago Exercise Program reduces falls by 35%, resulting
in net savings of $429 per participant.
The Community Aging in Place Advancing Better Living for
Elders Program (CAPABLE) provides home modifications to reduce
falls risks resulting in more than $30,000 in medical costs
savings.
The Chronic Disease Self-Management Program (CDSMP) shows
participants saved $714 in emergency department visits and
hospital utilization. If 10% of Americans with one or more
chronic conditions were reached by CDSMP, there is potential
for $6.6 billion in savings.\12\
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\12\ Lorig K, Ritter P, Stewart AL, et al. Chronic Disease Self-
Management Program: 2-Year Health Status and Health Care Utilization
Outcomes. Medical Care. 2001;39:1217-1223.
Given that 80% of older adults experience two or more chronic
conditions, NCOA believes CDSMP should be offered in every ZIP
code across the U.S. in an effort to save lives and decrease
health care costs. CDSMP is a workshop for adults with at least
one chronic health condition, which may include diabetes, heart
disease, or arthritis. Given that chronic conditions are the
primary drivers of health care costs and disability, as well as
declines in quality of life, we must ensure that anyone with a
chronic illness has access to this program. CDSMP focuses on
critical disease management skills, including decision making,
problem solving, and action planning. The program increases
confidence, physical and psychological well-being, knowledge of
ways to manage chronic conditions, and motivation to manage
challenges associated with chronic diseases. Interactive
educational activities include peer discussions, brainstorming,
action-planning and feedback, behavior modeling, problem
solving techniques, and decision making. The program also
results in behavior change, such as more exercise and
relaxation, better communication with health care providers,
healthy eating, medication management, and better management of
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fatigue.
The delivery of these programs to older adults is funded by OAA
Title III-D. Funding amounted to $26.3 million in the FY23
federal budget; this funding is shared across all states,
territories, and the District of Columbia. Beginning in 2012,
ACL required that programs funded by Title III-D meet strict
evidence-based criteria defined as proven effective for
improving the health and well-being or reducing disease,
disability, and/or injury among older adults; and proven
effective with older adult population, using experimental or
quasi-experimental design; and results published in a peer-
review journal; and fully translated in one or more community
site(s); and includes developed dissemination products that are
available to the public.
However, not all these programs are reaching older adults in
need, especially in rural and diverse communities. This lack of
access is due in part to inadequate funding under OAA Title
III-D, which has not kept pace with growing needs and costs to
deliver evidence-based programs. Congress and the
Administration must address lessons learned from the pandemic
related to promoting equitable access to services, addressing
diverse needs, and expanding healthy aging programs that are
offered both in-person and virtually. For example, the costs
associated with delivery of virtual programs are significantly
higher in most cases than in-person programs due to greater
technology and staffing needs.
NCOA recognizes that evidence-based programs have some
implementation challenges and inequities. Most have not been
tested with a full diversity of populations, communities, or
contexts. Some communities struggle to implement them as
designed. Therefore, we advocate for expanding the continuum of
programs funded under the OAA to include those that are
evidence-informed, defined as an approach in which
practitioners are encouraged to be knowledgeable about findings
coming from all types of studies and to use them in an
integrative manner, taking into consideration experience with a
program or intervention and judgment, clients' preferences and
values, and context of the interventions.\13\
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\13\ Adapted from: Nevo, I., & Slonim-Nevo, V. (2011). The myth of
evidence-based practice: towards evidence-informed practice. British
Journal of Social Work, 41(1), 1-22.
NCOA is proud to be leading the Innovation Lab through funding
from ACL's Center for Performance and Evaluation. We are
partnering with researchers to take a core-components approach
to identify what is truly necessary to achieve the ultimate
goal better outcomes for people and communities. This broader
approach gives communities the flexibility to deliver programs
that match their capacity and meet the needs of their
culturally diverse populations. This core components
methodology is being applied to falls prevention interventions,
and we believe it has significant potential across other areas
of aging services such as nutrition and chronic disease
management.
OAA reauthorization should:
Double authorized funding levels for OAA Title III-D to
support the licensing, training, technology, and other costs
required for implementation of evidence-based programs.
Expand the continuum of programs funded under the OAA to
include those that are "evidence-informed."
Jane's Story
One of our participants, a 76-year-old woman, initially relied
on a walker for mobility. However, as she diligently engaged in
the exercises taught in our sessions, her progress was
remarkable. By the third session, she entered class confidently
using only her cane, brimming with pride at her newfound
ability. Her excitement was palpable as she shared how these
exercises had significantly improved her mobility and daily
activities. Her husband, who accompanied her to class, echoed
her joy, thrilled to engage in activities together that had
been out of reach for a while.
Direct Care Workforce
Between 2021 and 2031, the direct care workforce is projected
to add more than one million new jobs, resulting in a total of
9.3 million direct care jobs need to be filled,\14\ according
to PHI. Low wages, lack of full-time employment, and the
pandemic have caused fewer workers to enter direct care at the
exact time the need for their services is growing.
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\14\ https://www.phinational.org/resource/direct-care-workers-in-
the-united-states-
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key-facts-2023/
Funded by ACL, the Direct Care Workforce Strategies Center,
housed at NCOA, is addressing this challenge by supporting
state systems change through the provision of resources,
technical assistance, and training to state systems, providers,
and stakeholders to improve direct care workforce recruitment,
training, and retention.
This Center addresses the charge of OAA and its National Family
Caregiver Support Program (enacted as part of the 2000 OAA
reauthorization) to build and strengthen the care
infrastructure needed to address the pressing challenges that
threaten the independence, health, and economic security of
older adults who rely on the support of family caregivers.
OAA reauthorization should:
Strengthen authorities for sustained funding for the Direct
Care Workforce Strategies Center beyond five years to increase
dissemination of state technical assistance and training
opportunities to ensure an adequate and well-trained direct
care workforce.
Economic Security
Older adults are more likely to face economic insecurity as
they age. In 2023, poverty among older adults rose for the
third consecutive year to 14%.\15\ An analysis conducted by
NCOA and the LeadingAge LTSS Center at the University of
Massachusetts, Boston found that of people age 60 and older,
80% (47 million) do not have the financial resources to cover
long-term care services or another financial shock, nearly 20%
of older households have no assets to draw upon to withstand a
financial shock, and 21-80% of older adults have modest assets
but would still be unable to afford more than two years of
nursing home care or four years in an assisted living
community.\16\
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\15\ https://www.ncoa.org/article/older-adult-poverty-continues-
upward-trend-reaching-an-unacceptable-14-percent
\16\ https://www.ncoa.org/article/80-percent-of-older-americans-
cannot-pay-for-long-term-care-or-withstand-a-financial-shock-new-study-
shows
An important factor in determining older adults? Economic
security is the geographic location of their primary residence.
Regions such as the Northeast and the West Coast have a higher
cost of living compared to states in the Sunbelt region. NCOA
urges Congress and the Administration to modernize and increase
flexibility in the determination of economic need with proven
tools such as the Elder Index\17\, which is a more accurate
measure of the income older adults need to meet their basic
needs and age in place with dignity. It includes household
size, geographic location, housing, and health status in
determining costs of living. The Elder Index is updated
annually to include the latest Consumer Price Index data to
account for inflation costs. Elder Index data show that nearly
half of older adults live alone, and one in five older couples
is economically insecure and cannot pay for necessities.\18\
The costs of necessities in every state exceeds the federal
poverty thresholds used in eligibility requirements for
benefits programs.
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\17\ https://elderindex.org/
\18\ Mutchler, Jan; Su, Yan-Jhu; and Velasco Roldan, Nidya,
"Living Below the Line: Economic Insecurity and Older Americans,
Insecurity in the States, 2022" (2023). Center for Social and
Demographic Research on Aging Publications. 66.
The Elder Index also shows that the average Social Security
benefit does not cover the cost of basic expenses. Researchers
from the University of Massachusetts, Boston reported that the
average Social Security benefit only covers 68% of the costs
for basic necessities for a single person living alone and 81%
for couples living together.\19\ This gap identifies the
reality that many older adults must use other means to cover
their basic costs either by working, withdrawing from savings
and other retirement accounts, or relying on social safety net
programs such as the Supplemental Nutrition Assistance Program
(SNAP) or Medicare Savings Programs.
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\19\ https://kffhealthnews.org/news/article/elder-index-aging-
costs-seniors-basic-necessities/
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OAA reauthorization should:
Modernize and increase flexibility in the determination of
economic need with proven tools such as the Elder Index to
ensure the local cost of living are addressed as future
generations are expected to age with limited financial
resources.
Christian's Story
Christian, 61, lives with disabilities and relies on a fixed
income of $1,156 monthly. He relocated to Windsor, Vermont, to
assist his 93-year-old father with his care. Christian
previously paid $148.50 for Medicare, along with co-pays for
medications, without receiving assistance for food, fuel, or
prescriptions. Unfamiliar with available resources in Vermont
due to being a nonnative, Christian faced financial strain when
prescribed a new medication with a $500 copay. With the help of
a local benefits enrollment center, Senior Solutions, Christian
received a tablet for telehealth, facilitating his connection
with family in New York and easing access to medical services.
Additionally, Christian applied for food benefits, fuel
assistance, and pharmacy aid programs, promptly receiving a
SNAP card with $202 for food, $56 for fuel assistance, and
relief from his Medicare Part B premium, qualifying him for
Medicaid after a $60 spend-down. Thrilled by these benefits,
Christian anticipates saving for a car, resulting in monthly
savings exceeding $500. These supports allow Christian to
continue to care for his father and himself, both remaining
independent.
Older Workers
For millions of Americans, aging well means having the
opportunity to work in the years leading up to and beyond the
traditional retirement age. The reasons older adults want or
need to work are the same as at any age. Work provides meaning,
social connections, and much needed income to pay for daily
needs. As longevity continues to climb and many Americans
struggle to save enough for retirement, work is also essential
to affording a longer life. This is especially true for older
adults of color, who experience higher rates of poverty than
white older adults, and among rural and LGBTQ+ older adults who
face access barriers and discrimination in employment.
Since 1968, NCOA has served as one of several national
administrators for the Senior Community Services Employment
Program (SCSEP). Today, we provide SCSEP services in 11 states
and Puerto Rico, including Georgia, New York, North Carolina,
and Pennsylvania. This work has given us clear insight into the
value older workers contribute to our economy.
A Department of Labor program that is authorized and funded
under OAA, SCSEP is the only federal job training program
focused exclusively on helping older Americans return to the
workforce. It prioritizes services to veterans, individuals
with disabilities, those living in rural communities, and other
most-in-need older adults who have low job prospects and
significant barriers to employment. Significant majorities of
participants have incomes below 125% of the federal poverty
line, are women, and are people of color. The program enables
them to develop new skills and add work experience through
subsidized community training assignments with local nonprofit
organizations.
SCSEP incorporates benefits coordination and access to
wraparound services. Older workers particularly low-income
individuals with significant barriers to employment have
traditionally been left behind by public workforce systems and
strategies. Many have been out of the workforce due to
caregiving responsibilities, health and disability challenges,
and age discrimination. For many, the traditional 40-hour week
and year-round employment placement envisioned in Workforce
Innovation and Opportunity Act (WIOA) and other public
workforce programs are not appropriate. These systems lack the
targeted, one-on-one counseling and assistance many older
workers require for successful training and re-employment.
However, the impact on ageism starts much before age 55. We
advocate for lowering SCSEP eligibility to age 50, so we can
broaden the impact of the program by helping people retool
their skillset earlier in life. Similarly, we recommend
broadening the income eligibility to at or below 200% of the
federal poverty level to recognize that those who are slightly
over the current cap still need the help of a program like
this. If we focus on younger individuals with slightly more
income initially, we will be able to further decrease the curve
of individuals falling into a position that requires federal
benefits and Medicaid.
OAA reauthorization should:
Update SCSEP eligibility to make it available to adults 50
years and older.
Adjust income eligibly guidelines to allow for individuals
with incomes at or below 200% of the federal poverty level to
improve access for older workers struggling with financial
security and employment.
Susan's Story
At age 75, Susan learned of the NCOA SCSEP program while
waiting at her doctor's office. Unsure of what to expect, but
in dire need of work, she took a chance and dialed the number
listed on the flyer, hoping for assistance. At the Crawford
County Read Program, Susan found fulfillment in helping people
of all ages improve their literacy and basic math skills.
However, when the program faced closure due to funding issues,
Susan feared returning to financial uncertainty.
Thankfully, another opportunity arose swiftly, and Susan
embarked on training as a receptionist at an organization
dedicated to mental health awareness. As Susan's tenure in the
program approached its conclusion, her colleagues recognized
her value and advocated for her to join the team permanently.
In a remarkable show of support, Susan's coworkers collectively
urged management to hire her full-time.
Now secure in her job and an active taxpayer, Susan expresses a
newfound sense of relief, stating that she can finally relax
knowing she has stable employment. She passionately shares her
experience with others, emphasizing the vital role of SCSEP in
assisting older adults facing employment obstacles, noting that
the program can be a lifeline for many.
Conclusion
The OAA provides our nation with a blueprint for ensuring we
have the infrastructure in place to support individuals across
the full spectrum of domains related to aging in community and
at home as we all desire. The various titles of the Act
intentionally and thoughtfully support an ecosystem for
deploying services and supports that reflect the needs of
states and communities, prioritizing the most vulnerable.
With nearly 12,000 people turning 65 each day this year and for
the next several years, we applaud ACL's leadership in updating
the Act with the recently released OAA regulations, largely
building upon lessons of the pandemic, and we also recognize
that demographic trends require us to further align Federal,
State, and local programs with the needs of today and tomorrow.
We appreciate this opportunity to offer our priorities to
reauthorize, modernize, and fund the Older Americans Act to
ensure every American can age well.
For more information, please contact: Marci Phillips
marci.phillips@ncoa.org.
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Statement for the Record
American Association of Retired Persons Testimony
AARP, which advocates for the more than 100 million Americans
age 50 and older, thanks the Committee for holding the hearing,
"The Older Americans Act: The Local Impact of the Law and the
Upcoming Reauthorization." We appreciate the opportunity to
work with you to advance support for older adults and their
family caregivers through the Older Americans Act (OAA). The
OAA has a powerful legacy. Since 1965, the OAA has supported
older adults so they can live at home with independence and
dignity, deferring or eliminating more costly institutional
services and hospitalizations. Our research shows that people
overwhelmingly want to age at home in their own communities,
but as the population of older adults rises exponentially, it
puts a greater strain on services provided by OAA.
Meeting this increasing demand is a significant challenge. In
2000, adults age 65 and older made up approximately 12 percent
of the US population; today, the proportion is estimated at 17
percent and is expected to rise to 23 percent by 2050. The
number of people age 80 and older, who are the most likely to
need help to live independently in their homes and communities,
is projected to nearly double from 2023 to 2040.
America is on the brink of a serious national crisis. Right
now, nearly 48 million family caregivers are filling in the
gaps, providing $600 billion in uncompensated care to their
loved ones. Many, especially women, are dropping out of the
workforce or cutting back hours to care for their loved ones,
exacerbating labor shortages across the economy. As the
population ages, the number of family caregivers is not likely
to keep up with the demand.
As OAA's funding levels have declined relative to the
population demanding these services, more and more is falling
on the backs of these caregivers - and they are already at the
brink. When adjusted for inflation, total OAA funding has
declined by 18 percent since 2001. Without sufficient funding,
critical OAA programs are often unable to meet rising demand,
and many have been forced to implement waiting lists. For
example, according to Meals on Wheels, one in three of their
programs currently have a waitlist, with older adults waiting
an average of three months for vital meals.
In a typical year, thanks to the OAA, 11 million older adults
receive help to stay in their homes, receive congregate and
home-delivered meals, case management, family caregiver
support, transportation, adult day care, legal services, elder
abuse prevention, and job training and employment opportunities
for low-income older adults. Additionally, OAA Native American
programs provide nutrition, support and caregiver services to
older American Indian, Alaska Native and Native Hawaiian
people. The OAA plays a critical role in making sure people in
this country can age at home, where they want to be. OAA
programs are cost-effective investments that serve the needs of
older Americans while deferring or eliminating the need for
costly institutionalization. Now more than ever, OAA is
essential for our country.
As we approach OAA reauthorization, we look forward to
continuing to work with you to improve upon OAA's many existing
programs. Our recommendations for ways OAA can be improved to
meet the needs of our aging population are outlined below.
OAA Reauthorization Priorities
AARP supports a number of proposals that will help to improve
OAA, including:
Strengthening support for family caregivers;
Improving food security and social isolation through the
Nutrition Services Programs;
Supporting housing stability among older adults;
Addressing direct care workforce shortages; and
Protecting and strengthening the reach of OAA programs.
Strengthen Support for Family Caregivers
Connect Caregivers to the needed resources through caregiver
assessments
OAA's National Family Caregiver Support Program (NFCSP)
includes a range of services to support family caregivers and
older relative caregivers. One of AARP's 2019 OAA
reauthorization priorities was to ensure caregivers were being
connected to the right resources and support for their
particular caregiving situation. The final bill included
provisions to allow for and encourage the use of caregiver
assessments under NFCSP, which AARP supported, but it did not
require their use as we had urged. The Administration for
Community Living (ACL) furthered this effort in their recently
finalized OAA regulations by including language to allow "an
evidence-informed or evidence-based caregiver assessment."
We understand that due to the COVID-19 pandemic and
availability of resources, some caregiver assessment-related
provisions have not been completed or fully implemented at this
time. This includes the technical assistance to promote and
implement the use of caregiver assessments, an analysis and
report on the use of caregiver assessments by the Aging
Network, the inclusion of caregiver assessments used in the
states in data and reports from states to ACL, and identifying
and making available best practices relating to NFCSP and
Native American Caregiver Support Services. It is important for
these activities to be completed as soon as possible so family
caregivers, the Aging Network and others can benefit. We
understand that agreements awarded by ACL to provide technical
assistance and capacity building to support the aging and
tribal services networks with implementing the National
Strategy to Support Family Caregivers will help with
implementation of some of these provisions.
In addition to completing work from the last reauthorization
period, it is important to strengthen caregiver assessments and
expand their use so that more caregivers can get the support
they individually need. The assessments should be used to
provide a no wrong door approach to help connect caregivers
with any supports they may need - including programs outside of
OAA authority.
We recommend multiple improvements to the current OAA caregiver
assessment provisions that AARP supported and were successfully
enacted in 2020, including:
Ensure caregiver assessments are:
*culturally appropriate;
*person-and family-centered; and
*evidence-informed or evidence-based.
Amend OAA so that services provided under the NFCSP must be
informed by a caregiver assessment starting two years after the
date of enactment. Currently, this is permitted but not
required. The two-year timeframe would allow time to complete
caregiver assessment activities from the 2020 reauthorization
and build on those activities.
These changes are consistent with the National Strategy to
Support Family Caregivers. We note that Outcome 2.2 in the
National Strategy is, "Where appropriate, identifying services
and supports needs for caregivers consistently starts with a
review of family caregiver strengths and preferences using
evidence-based assessments." The Strategy also states,
"Accurately assessing the needs of family caregivers with
evidence-based tools and protocols is critical to providing
services that make a difference for the caregiver and empower
them to better meet the needs and preferences of the person
they are supporting."
Increase awareness of and education about existing family
caregiver supports
Too often, family caregivers are not aware of support in their
communities and how to find it. To help make it easier for
caregivers to learn about existing available support, we
propose adding language to OAA Sections 305, 306, and 373 to
help increase awareness of and education about existing family
caregiver supports.
Improve Counseling in the National Family Caregiver Support
Program (NFCSP) and Native American Caregiver Support Services
To help improve consistency, improve OAA family caregiver
counseling services, and incorporate an element from the
National Strategy, we recommend adding language to help ensure
that counseling under NFCSP and within Native American
Caregiver Support Services is person-centered and trauma-
informed. This could also help increase caregiver engagement
with caregiver support services, consistent with the National
Strategy.
Measure the caregiver navigation experience and impact of
caregiver supports
Caregivers say they are stressed emotionally (72%), overwhelmed
by responsibilities (60%), and financially strained (55%). Time
is also a top challenge for them. They do not have the time to
spend unnecessary and inefficient efforts navigating to get the
help, information, and support they need. To help ensure that
family caregivers receive the navigation support/customer
service experience they need and deserve, we recommend
requiring ACL to develop and implement family caregiver
experience and outcome measures for the NFCSP, Native American
Caregiver Support Services, and Aging and Disability Resource
Centers (ADRCs) within two years of enactment.
This would help focus additional attention on caregiver
experience and outcomes, as measures have traditionally been
more focused on the number of people served or processed. There
are measures, such as "Maintain at 75% or higher the percentage
of caregiver services clients who report that services enabled
them to provide care for the care recipient for a longer time
than would have been possible without these services" and
"Increase the likelihood that the most vulnerable people
receiving Older Americans Act Home and Community-based
Supportive Services and Caregiver Support Services will
continue to live in their homes and communities." However, more
outcomes and experience measures can help improve caregivers'
overall experience.
Ensure access to flexible respite services that meet the
specific needs of each family caregiving situation
As with other recommendations to the NFCSP, AARP recommends
authorizing language be added to ensure a person- and family-
centered approach to respite care. Ensuring flexible options
will help meet the specific needs of individual family
caregiver situations.
According to a 2024 AARP report, while family caregivers often
feel their role provides meaning in their lives, they also face
significant challenges. Caregivers can feel stressed,
overwhelmed, and lonely. They may also have physical and
financial stressors related to taking care of children, keeping
up with their jobs, and managing finances. Some care
recipients, especially those with cognitive impairment or
dementia, need a caregiver to be on call 24 hours a day.
Many family caregivers need respite care-that is, short breaks
from their responsibilities. Respite is most often defined as
care provided to an older adult or person with disabilities so
that their family caregiver can get a short break from their
care responsibilities.
OAA provides respite services through the Title III National
Family Caregiver Support Program. These supports help family
caregivers balance caregiving with other responsibilities
which, in turn, helps ensure more older adults can remain in
their homes and communities. Evidence shows that respite
services are helpful to family caregivers, including those who
care for people with dementia.
AARP research shows tailored communications, flexible and
accessible services, and trained staff delivering high-quality
care are important and respite programs that take this into
account will be better able to meet the needs of family
caregivers and their care recipients. Family caregivers could
benefit from a range of services that are tailored to their
needs, as different caregiving situations may necessitate
different types of respite services.
Improve Food Security and Reduce Social Isolation by Ensuring
Flexibility in the Nutrition Services Programs
In 2022, nearly 11.8 million (or about 1 in 10) Americans age
50 and older faced food insecurity and the threat of hunger.
Food insecurity among this age group increased 25 percent
between 2021 and 2022, reversing a decade-long decline. While
only part of the solution, OAA nutrition programs are a
critical component of addressing senior hunger.
Congregate nutrition services and home-delivered nutrition
services provided by the OAA Nutrition Services Program reduce
hunger and support older adults' health and independence,
including their ability to remain in their homes. A 2017
evaluation found that 42 percent of congregate meal
participants and 61 percent of home-delivered meal participants
reported they would skip meals or eat less without the program.
The majority of participants report that the program helped
them to eat healthier and continue to live independently.
Furthermore, OAA-funded senior nutrition programs also provide
more than a meal; they provide opportunities for social
engagement, offer nutrition screening and counseling, and link
participants to other home- and community-based supports. A
2017 AARP Public Policy Institute study found social isolation
costs Medicare $6.7 billion per year. Congregate meals
participants report seeing friends more often due to the meals
and the home-delivered meal program is associated with reduced
loneliness among new participants, with delivery individuals
often being the only human contact of the day for homebound
clients. The improved social connections among participants can
lead to improved health and lower associated health care costs
among program participants.
We recommend permanently implementing several COVID-era
flexibilities for the nutrition services program. AARP believes
the following changes would improve efficiency and allow local
providers to tailor services to best meet the needs of their
communities.
Grant nutrition service providers funding flexibility to
meet the specific needs of their individual communities
Title III-C Nutrition Programs are currently funded separately,
meaning providers have limited flexibility to transfer funds
from one to another should demand or need differ between the
programs. Local providers say combining the home-delivered
meals and congregate meals programs into one funding stream or
allowing the transfer of funds between the two programs, will
improve efficiency and allow the providers to better tailor
services to the needs of their participants.
AARP recommends agencies within the Aging Network be given the
funding flexibility to offer services based on the needs of the
participants and communities, while ensuring they continue to
address the program's three goals of reducing hunger, promoting
socialization, and promoting the health and well-being of older
adults. While this flexibility is key, participants must
continue to have the option to receive either congregate or
home-delivered meals.
Codify flexible nutrition service models allowed during
COVID-19 and included in the most recent OAA Regulations
Pandemic flexibilities allowed for alternative meal options,
such as carry-out, grab-and-go and drive through meals, through
the congregate meals program. While included in the most recent
OAA regulations, these flexibilities should be permanently
extended in statute not only to address hunger but to reach
older adults struggling with social isolation.
Protect and Strengthen the Reach of OAA Programs
OAA is a major delivery system of a variety of services for
older adults and their family caregivers. In addition to the
policy areas addressed above, we are also focused on finding
ways to strengthen other critical OAA programs, including - but
not limited to - the following:
The Senior Community Service Employment Program (SCSEP)
SCSEP is the only federal program specifically created to
assist low-income workers age 55 and older to regain entry into
the workforce. The program provides part-time community service
assignments for low-income persons age 55 or older who would
otherwise have poor employment prospects because older
jobseekers continue to face barriers to employment, often due
to age discrimination. SCSEP-funded services are available in
nearly all 3,000 U.S. counties and territories.
Grantees include public workforce agencies and national
nonprofit organizations. Participants are unemployed,
disadvantaged older workers who work an average of 20 hours a
week at minimum wage. Work experience is gained typically in
community service activities at nonprofit and public
facilities, serving as a bridge to unsubsidized employment
opportunities. SCSEP has helped thousands of older jobseekers
into jobs providing them work-based training and the
opportunity to use their skills. According to the recent
Department of Labor Workforce GPS survey, participants strongly
believe that the program helped prepare them for success in the
workforce (8.4 on a 10-point scale). SCSEP adds needed value as
the only federal program targeted at lower income older
jobseekers.
The Long-Term Care Ombudsman Program (LTCOP)
LTCOP is the most effective program to advocate and act as a
resource for older adults and people with disabilities who live
in nursing homes, assisted living, and other licensed adult
care homes. Every state - plus Puerto Rico, Guam and the
District of Columbia - has a long-term care ombudsman office.
These offices work to resolve problems related to the health,
safety, welfare, and rights of individuals who live in long-
term care facilities, and help residents understand and
exercise their rights to good care in an environment that
promotes and protects their dignity and quality of life.
Data from the 2022 National Ombudsman Reporting System (NORS),
shows that LTCOP's nearly 2000 full time staff and
approximately 4000 certified volunteers investigated more than
182,000 complains nationwide and provided assistance to more
than 400,000 individuals looking for information about long-
term care.
The COVID-19 pandemic highlighted the critical role these
ombudsmen play in the long-term care system and the challenges
they face, including significant workload with limited staff
and funding.
Support Housing Stability Among Older Adults
Through nutrition assistance, in-home care services and support
to family caregivers, OAA is providing a vital resource for
millions of older adults who want to age in their homes. In
addition to food and caregiving assistance, OAA also provides
assistance for home repair and modifications to ensure the home
is safe and updated with accessibility features to make the
home easier to navigate. However, rising costs to remain in the
home, everything from rent and insurance to taxes, is also
making it harder for older adults to age in place. According to
the Department of Housing of Urban Development's (HUD) recent
2023 Annual Homelessness Assessment Report, there has been a 12
percent increase in homelessness in the last year, with eight
percent of all people experiencing homelessness over the age of
64, and almost 30 percent elderly or near elderly (55 years or
older).
OAA could play a larger role in supporting local partnerships
between Area Agencies on Aging (AAA) and housing providers and
enabling access to services and supports for older adults
residing in HUD-assisted housing, as well as funding, to
support housing stability with service coordination and
delivery.
Strengthen the Direct Care Workforce
AARP supports efforts to bolster the direct care workforce,
including through additional support and investments in the OAA
Direct Care Workforce Demonstration.
Around 12.6 million adults in the US need long-term services
and supports (LTSS). Despite the increased demand for direct
care workers as the population continues to age, job quality
for all members of the direct service workforce remains low.
About 38 percent of direct service workers leave their
positions in less than six months, and approximately 21 percent
leave within six to 12 months. According to a 2023 AARP report
on the direct care workforce, major challenges contributing to
a high turnover rate within the direct care workforce include:
low wages and lack of benefits;
minimal or insufficient training and career development
opportunities;
physically and emotionally demanding positions, with high
rates of occupational injury;
high rates of burnout; and
racial and gender discrimination that causes, compounds,
and/or exacerbates other challenges.
OAA's Direct Care Workforce Demonstration provides funding for
a national technical assistance center for federal, state, and
private entities to access model policies, best practices, and
training materials for recruiting and retaining direct care
workers.
Conclusion
AARP appreciates the opportunity to share our OAA
reauthorization priorities with the Committee. We look forward
to working with you on a bipartisan basis to build upon the
success of the OAA as the 2024 reauthorization process moves
forward. If you have additional questions, feel free to contact
me or have your staff contact Lauren Ryan on our Government
Affairs team at lryan@aarp.org or (202) 434-0351.
Sincerely,
/s/
Bill Sweeney
Senior Vice President
Government Affairs
U.S. Senate Special Committee on Aging
"The Older Americans Act: The Local Impact of The Law and
The Upcoming Reauthorization"
May 23, 2024
Statement for the Record
Meals on Wheels Testimony
Dear Chairman Casey, Ranking Member Braun, and Members of the
Senate Special Committee on Aging:
Thank you for the opportunity to submit this statement for the
record for the recent hearing, "The Older Americans Act: The
Local Impact of the Law and the Upcoming Reauthorization." On
behalf of Meals on Wheels America, the nationwide network of
more than 5,000 community-based senior nutrition providers and
the older adults they serve, we urge you to prioritize our
recommendations to strengthen and improve the Older Americans
Act (OAA) Nutrition Program. Please reference the provided
materials for detailed information about Meals on Wheels
America's priorities and recommendations for the OAA
reauthorization:
Ellie Hollander, President and CEO of Meals on Wheels
America, Testimony before the Senate HELP Committee hearing,
"The Older Americans Act: Supporting Efforts to Meet the Needs
of Seniors" on March 7, 2024
Meals on Wheels America's response to the Request for
Information from the HELP Committee, submitted March 21, 2024
Meals on Wheels America's Older Americans Act priorities
We look forward to continuing to work together toward the
successful reauthorization of the Older Americans Act. The
reauthorization process presents an important opportunity to
strengthen and preserve the Act's original intent and core
purpose to reduce hunger, promote socialization and improve
health and well-being for older adults in greatest social and
economic need.
We hope that you will consider Meals on Wheels America a
trusted partner as we collectively address the growing issues
of senior hunger and social isolation. Please don't hesitate to
reach out whenever we may be of service.
/s/
Ellie Hollander
President and CEO
Contact Information:
Josh Protas
Chief Advocacy and Policy Officer
Josh.Protas@mealsonwheelsamerica.org
Good morning, Chairman Sanders, Ranking Member Cassidy, and
esteemed Members of the Committee. Thank you for the
opportunity to testify before you at this critical hearing. I'm
Ellie Hollander and am proud to present before you as the
President and CEO of Meals on Wheels America. Meals on Wheels
America is the national leadership organization representing
over 5,000 local nutrition programs committed to addressing
senior hunger and isolation in virtually every community across
the country and working toward a vision in which all seniors
live nourished lives with independence and dignity.
With the support of hundreds of thousands of committed
volunteers and staff members, local community programs deliver
nutritious meals in a variety of ways, including in group and/
or grab-and-go settings, as well as to individual homes, where
they also provide friendly visits and social interaction,
safety checks, and connections to other health and wellness
services to support older Americans in greatest need, and the
underpinning of all this work and impact is a direct result of
the support, policies and funding provided through the Older
Americans Act (OAA).
For more than 50 years, the OAA has supported millions of our
nation's seniors and caregivers through a network of state,
regional and local community-based programs. The local
providers that we represent at Meals on Wheels America serve as
a direct lifeline to those struggling with food insecurity,
malnutrition, mobility, loneliness, and countless other
difficulties of aging. We frequently say the service starts
with the meal and opens the door to so much more. It's the
purposeful and unique combination of nutritious meals and
social connection that fosters a relationship with the
individual senior, enabling Meals on Wheels providers to
identify and deliver valuable services that promote
independence and well-being. The impact not only saves lives
but also saves taxpayer dollars by ensuring that our nation's
seniors live safer, longer and more nourished in their own
homes and out of other more costly healthcare settings. In
fact, we can serve a senior Meals on Wheels for an entire year
for roughly the same cost as one day in the hospital or ten
days in a nursing home.\1\
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\1\ Meals on Wheels America (2024), special analysis of ACL and
Mathematica's estimated meal cost (OAA Nutrition Programs Evaluation:
Meal Cost Analysis), Kaiser Family Foundation's daily hospital expense
data (State Health Facts: Hospital Adjusted Expenses per Inpatient
Day), and Genworth's cost of semi-private nursing home room (2021 Cost
of Care Survey) adjusted for inflation. Sources and methods available
at: https://www.mealsonwheelsamerica.org/docs/default-source/fact-
sheets/2023/what--we--deliver--2023--national--snapshot--sources--
methods.pdf
The OAA is considered the gold standard of a successful public-
private partnership, having delivered on its original intent
and shown great resiliency and adaptability through challenging
times, including a global pandemic. As its reauthorization
approaches, Meals on Wheels America is focusing on several key
legislative recommendations that further enhance the support
and services provided to older adults. Given the significant
need, changing demographics, and inflationary pressures, we are
pushing for increased authorized funding levels across all OAA
programs, with an emphasis on closing the existing needs gap
for nutrition services and establishing incentives and funding
for medically tailored and culturally appropriate meals. An
important strategic proposal we are recommending involves
unifying the Congregate and Home-Delivered Nutrition Services
with the Nutrition Services Incentive Program (NSIP) under a
single Title III-C Nutrition Program and funding stream. This
shift would improve efficiency at all levels of the aging
network and enable local service providers to tailor their
offerings to meet the diverse needs of seniors in their
community far more easily. Additionally, we believe there
should be a concerted effort to prioritize community-based
organizations for nutrition services contracts, as local
providers are delivering a holistic service and not just a
meal. Finally, this reauthorization is also an opportunity to
continue to modernize the OAA to incorporate innovations,
flexibility, and successful practices that were leveraged
during the pandemic, ensuring that the Act is adaptable and
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responsive to the evolving needs of America's older population.
The Foundation of the Older Americans Act
As we look toward this year's reauthorization of the OAA, we
first and foremost want to protect the core purposes of the Act
and underscore the significance of it as a solution to ending
senior hunger and social isolation in our country and why it
must be sufficiently resourced.
The Older Americans Act of 1965 (OAA) was signed into law on
July 14, 1965, as an answer to improving access to social
services and supports for older adults living in the community.
Since then, the Act has served as the primary federal
legislation supporting community-based social services for
adults 60 and older and the bedrock of federal support to the
nationwide network of senior nutrition programs that rely on
federal funding.
The OAA has evolved and grown over time through prior
reauthorizations and consists of seven titles today. Of the
seven titles, all but one is administered by the Administration
on Aging (AoA), a federal sub-agency established by the OAA
within the U.S. Department of Health and Human Services (HHS)
Administration for Community Living (ACL). At the state and
local levels, OAA activities are carried out by 56 State Units
on Aging (SUA), over 600 Area Agencies on Aging (AAA), and
thousands of community-based organizations. AoA, housed within
ACL, is tasked with advocating for older adults and persons
with disabilities and supporting them in securing and
maintaining their health, well-being, and independence in the
community.
The largest title of the Act, accounting for 72% of the OAA's
total funding in FY 2023, is Title III Grants for State and
Community Programs, which provides grants to states to help
carry out a variety of supportive service and health promotion
programs for older adults and their caregivers.\2\ The Title
III Nutrition Program, which includes congregate (Title III-C1)
and home-delivered (Title III-C2) nutrition services, and the
Nutrition Services Incentives Program (Title III-C), is a
federal program that supports the health and well-being of
older adults through nutrition services. We are proud and
thankful and want to underscore the significance of the OAA
Nutrition Program, which is the only federal program designed
specifically to meet older adults' nutritional and social
needs. The OAA Nutrition Program is a successful public-private
partnership, with the critical federal dollars provided
leveraging an impressive funding match of approximately three
to one, from additional state, local, and private sources.\3\
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\2\ Congressional Research Service (2023), Older Americans Act:
Overview and Funding. https://crsreports.congress.gov/product/pdf/R/
R43414
\3\ ACL (2019), Written Statement by Administrator and Assistance
Secretary for Aging Lance Robertson for the Senate Special Committee on
Aging. https://acl.gov/news-and-events/announcements/asa-robertson-
testified-senate-hearing-oaa-today
Again, we believe that the Act successfully fulfills its
purpose, and that reauthorization efforts and modifications
should be primarily focused on improving the ability to reach
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more seniors.
The Pervasive Problem of Senior Hunger
Since its inception, the OAA Nutrition Program has provided
billions of meals to seniors in need, improved countless lives,
and saved considerable taxpayer dollars through well-
established trust built at both the community and national
levels. While this program has worked as it was designed for
decades, it is not reaching all those in need. Eight out of ten
(80.3%) low-income, food insecure older adults are not
receiving the congregate or home-delivered meals that they are
eligible for and likely need.\4\ From a national survey, we
found that one in three local Meals on Wheels programs maintain
waiting lists, with seniors waiting on average three months for
vital meals-an increase of 10% for program waitlists from
2021.\5\ The same survey found an overwhelming majority of
programs, 78%, have already or would need to add seniors to
waitlists due to funding cuts. These are only the individuals
we are aware of and know that it is an underrepresentation of
the true need across the country. In fact, 97% in our survey
indicated they believe that there is unmet need in their
communities.
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\4\ U.S. Census Bureau (2022), Current Population Survey (CPS) Food
Security Supplement, Meals on Wheels America calculation of dataset
available at: https://www.census.gov/data/datasets/time-series/demo/
cps/cps-supp--cps-repwgt/cps-food-security.html
\5\ Meals on Wheels America (November 2023), #SaveLunch Member
Pulse Survey. Internal report.
Additional research has found that older adults who seek Meals
on Wheels services are already more vulnerable than the average
American seniors, with poorer self-reported health, higher
levels of depression and anxiety, greater fears of falling and
more.\6\ Simply put, while older adults are on waiting lists
and struggling to have their nutritional and social needs met,
their health is continuing to decline and are more likely to
end up in a hospital or nursing home prematurely and at
significantly higher cost to the individual and taxpayers.
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\6\ Meals on Wheels America (2015), More Than a Meal Pilot Research
Study, commissioned report prepared by Thomas & Dosa. https://
www.mealsonwheelsamerica.org/learn-more/research/more-than-a-meal/
pilot-research-study
The OAA Nutrition Program is an essential linchpin in
supporting the healthy aging process for millions of Americans,
but its effectiveness in making a dent in the national dual
crises of senior hunger and social isolation depends on being
adequately funded. The reality of senior hunger and isolation
in our country is sobering. 12 million older adults aged 60+
worry about having enough food (i.e., are marginally food
insecure). This was an increase of 2.2 million over 2021.\7\
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\7\ See note 4.
While daunting, even one individual struggling with hunger is
far too many. With the issue being pervasive in American
communities and additional challenges fast approaching with the
growth of our senior population, there is no time to wait for
action. The number of OAA meals and seniors we are able to
serve nationwide, however, has failed to keep pace with
demographic shifts, growing demand, and the rising costs of
food, transportation, and other expenses. While we currently
serve 251 million nutritious home-delivered and congregate
meals annually to the 2.2 million older adults facing hunger
and isolation, we have the infrastructure and know how to reach
millions more, especially through increased appropriations and
a strong and timely reauthorization.\8\
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\8\ Administration for Community Living/Administration on Aging
(2023), State Program Report (SPR) 2021, available on ACL's Aging,
Independence, and Disability Program Data Portal (AGID) at: https://
agid.acl.gov/
The Costs and Consequences of Senior Hunger and Social
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Isolation
Today, millions of seniors are experiencing some degree of food
insecurity and/or social isolation, leaving them at risk for a
multitude of adverse health issues. Food-insecure older adults
experience worse health outcomes than food-secure seniors, with
greater risk for heart disease, depression, and decline in
cognitive function and mobility.\9\ Some of the most vulnerable
seniors that the OAA serves - those who are frail, homebound,
and socially isolated - rely on the home-delivered meal
program. Despite the well-founded, inextricable link between
healthy aging and access to nutritious food and regular
socialization, millions of seniors struggle to meet these basic
human needs. The infrastructure and cost-effective
interventions to address these consequences already exist
through the OAA network. As stated above, local, community-
based organizations serve a critical role in addressing the
nutritional and social needs of our nation's older adults. The
impact of these services on seniors' lives is powerful.
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\9\ Ziliak and Gunderson (2021), The Health Consequences of Senior
Hunger in the United States: Evidence from the 1999-2016 NHANES, report
prepared for Feeding America. www.feedingamerica.org/research/senior-
hunger-research/senior
Most seniors receiving OAA nutrition services from senior
nutrition programs consistently report that participating in
the program helps them feel more secure, helps them eat
healthier foods, prevents falls or fear of falling, and allows
them to stay in their own homes. In turn, this helps avoid
preventable emergency room visits, hospital admissions and
readmissions, and extended rehab stays, preventing premature
institutionalization and ultimately reducing our nation's
health care costs. The cost of not providing these services and
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increasing funding is clear.
Currently, almost 95% of older adults have at least one chronic
condition, while nearly 80% have two or more chronic
conditions.\10\ Increasingly, older adults need access to
nutritious meals and comprehensive services that can help them
manage their chronic conditions.
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\10\National Council on Aging (April 2022), Chronic Inequities:
Measuring Disease Cost Burden Among Older Adults in the U.S. A Health
and Retirement Study Analysis. https://ncoa.org/article/the-inequities-
in-the-cost-of-chronic-disease-why-it-matters-for-older-adults
Malnutrition, senior falls, and social isolation tell a similar
story. The economic burden of senior malnutrition alone costs
$51.3 billion annually (in 2010 dollars), while senior falls
account for $50 billion (in 2015 dollars).\11\,\12\ Studies
show the highest rates of social isolation are found among
older adults, putting seniors at risk for high blood pressure,
heart disease, obesity, a weakened immune system, anxiety,
depression, cognitive decline, Alzheimer's disease, and even
death. Research demonstrates that social isolation among older
adults leads to an extra $6.7 billion in Medicare spending a
year (in 2012 dollars) similar expenditures to that of having
high blood pressure or arthritis.\13\
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\11\ Snider, et al. (2014), Economic Burden of Community-Based
Disease-Associated Malnutrition in the United States. Journal of
Parenteral and Enteral Nutrition, 38(2S), 77S-85S. https://doi.org/
10.1177/0148607114550000
\12\ Thomas, et al. (2018), Home-Delivered Meals and Risk of Self-
Reported Falls: Results From a Randomized Trial. Journal of Applied
Gerontology, 37(1), 41-57. https://doi.org/10.1177/0733464816675421
\13\ Meals on Wheels America (September 2023), The Case for Meals
on Wheels: An Evidence-Based Solution to Senior Hunger and Isolation.
https://www.mealsonwheelsamerica.org/learn-more/research/the-case-for-
meals-on-wheels-sept23
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The Case for Meals on Wheels and the Older Americans Act
As noted throughout this testimony, Meals on Wheels is a proven
solution that addresses the escalating issues of senior hunger
and isolation. We know this not only through the daily
anecdotes we hear of how Meals on Wheels has impacted people's
lives, but through decades of research. Our recently released
report, The Case for Meals on Wheels: An Evidence-Based
Solution to Senior Hunger and Isolation, showcases consistent
findings that Meals on Wheels improves senior health, safety,
social connection, and more while saving taxpayer dollars.13
The Case for Meals on Wheels analyzed a total of 38 studies,
spanning 1996 to 2023, and found they consistently reported
that Meals on Wheels programs reduce healthcare utilization and
costs, falls, nursing home use, social isolation and loneliness
while improving food security, diet quality, and nutritional
status and seniors' ability to age in place. These remarkable
outcomes, highlighted below, underscore the life-changing
impact that Meals on Wheels services have on the lives of the
older adults we serve:
1. Reduced use of costly health care services: Several studies
found Meals on Wheels program participants needed fewer visits
to the emergency room or experienced fewer hospital stays or
readmissions.
2. Reduced nursing home use and increased ability to age in
place: Access to medically tailored and home-delivered meals
allowed individuals to stay in their homes rather than transfer
to a nursing facility for nutritional support. Nearly all (92%)
home-delivered meal participants said the meals help them
continue to live independently, according to the 2022 national
survey of Older Americans Act Title III home-delivered meal
participants.
3. Reduced health care costs attributed to reduced hospital and
nursing home spending: In line with outcomes one and two, their
reduced health care and nursing home use also meant Meals on
Wheels participants spent less on health care. One study found
that among individuals receiving medically tailored meals,
average medical expenditures were 40% lower per month for those
receiving meals than for a matched group not receiving meals
($843 vs. $1,413).
4. Increased food security: Several studies concluded that
home-delivered meal participants worried less about having
enough to eat. Those individuals who received breakfast and
lunch deliveries, rather than just lunch, benefited even more.
5. Improved diet quality: Home-delivered meals led to higher-
quality diets among participants, as measured by nutrient
intake, calories, vitamins, and other indicators. Participant
feedback reinforced that meal delivery helped them eat
healthier, more nourishing foods.
6. Reduced or slow decline in nutritional risk: Program
participants threatened by malnutrition saw improvement in
their nutritional risk scores. Individuals benefited from both
improved dietary intake and improved food security.
7. Reduced social isolation and loneliness: Several studies
found a link between home-delivered meals and reduced social
isolation or loneliness, particularly among participants who
lived alone. These benefits resulted from contact with drivers
during meal deliveries and opportunities for social connection
via other Meals on Wheels programs.
8. Reduced falls and increased home safety: Several studies
found Meals on Wheels participants experienced fewer falls and
minimized exposure to hazards in the home, outcomes
attributable to safety checks provided at meal delivery, and a
reduced need to cook in the kitchen.
This research alone cannot bring these evidence-based programs
to the older adults who desperately need them. Seniors' access
to these critical services is only possible with the support of
Congress and sufficient federal funding. This report
illuminates the impact that Meals on Wheels has and the
necessity to protect and increase federal funding to meet the
current needs of our growing senior population.
Older Americans Act Reauthorization Priorities
While the need for far greater federal funding is the primary
key to serving more seniors, especially in the years following
the COVID-19 pandemic, there are opportunities to ease
administrative burdens and improve our insight into the
performance and operations of the network at all levels. The
Act, including the Nutrition Program, must continue to be
robust and successful and fulfill its original intent and core
purpose to reduce hunger, promote socialization, and improve
health and well-being for older adults in greatest social and
economic need. Any policy changes must, first and foremost, do
no harm to the aging services network and the seniors they
support. Instead, they must address the pervasive and growing
challenges of senior hunger and social isolation. We believe
reauthorization should also build on the newly updated OAA
regulations by modernizing the law and reflecting the on-the-
ground needs of service providers, older adults, and their
families and caregivers. Accordingly, Meals on Wheels America
urges Congress to enact the following recommendations:
1. Increase authorization funding levels for all OAA programs
and provide additional resources for enhanced nutrition
services.
Increase authorized funding, including sufficient funding
for Title III Nutrition Services, to address existing waiting
lists and reach the ever-growing number of older adults who
would benefit from OAA programs.
Authorize new funding streams and establish incentives for
senior nutrition programs to offer medically tailored and/or
culturally appropriate meals and expand reach in underserved
areas.
Improve and clarify authorization of funding for senior
nutrition programs to maintain and invest in the infrastructure
and resources needed to prepare and deliver services, including
kitchen equipment, delivery vehicles, labor, etc.
2. Unify OAA Congregate, Home-Delivered and the Nutrition
Services Incentive Program into a single Title III-C Nutrition
Program.
Create one authorized funding stream to remove
administrative burden, improve efficiency, and enable
community-based organizations to tailor nutrition services to
seniors' needs more easily.
Codify alternative nutrition services models, such as grab-
and-go and drive-thru meals, proven to reach more older adults
struggling with hunger and social isolation.
Modernize the Nutrition Services Incentive Program through
enhanced partnership and coordination with USDA, HHS, states,
Area Agencies on Aging (AAA), and local providers to procure
commodity foods for preparing OAA meals and coordinate other
important federal benefits and programs for seniors.
3. Prioritize community-based nutrition programs and
experienced network providers in OAA grant awards and
contracts.
Encourage states and AAAs to partner more closely with and
leverage senior nutrition programs' established infrastructure,
dedicated volunteer base, and experience serving their
communities to deliver nutritious meals, socialization
services, and safety checks to more older adults.
Ensure timely payment and reimbursement processes for
nutrition services provided.
4. Expand senior nutrition program capacity and infrastructure
support for further integration into the health care system.
Reduce administrative and regulatory burdens on local
nutrition and aging services providers seeking to establish
contracts and partnerships with health care providers and
payors.
Provide additional resources and promote incentives for the
aging services network to build the capacity, including
infrastructure and technology, to meet the compliance and
privacy standards for providing covered health care benefits.
5. Promote innovations and successful practices learned during
the COVID-19 pandemic.
Facilitate continued innovation and implementation of many
successful practices leveraged during the COVID-19 public
health emergency, including new partnerships, programming,
emergency preparedness and outreach.
Support the expansion of evidence-informed and/or
technology-based solutions that can help meet the needs of
seniors, including their preferences for meals and social
connectedness.
In addition to improvements through reauthorization, our
organization and network of senior nutrition providers are
pleased with the recent effort to update federal regulations
for OAA policies and programs for Titles III, VI, and VII for
the first time in 36 years.\14\ As a result, they are now
better aligned with language and additions from recent
reauthorizations and better reflect the needs of today's
growing and diversifying older adult population.
---------------------------------------------------------------------------
\14\ ACL (February 2024), Final Rule [89 FR 11566]: Older Americans
Act: Grants to State and Community Programs on Aging; Grants to Indian
Tribes and Native Hawaiian Grantees for Supportive, Nutrition, and
Caregiver Services; Grants for Supportive and Nutritional Services to
Older Hawaiian Natives; and Allotments for Vulnerable Elder Rights
Protection Activities. https://www.federalregister.gov/documents/2024/
02/14/2024-01913/older-americans-act-grants-to-state-and-community-
programs-on-aging-grants-to-indian-tribes-and
Among the several updated policies we look forward to being
implemented, we remain supportive of the following nutrition-
related provisions that are included and/or clarified per ACL's
---------------------------------------------------------------------------
final rule (effective Friday, March 15, 2024):
Home-delivered meals - and a certain amount of congregate
meals - may be provided via home delivery, pick-up, carry-out,
or drive-through.
Eligibility for home-delivered meals is not limited to
people who are "homebound;" criteria may depend upon many
factors (including ability to leave home unassisted, ability to
shop for and prepare nutritious meals, mental health, degree of
disability or other relevant factors about their need for the
service, including social and economic need).
Requirements regarding the use and transfer of funding for
Title III programs, including clarification under Title III C-1
and C-2 that funds can be used for nutrition education,
nutrition counseling, and other nutrition services, as well as
cautioning against transitioning money away from Title III-B
and Title III-C services for which they were appropriated and
intended by Congress.
States have the option to receive NSIP allocation grants as
cash, commodities or a combination of both, and that funds can
only be used to purchase domestically produced foods used in
meals.
We are encouraged to see much consideration and modernization
of OAA regulations through this regulatory process.
Nonetheless, regulatory updates and guidance can only achieve
so much and look forward to addressing remaining policy
priorities and making further legislative improvements during
this OAA reauthorization process.
Conclusion
Thank you for holding this timely hearing and inviting me to
testify before you. I appreciate the chance to share how the
OAA improves the lives of senior citizens, communities, and our
nation. I would like to extend a special thanks to Chairman
Sanders for his leadership on the OAA in past reauthorizations
and in seeking increased funding, and I want to thank all
members of the Committee for sharing the belief that no senior
in America should be left hungry or isolated. I hope the
information I provided today is helpful as you consider the
next reauthorization and look forward to working together to
make this vision a reality for our older adults. Thank you
again for your time, and I am pleased to answer any questions
you might have.
Dear Committee Chairmen Sanders and Casey, Ranking Members
Cassidy and Braun, and Senators Kaine, Collins, Markey, and
Mullin:
On behalf of Meals on Wheels America, the nationwide network of
community-based senior nutrition programs and the seniors they
serve, thank you for the opportunity to provide input and
submit responses to this bipartisan Request for Information
(RFI) regarding the upcoming Older Americans Act (OAA)
reauthorization. There is a great urgency for strong
legislation that meets our aging population's current and
future needs. The upcoming reauthorization deadline comes
during a critical period of rapid growth in the senior
population. With this population boom comes an even greater
need for long-term care solutions like Meals on Wheels - a
trusted, tested, and cost-effective solution to senior hunger,
malnutrition, isolation and loneliness - instead of costly and
preventable health care utilization among the 60+ population.
Responses to the general and targeted questions identified in
the RFI are below:
Question:
1. What are the biggest challenges currently facing the older
adult population? How have OAA programs performed historically
in addressing these challenges? How can OAA programs be
improved upon to better address these challenges?
Response:
Our nation is ill-prepared for the massive growth in the older
adult population. The in community services and supports
necessary to enable seniors' independence, health, well-being
and dignity are not keeping pace with need. However, if
properly resourced, the OAA network is poised and ready to
deliver lifesaving services to America's seniors.
Biggest Challenges:
Unmet Need and Population Increase
The reality of senior hunger and isolation in our country is
sobering. 12 million older adults aged 60+ worry about having
enough food (i.e., are marginally food insecure). This is a
devastating increase of two million over 2021. While daunting,
even one individual struggling with hunger is far too many.
With this pervasive issue affecting so many American
communities and additional challenges fast approaching due to
the growth of our senior population, there is no time to wait
for action. The number of OAA meals and seniors we are able to
serve nationwide fails to keep pace with demographic shifts,
growing demand, and the rising costs of food, transportation,
and other expenses. While we currently serve 251 million
nutritious home-delivered and congregate meals annually to the
2.2 million older adults facing hunger and isolation, we have
the infrastructure and know-how to reach millions more,
especially through increased appropriations and a strong and
timely reauthorization.
While this program has worked as designed for decades, it is
not reaching all those in need or who would benefit due to the
lack of adequate funding. Eight out of ten (80.3%) low-income,
food insecure older adults are not receiving the congregate or
home-delivered meals for which they are eligible and likely
need. These are only the individuals we are aware of, and we
know it is an underrepresentation of the true unmet need across
the country. Nearly all (97%) programs in our national survey
indicated they believe there is an unmet need in their
communities.
Unmet Need and Waitlists
Due to insufficient funding, our local programs have
regrettably been forced to place some older adults on
waitlists. From the aforementioned national survey, we found
one in three local Meals on Wheels programs maintain waiting
lists, with seniors waiting an average of three months for
vital meals. The same survey found an overwhelming majority of
programs (78%) have already or would need to add seniors to
waitlists due to funding cuts. In 2023, 33% of programs
reported having a waitlist for their home-delivered meal
services, higher than the 23% of programs that reported
maintaining a waitlist in 2021.\15\ In response to the surge in
demand and growing unmet need among seniors exemplified by
increased program waitlist for services, our Meals on Wheels
network is urging increased funding for the OAA as part of its
reauthorization.
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\15\ Meals on Wheels America (November 2023), #SaveLunch Member
Pulse Survey. Internal report.
Additional research has found that individuals who seek Meals
on Wheels services are already more vulnerable to adverse
health outcomes than the average American older adult, with
poorer self-reported health, higher levels of depression and
anxiety, greater fears of falling, and more. Simply put, while
seniors on waiting lists struggle to have their nutritional and
social needs met, their mental and physical health declines,
and they are at greater risk of hospitalization or premature
nursing home placement-at a significantly higher cost to the
---------------------------------------------------------------------------
seniors, their families, and taxpayers.
Cost of Food Insecurity, Malnutrition and Social Isolation
Today, as millions of seniors are experiencing food insecurity
and/or social isolation, they are at greater risk of serious
health issues. Food-insecure older adults experience worse
health outcomes than food-secure seniors, with a higher risk
for heart disease, depression, and decline in cognitive
function and mobility. Almost 95% of older adults have at least
one chronic condition, while nearly 80% have two or more.\16\
Some of the most vulnerable seniors the OAA serves - those who
are frail, homebound, and socially isolated - rely on the home-
delivered meal program. Increasingly, older adults need access
to nutritious meals and comprehensive services that can help
them manage their chronic conditions and ease the economic
burden for our clients and taxpayers alike.
---------------------------------------------------------------------------
\16\ National Council on Aging (April 2022), Chronic Inequities:
Measuring Disease Cost Burden Among Older Adults in the U.S. A Health
and Retirement Study Analysis. https://ncoa.org/article/the-inequities-
in-the-cost-of-chronic-disease-why-it-matters-for-older-adults
The economic burden of senior malnutrition alone costs $51.3
billion annually (in 2010 dollars), while senior falls account
for $50 billion (in 2015 dollars). Studies show the highest
rates of social isolation are found among older adults, putting
seniors at risk for high blood pressure, heart disease,
obesity, a weakened immune system, anxiety, depression,
cognitive decline, Alzheimer's disease and even death. Research
demonstrates that social isolation among older adults leads to
an extra $6.7 billion in Medicare spending a year (in 2012
dollars), similar expenditures to that of having high blood
---------------------------------------------------------------------------
pressure or arthritis.
Meals on Wheels Historical Impact and Ways to Face these
Challenges:
For more than 50 years, the OAA has consistently demonstrated
how access to nutritious food and regular socialization have
enabled millions of our seniors to remain healthier, safe, and
independent in the comfort of their homes. Despite such cost-
effective interventions, these basic human needs are out of
reach for hundreds of thousands of American seniors. Community-
based organizations are critical to addressing the nutritional
and social needs of our nation's older adults-and keeping our
healthcare costs in check-but they can only reach their full
potential when they have the resources to do so. Nationally,
research shows that participation in home-delivered meal
programs is associated with lower medical spending and
emergency department visits.
In addition to decreasing health care costs, home-delivered
meal clients consistently self-report positive and improved
health outcomes as a result of participating in the program:
92% say services help them live independently
77% say meals help improve their health
79% say meals help them eat healthier foods
85% say services help them feel more secure
As discussed below, Meals on Wheels is an intervention to
reduce these kinds of costs. The local providers Meals on
Wheels America represent serve as a direct lifeline to those
struggling with food insecurity, malnutrition, mobility,
loneliness, and countless other difficulties of aging. The
Meals on Wheels service begins with the meal and opens the door
to so much more. The purposeful and unique combination of
nutritious meals and social connection fosters a relationship
with the individual senior, enabling Meals on Wheels providers
to identify and deliver valuable services that promote
independence and well-being. The impact not only saves lives
but also saves taxpayer dollars by ensuring that our nation's
seniors live safer, longer, and more nourished in their own
homes and out of other more costly healthcare settings. In
fact, we can serve a senior through Meals on Wheels for an
entire year for roughly the cost of one day in the hospital or
ten days in a nursing home.\17\
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\17\ Meals on Wheels America (2024), special analysis of ACL and
Mathematica's estimated meal cost (OAA Nutrition Programs Evaluation:
Meal Cost Analysis), Kaiser Family Foundation's daily hospital expense
data (State Health Facts: Hospital Adjusted Expenses per Inpatient
Day), and Genworth's cost of semi-private nursing home room (2021 Cost
of Care Survey) adjusted for inflation. Sources and methods available
at: https://www.mealsonwheelsamerica.org/docs/default-source/fact-
sheets/2023/what--we--deliver--2023--national--snapshot--sources--
methods.pdf
---------------------------------------------------------------------------
The Case for Meals on Wheels
Meals on Wheels is a proven solution to the escalating issues
of senior hunger and isolation. We know this through decades of
research and the daily anecdotes we hear about how Meals on
Wheels has impacted people's lives. Our recently released
report, The Case for Meals on Wheels: An Evidence-Based
Solution to Senior Hunger and Isolation, showcases consistent
findings that Meals on Wheels improves senior health, safety,
social connection, and more while saving taxpayer dollars.\18\
---------------------------------------------------------------------------
\18\ Meals on Wheels America (September 2023), The Case for Meals
on Wheels: An Evidence-Based Solution to Senior Hunger and Isolation.
https://www.mealsonwheelsamerica.org/learn-more/research/the-case-for-
meals-on-wheels-sept23
This analysis of 38 studies, spanning 1996 to 2023, found that
Meals on Wheels programs are consistently reported to reduce
healthcare utilization and costs, falls, nursing home use,
social isolation, and loneliness while improving food security,
diet quality, nutritional status, and seniors' ability to age
in place. The significant outcomes of this research highlighted
below underscore the life-changing impact that Meals on Wheels
---------------------------------------------------------------------------
services have on the older adults we serve:
1. Reduced use of costly health care services: Several
studies found Meals on Wheels program participants needed fewer
visits to the emergency room or experienced fewer hospital
stays or readmissions.
2. Reduced nursing home use and increased ability to age in
place: Access to medically tailored and home-delivered meals
allowed individuals to stay in their homes rather than transfer
to a nursing facility for nutritional support. Nearly all (92%)
home-delivered meal participants said the meals help them
continue to live independently, according to the 2022 national
survey of Older Americans Act Title III home-delivered meal
participants.
3. Reduced health care costs attributed to reduced hospital
and nursing home spending: In line with the first and second
outcomes identified above, the reduced health care and nursing
home use by Meals on Wheels participants also meant less was
spent on health care. One study found that among individuals
receiving medically tailored meals, average medical
expenditures were 40% lower per month for those receiving meals
than for a matched group not receiving meals ($843 vs. $1,413).
4. Increased food security: Several studies concluded that
home-delivered meal participants worried less about having
enough to eat. Those individuals who received both breakfast
and lunch, rather than just lunch, benefited even more.
5. Improved diet quality: Home-delivered meals led to higher-
quality diets among participants, as measured by nutrient
intake, calories, vitamins, and other indicators. Participant
feedback reinforced that meal delivery helped them eat
healthier, more nourishing foods.
6. Reduced or slower decline in nutritional risk: Program
participants threatened by malnutrition saw improvement in
their nutritional risk scores. Individuals benefited from both
improved dietary intake and improved food security.
7. Reduced social isolation and loneliness: Several studies
found a link between homedelivered meals and reduced social
isolation or loneliness, particularly among participants who
lived alone. These benefits resulted from contact with drivers
during meal deliveries and opportunities for social connection
via other Meals on Wheels programs.
8. Reduced falls and increased home safety: Several studies
found Meals on Wheels participants experienced fewer falls and
minimized exposure to hazards in the home, outcomes
attributable to safety checks provided at meal delivery, and a
reduced need to cook in the kitchen.
Improvements to the OAA:
Despite such remarkable improvements to health and well-being
as the evidence-base shows, not the chasm is widening between
those who need access to these critical services and those we
are able to reach. That's why we are imploring Congress to
boost federal funding to sufficient levels to not only maintain
current utilization but also to expand and bridge the growing
gap of unmet need. Additional resources are essential to enable
the Meals on Wheels network to meet the evolving needs of our
growing senior population and continue delivering the powerful
and proven return on investment their services provide. The OAA
is a foundational law that continues to function exceptionally
well, consistent with its original, intended purposes. It has
withstood the test of time. Any changes made to the legislation
through the reauthorization process should maintain the
integrity of the enacted OAA and support community-based aging
programs as the backbone of service provision to older adults
across the country. Especially as the older adult population
skyrockets, the next reauthorization must allow the OAA network
to evolve and expand in tandem with the increasing need/demand
that will occur through this authorization period. In the
following question, our priorities and improvements for the OAA
are listed in greater detail.
2. What are your top priorities for OAA reauthorization? Please
explain why.
Response:
As reauthorization approaches, Meals on Wheels America is
focusing on several key legislative recommendations that
further enhance the services and supports provided to older
adults. Given the significant need, changing demographics, and
inflationary pressures, we are pushing for increased authorized
funding levels across all OAA programs, with an emphasis on
closing the existing needs gap for nutrition services and
establishing incentives and funding for medically tailored and
culturally appropriate meals.
To ensure that any changes enacted through the upcoming OAA
reauthorization do not harm older adults or the existing aging
network, Meals on Wheels America has developed legislative
priorities based on input from our diverse senior nutrition
network. This network has decades of experience delivering
services in their communities, in addition to Area Agencies on
Aging (AAAs) and several State Units on Aging. We believe
reauthorization should improve efficiencies and remove
administrative burdens - such as complex funding transfer
protocols and requirements - in the implementation of funding.
As well, it should also build on the newly updated OAA
regulations by reflecting the on-the-ground needs of service
providers, older adults, and their families and caregivers.
Ultimately, the goal is to continually address the growing,
pervasive issues of senior hunger and isolation.
Top Priorities:
Meals on Wheels urges Congress to enact the following
recommendations:
1. Increase authorization funding levels for all OAA programs
and provide additional resources for enhanced nutrition
services.
Increase authorized funding, including sufficient funding
for Title III Nutrition Services, to address existing waiting
lists and reach the ever-growing number of older adults who
would benefit from OAA programs.
Authorize new funding streams and establish incentives for
senior nutrition programs to offer medically tailored and/or
culturally appropriate meals - which are more costly to
prepare/procure - and expand reach in underserved areas.
Improve and clarify authorization of funding for senior
nutrition programs to maintain and invest in the infrastructure
and resources needed to prepare and deliver services, including
kitchen equipment, delivery vehicles, labor, etc.
2. Unify OAA Congregate, Home-Delivered and the Nutrition
Services Incentive Program into a single Title III-C Nutrition
Program.
Create one authorized funding stream to remove
administrative burden, improve efficiency, and enable
community-based organizations to tailor nutrition services to
seniors' needs more easily.
Codify alternative nutrition services models, such as
grab-and-go and drive-thru meals, which have been proven to
reach more older adults struggling with hunger and social
isolation.
Modernize the Nutrition Services Incentive Program through
enhanced partnership and coordination with USDA, HHS, states,
Area Agencies on Aging (AAAs), and local providers to procure
commodity foods for preparing OAA meals and coordinate other
important federal benefits and programs for seniors.
3. Prioritize community-based nutrition programs and
experienced network providers in OAA grant awards and
contracts.
Encourage states and AAAs to partner more closely with and
leverage senior nutrition programs' established infrastructure,
dedicated volunteer base, and experience serving their
communities to deliver nutritious meals, socialization
services, and safety checks to more older adults.
Ensure timely payment and reimbursement processes for
nutrition services provided.
4. Expand senior nutrition program capacity and
infrastructure support for further integration into the health
care system.
Reduce administrative and regulatory burdens on local
nutrition and aging services providers seeking to establish
contracts and partnerships with health care providers and
payors.
Provide additional resources and promote incentives for
the aging services network to build the capacity, including
infrastructure and technology, to meet the compliance and
privacy standards for providing covered health care benefits.
Promote innovations and successful practices learned
during the COVID-19 pandemic.
Facilitate continued innovation and implementation of many
successful practices leveraged during the COVID-19 public
health emergency, including new partnerships, programming,
emergency preparedness and outreach.
Support the expansion of evidence-informed and/or
technology-based solutions that can help meet seniors' needs,
including their preferences for meals and social connectedness.
3. The demographics of the older adult population are changing
rapidly: Please describe changing needs and how the aging
network (including area agencies on aging, senior centers,
state units on aging, aging and disability resource centers,
centers for independent living, etc.) plans to address them?
Response:
The OAA Nutrition Program is the essential linchpin to
supporting the healthy aging process for millions of Americans.
While this program continues to make inroads in addressing the
national dual crises of senior hunger and social isolation, its
ability to scale to the magnitude of the need and have the
impact that is warranted (and that it is capable of) requires a
concomitant level of investment.
As the population diversifies further, the types of meals and
how meals are provided are also changing and adapting. More
programs are offering medically tailored and culturally
appropriate meals. They are tailoring nutrition to meet the
unique health needs of their clients, treating food as
medicine. Enabling seniors to have flexibility in when and
where they enjoy their meals is yet another evolving trend
borne out of the pandemic. There are key ways the aging network
through the OAA is addressing the growing and changing needs of
older adults.
Since its inception, the OAA Nutrition Program has provided
billions of meals to seniors in need and improved countless
lives. Our local programs do this through the more than a meal
service model, such as daily safety checks, opportunities for
socialization to prevent loneliness, phone calls to ensure the
well-being of the most isolated individuals, monitoring of
change of condition, caregiver support and connections to other
critical community services that support the health and well-
being of seniors. One of the ways our local programs are
adapting to the changing needs of older adults is by offering
medically tailored and culturally appropriate meals, which
allow for increased access to nutritious meals.
4. What changes could Congress make to improve the efficiency
and effectiveness of OAA services and programs?
Response:
While greater funding is the primary key to serving more
seniors and improving the efficiency and effectiveness of the
OAA, especially in the years following the COVID-19 pandemic,
the OAA Nutrition Program must also continue to evolve and
fulfill its original intent and core purpose to reduce hunger,
promote socialization, and improve health and well-being for
older adults in greatest social and economic need.
Unifying the Congregate and Home-Delivered Nutrition Services
with the Nutrition Services Incentive Program (NSIP)
An important strategic proposal we recommend for the upcoming
reauthorization, which we mentioned earlier, involves unifying
the Congregate and Home-Delivered Nutrition Services with the
Nutrition Services Incentive Program (NSIP) under a single
Title III-C Nutrition Program and funding stream. This shift
would improve efficiency at all levels of the aging network and
would provide local service providers with the flexibility they
require to tailor their offerings to meet seniors' preferences
and the diverse needs of individuals across local communities
far more easily. The OAA Nutrition Program is effective at
supporting healthy aging because of the combination of proper
nutrition and social connection that enables older adults to
remain healthier and independent in their own homes, where they
want to be; however, the current structure of the OAA Nutrition
Program has inevitably contributed to disproportionate funding
between different types of delivery models and creates a
fragmented approach to delivering the spectrum of service
offerings. Local nutrition programs consider the currently set
percentage limits and reporting requirements on transfer
authority between the nutrition services to be arbitrary and
unnecessarily burdensome as they further complicate the
movement and use of resources for nutrition providers to meet
seniors' needs and preferences to age at home.
While we believe this legislative priority could be achieved in
various ways and statutory language, we are recommending a
proposal to restructure the program similarly to Sec. 321 of
the Act, where allowable activities that are eligible and
funded under Title B Supportive Services are outlined in a
codified list of services. Further, funding traditionally
allocated to NSIP would be redistributed into the consolidated
Title III Nutrition Program funding. As a recommended example,
under an amended section for a unified program, state and local
agencies could have the flexibility to allocate nutrition
service funds towards any of the following activities without
caps limiting funding distribution of various subprograms/
allowable services currently authorized under Title III-C of
the Act and per the finalized regulations:
1. Congregate meals
2. Home-delivered meals
3. Grab-and-go, carry out and/or curbside meals
4. Nutrition counseling, assessments, and education related-
services (provided in tandem with congregate, home-delivered,
and/or eligible alternative meal
Encouraging and Incentivizing Greater Partnership and
Coordination
We believe there is further opportunity to modernize NSIP by
encouraging and incentivizing greater partnership and
coordination in the OAA Nutrition Program among USDA, HHS,
states, and Area Agencies on Aging (AAAs). The envisioned
collaboration between these entities would allow them to be
better poised and connected to help local providers procure the
commodity foods needed to prepare and provide balanced Title
III meals.
As these federal departments and agencies and their state and
local affiliates are heavily involved with the administration
and implementation of many other benefits and direct services
that support seniors, we propose language and/or requirements
encouraging greater partnership in connecting local providers
with commodities to reduce procurement costs and connect
eligible older adults with all of the federal nutrition, social
and financial support from which they may benefit.
Prioritize Community-Based Organizations
Additionally, we believe there should be a concerted effort to
prioritize community-based organizations for nutrition services
contracts, as local providers deliver a holistic service, not
just a meal. The Act has the potential to go further in
supporting the long-serving community-based senior nutrition
programs that are experts in addressing these interconnected
issues by prioritizing them for limited federal grant funding
and the OAA contracting process. Nonprofit community-based
organizations (CBOs) are uniquely positioned to meet the needs
of individuals in their own community as they understand the
interplay of resources and connection to other local services
and coalitions. Encouraging contracts with these entities helps
ensure that the services provided include the more than a meal
service model, such as daily safety checks, opportunities for
socialization to prevent loneliness, phone calls to ensure the
wellbeing of the most isolated individuals, monitoring of
change of condition, caregiver support and connections to other
critical community services that support the health and well-
being of seniors. Currently, many long-time OAA providers risk
or face the loss of critical resources to contracts being
awarded to for profit nutrition services as the lowest cost
meal provider. These company models may not provide the same
level and breadth of service and coordination that Meals on
Wheels provides to holistically meet the needs of seniors
living independently at home.
There is also wide variation in the amount reimbursed for each
meal provided through OAA funding between states and geographic
regions and limited information on the processes used to
determine this per meal reimbursement. The overwhelming
majority of reimbursement rates do not cover the total cost of
the meal and services provided, and many have not increased in
years. Further, better public information on reimbursement
rates would help to improve understanding of how reimbursement
rates are determined and the role they might play in creating
waiting lists and exacerbating unmet need in local communities.
This recommendation helps ensure that funding explicitly
appropriated to the OAA Nutrition Program assists the seniors
it is designed and intended to serve. It continues to support
the community-based organizations that have built the
community's trust and are the "eyes and ears" for those they
serve.
Finally, as we expand upon our responses to the Targeted
Questions below, this reauthorization is also an opportunity to
further modernize the OAA by incorporating innovations,
flexibility, and successful practices that were leveraged
during the pandemic and ensuring that services authorized under
the Act remain adaptable and responsive to the evolving needs
of America's older population.
Targeted Questions:
A. Legislation passed by Congress in response to the COVID-19
pandemic made temporary changes to some OAA programs, including
flexibility for nutrition services funding and adjustments to
eligibility for home-delivered meals.
1. What impact did these changes have on older adults and
program operations?
Response:
Enhanced flexibility has been extremely beneficial and remains
a top priority for many OAA nutrition service providers.
During the pandemic, the flexibilities enabled local programs
to adjust on the fly, as they encountered situations they never
faced before and needed the space to innovate and reach as many
people as possible. In particular, the ability to transfer 100%
of funding between Congregate and Home-Delivered meals during
the Public Health Emergency was essential. It allowed OAA
nutrition providers to serve each person individually and
ensure the strategic and cost-effective use of federal funding
to provide people with the services they required as needs
evolved.
As one senior nutrition program representative recently noted
to us regarding the ACL's final rule:
"[OAA policies] must include as much flexibility as
possible for funding of congregate and home delivered funds.
The 'boots on the ground' who are providing services should be
allowed to make decisions based on the people they serve."
2. How should Congress consider these changes outside of a
public health emergency?
Response:
We would like Congress to make permanent the ability to direct
nutrition funding to where it is needed most in each community,
rebalancing and streamlining to accommodate flexibility is
critical. As previously noted, we consider the authorized
percentages and limits on transfer authority between the
nutrition services to be arbitrary and unnecessarily burdensome
as they further complicate the movement and use of resources
for nutrition providers at the state and local levels. As such,
we strongly support a permanent combination of the C1 and C2
nutrition programs and the Nutrition Services Incentives
Program (NSIP) into a single Title III-C program (or at a
minimum, permanently allow 100% transfer authority between the
nutrition funds).
Currently, State Units on Aging have the ability to transfer up
to 40% of allocated funding between Title III C1 (Congregate)
and Title III C2 (Home-Delivered). However, our network of
community-based providers reports that the rationale for the
levels and timing of transfer at the state level is not always
clear, and the reporting and administrative requirements to
initiate and complete funding transfers between their funding
services can be onerous.
We have long advocated for greater parity in budget allocations
between the congregate and home-delivered meal programs. In FY
2023, only 40% of the total nutrition funding was appropriated
to home-delivered meals. To allow full flexibility of transfer
between these programs or by eliminating the separate subparts
entirely, programs with limited capacity and resources at their
disposal will be able to direct funding toward the specific
needs and preferences of older adults in their communities.
Further, in our proposal to eliminate NSIP and redirect
appropriations toward the unified Title III-C Nutrition
Program, we believe the program's resources would be better
utilized as direct funding for the network.
3. What changes made during the COVID-19 pandemic but not
mentioned above should Congress examine for this
reauthorization?
Response:
Supplemental funding provided through the various emergency
COVID-19 relief packages in 2020 and 2021 was absolutely
critical. It allowed organizations to respond rapidly with the
reassurance that resources were coming and that seniors in
communities would not be going without nutritious meals. It
also allowed our network to begin addressing the services and
unmet needs gap before the pandemic started.
While it's our understanding that only a few states have
expended all COVID-relief funding, a growing majority (75%)
have expended half or more. Under the statute, states have
until September 30, 2024, to expend American Rescue Plan Act
funds. Our hypothesis is that resources are not flowing to
local service providers more quickly due to fears about annual
appropriations cuts that could occur because of what is
happening right now in Congress. The Aging Network again needs
reassurance that more funding will be coming so that older
adults don't begin services and then be forced off the program
when there's no longer adequate funding.
Investments in the Older Americans Act had declined well before
the COVID-19 pandemic and has neither kept pace with a rising
age 60+ population nor inflation. Adjusted for inflation,
regular federal funding (excluding emergency supplemental
funding) appropriated to the OAA Nutrition Program decreased by
$20 million (1.9%) between FY 2019 and FY 2023. Before the
influx of emergency supplemental funding in FY 2020-2021, about
18 million fewer OAA meals were served in 2019 than in 2009 due
to inflation, rising costs, and inadequate funding. Without
increasing both the authorization and appropriation levels on
which these programs depend, local programs must attempt to
fill the ever-growing gap in other ways. Or worse, Meals on
Wheels programs will be forced to reduce services, add more
food insecure seniors to wait lists or turn them away
altogether.
4. How should Congress consider the impact of the pandemic
when working to reauthorize OAA?
Response:
Increased federal funding and extended flexibility within the
nutrition program following the COVID-19 pandemic are essential
to help ensure that programs have the resources needed to
continue providing a wide range of services that meet the
unique needs of their communities. Local senior nutrition
providers recognize the importance of providing a range of
appropriate nutrition options to older individuals and should
be used as experts in this field, but they need more resources
to do so. The response of the senior nutrition program network
in the wake of COVID-19 proved that this model of service is
not only effective at working with limited resources but also
highly adaptable and able to address unmet needs as they arise.
B. During the COVID-19 pandemic, OAA partners, including
congregate meal providers, adapted to new ways of delivering
services, such as providing grab-and-go meals.
1. In the absence of a public health emergency, is it
appropriate to retain flexibility in meal delivery services for
the congregate meals program? If so, why? What effect would
changes in meal delivery services have on older Americans?
Response:
Since the onset of the pandemic, local senior nutrition
providers have experienced a drastic increase in demand for
home-delivered services and alternative delivery models such as
grab-n-go, carry-out, and curbside meals. Greater flexibility
in providing these alternative delivery methods in the OAA
statute would provide greater balance and flexibility for
programs to tailor their services better and support older
adults in the coming years. We believe it is important to give
local programs the freedom to respond to their diverse and
evolving local needs.
Meals on Wheels programs also play a critical role in providing
regular meals and socialization opportunities. For countless
individuals participating in the program, the staff members and
peers at a congregate dining facility, or the volunteer
delivering a meal and visit to the home, may be the only
person(s) an older adult sees that day, providing critical
occasions for social connection. Therefore, we believe that any
flexibility in service delivery must be assured not to reduce
and/or prevent access to opportunities for vital social
connection provided through the nutrition program. In any
capacity and especially through home-delivered meal services,
Meals on Wheels volunteers and/or staff are additional eyes and
ears in seniors' homes, often serving as first responders if an
emergency has occurred or preventing them from occurring
altogether. As many local programs have described, without
greater flexibility to provide home-delivered and alternative
delivery models, older adults' safety and well-being would be
at greater risk:
"We consistently hear from HDM [home-delivered meal]
clients that our driver is the only individual they see each
day. Social isolation is a crisis in our country, and we are
battling it on a daily basis, one delivery at a time. In
addition, delivery drivers frequently find clients in distress
and needing immediate assistance. Clients have fallen and have
been lying on the floor for hours, unable to get up on their
own. Clients have been found on the verge of a diabetic coma or
having breathing problems. Without our safety check, we can
only imagine the outcome." - Meals on Wheels program in Ohio
"One example of how important the home-delivered meals
program is a driver found a female who had fallen out of her
wheelchair and was stuck between it and a table. She was unable
to call for help and he was able to call 911. She had been in
that situation for approximately two hours." - Meals on Wheels
program in West Virginia
The consequence of not allowing flexibility and the ability to
provide nutritious meals and meet the needs of the community
include harm, loss of quality of life, and financial cost to
our clients, their families, and taxpayers for preventable
healthcare costs incurred.
2. Should Congress consider any requirements related to
different ways of providing congregate meals?
Response:
Our primary position and recommendation regarding congregate
meals is to unify the nutrition services under one Title III-C
program so that providers have the flexibility to deliver
services in a way that meets the needs of their communities.
Again, this reauthorization should modernize the OAA by
consolidating the OAA Nutrition Program, which would simplify
operations and increase the local programs' abilities to
provide person centered services that still focus on enhancing
nutrition and reducing social isolation. By unifying the
nutrition services under a single program and line item, this
modification would protect the core purpose of the OAA
Nutrition program, which is to reduce hunger, promote
socialization, and promote health and well-being. Furthermore,
it would better help programs respond to seniors' evolving and
diverse needs across communities and enable more decision-
making at the local level, which is best positioned to address
their communities' needs.
Without full 100% transfer authority between all service
delivery models or a consolidated Title III-C Nutrition
Program, we believe the congregate meal program should be
established as the prioritized/mandated funding stream for
grab-and-go, take out and/or curbside meals. As this level of
flexibility within the nutrition program was not achieved in
the newly finalized regulations, we maintain the urgent need to
address the disproportionate budget allocations between
congregate and home-delivered nutrition programs. Similarly,
while we strongly support flexibilities established and granted
through the regulations, terms like "grab-and-go," "carry-out"
or "drive through" are not technically home-delivered meal
models in name or practice, so we urge careful consideration of
terms - as well as the appropriate funding streams - that are
selected so that it is not confusing to the people for whom it
is designed to serve.
C. Congress made several changes to OAA through the Supporting
Older Americans Act of 2020, including adding caregiver
assessments to the National Family Caregiver Support Program as
well as efforts to improve social isolation.
1. Have these policies better informed resources needed by
caregivers or older Americans? Please explain why or why not,
and if yes, how.
Response:
We are supportive of the several provisions, including
requiring a report on social isolation and the effect of the
OAA program included in the last reauthorization to increase
focus and understanding of social isolation and the evidence-
based practices to prevent and address loneliness, The final
reauthorization's provisions to expand and improve screening of
and long-term planning and coordination to address social
isolation are especially beneficial for older adults receiving
these services as these issues and the negative outcomes
associated with them are historically overlooked and under-
addressed.
The importance of focusing on social isolation and loneliness
in the last reauthorization was realized almost immediately
upon enactment during the COVID-19 pandemic.
2. How can Congress improve these efforts?
Response:
Leveraging the network of senior nutrition providers to combat
social isolation and loneliness is a crucial focus at Meals on
Wheels America. While we believe these OAA amendments have
brought much-needed awareness of the issues and strengthened
the capacity for OAA programs and resources to address them
better, additional support is necessary beyond the critical
work already done to ensure the safety and social connectedness
of our nation's seniors. As with other OAA services and
programs, these activities remain underfunded, and much more
investment of resources to address social isolation and
loneliness among older adults is urgently needed.
As recommended above, we believe the Act can further support
the long-serving community based senior nutrition programs that
are experts in addressing these interconnected issues by
prioritizing them for limited Federal Grant Funding and the OAA
contracting process. For decades, and now more than ever,
seniors are relying on Meals on Wheels programs to provide
services, including essential socialization, through various
creative and resourceful ways that meet the growing needs in
their communities. Below are a few examples of these activities
that programs are able to offer to support social connection
and wellness among participants:
Telephone reassurance services are designed to have a
volunteer or staff member make consistent phone calls to
isolated older adults.
Friendly visitor or senior companion programs designed to
offer human connection by providing companionship and emotional
support to older adults who are socially isolated or lonely.
Pet assistance and food delivery programs often leverage
partnerships with shelters, veterinarians, pet food stores,
and/or boarding and sheltering services to provide holistic
animal care and encourage animal companionship. Seniors with
pets are less likely to exhibit depression, report feelings of
loneliness and experience illness.
Unfortunately, many long-time OAA providers are at risk of
losing critical resources to contracts with for-profit
nutrition services. Meals on Wheels provides a more holistic,
service-oriented approach to meeting the needs of seniors
living independently at home than many for-profit models. When
these models are selected and prioritized for OAA meal service
delivery over traditional local Meals on Wheels programs and
senior nutrition providers, far fewer individuals receive the
social connection they need with their meals. For this reason,
we have long advocated for greater prioritization, utilization,
and support for the network of community-based programs that
specialize in nutrition services and are already delivering
nutritious meals with trusted human connection.
3. What changes made in the Supporting Older Americans Act
of 2020 but not mentioned above should Congress examine for
this reauthorization?
Response:
We remain highly supportive of changes in the last
reauthorization that highlighted the importance of addressing
and mitigating the negative impact of issues pertaining to
senior hunger and nutrition, such as malnutrition, chronic
diseases, older adult falls, and home safety, as well as social
isolation and loneliness described above.
We believe this reauthorization can build upon the advances
made in the Supporting Older Americans Act of 2020 with
language and authority regarding Food is Medicine (FIM) and
medically tailored meals, which are burgeoning practices in the
nutrition and healthcare field. Health providers and insurers
are increasingly looking to work with the aging services
network and Meals on Wheels providers to support and execute
their FIM/medical meal strategies; however, many barriers
remain in forming and sustaining these partnerships, including
restrictive policies and resources.
Several state Medicaid plans offer Home- and Community-Based
Services (HCBS) waivers to provide home-delivered meals as a
covered service, which is particularly relevant to elderly and
disabled beneficiary populations. Additionally, with guidance
under the Centers for Medicare and Medicaid Services (CMS),
Medicare Advantage (MA) Special Need Plans (SNP) for
beneficiaries with chronic conditions are now able to cover
additional supplemental benefits, including meals delivered to
the home, that are tailored specifically to the patient's
conditions and health needs. Greater contracting with Meals on
Wheels programs that can also provide efficient, cost-effective
health monitoring in the home setting is critical, though, to
scale and unlock the true cost-saving advantages of these
benefits. To be able to offer many of these services through
healthcare partnerships, additional investments must be made to
enable senior nutrition programs to meet the requirements and
protocol for such infrastructure and operations.
Similarly, we often hear from local senior nutrition providers
how special meals, such as medical or cultural meals, are more
costly to produce and deliver and may differ based on the
community. As evidence shows promising outcomes for these types
of special meals in certain communities and in certain
healthcare interventions, we believe the next reauthorization
should recognize the value of and appropriately resource these
enhanced nutrition services. By providing additional targeted
funding that is structured in a way that allows for flexible,
age-appropriate implementation and promoting opportunities for
programs to access alternative revenue streams for special
meals, the aging network will be better supported and have the
capacity to cater to the health and medical needs and/or
preferences of older adults they serve. For example, securing
more resources for senior nutrition programs to establish and
manage partnerships with local farms would assist older adults
actively seeking out easily peelable and digestible fruits and
vegetables.
D. ACL recently finalized regulations regarding OAA. Should
Congress consider any changes in response to the new rule?
Response:
Our organization supports the recent effort to update federal
regulations for OAA policies and programs for Titles III, VI,
and VII for the first time in 36 years.\19\ We appreciated the
opportunity to provide comments on the rule and ACL's
partnership. As a result, they are better aligned with language
and additions from recent reauthorizations and better reflect
the needs of today's growing and diversifying older adult
population.
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\19\ ACL (February 2024), Final Rule [89 FR 11566]: Older
Americans Act: Grants to State and Community Programs on Aging; Grants
to Indian Tribes and Native Hawaiian Grantees for Supportive,
Nutrition, and Caregiver Services; Grants for Supportive and
Nutritional Services to Older Hawaiian Natives; and Allotments for
Vulnerable Elder Rights Protection Activities. https://
www.federalregister.gov/documents/2024/02/14/2024-01913/older-
americans-act-grants-to-state-and-community-programs-on-aging-grants-
to-indian-tribes-and
We are especially supportive of the final rule as it contains
clarifying language around the home-delivered meals for
seniors, including clarification that eligibility for home-
delivered meals is not limited to people who are "homebound"
and that criteria for home-delivered meals may depend upon many
factors (including ability to leave home unassisted, ability to
shop for and prepare nutritious meals, mental health, degree of
disability or other relevant factors pertaining to their need
---------------------------------------------------------------------------
for the service, including social and economic need.
While we are encouraged to see much consideration and
modernization of OAA regulations through this process,
regulatory updates and guidance can only achieve so much, and
we look forward to addressing remaining priorities and making
further legislative improvements during reauthorization.
Federal level, these include:
Unifying - or authorizing permanent 100% funding transfer
authority between - the home delivered, congregate, and NSIP
into a single Title III Nutrition Program.
Increasing funding authorization levels for all OAA
programs, particularly as current funding and reimbursement
rates are not keeping pace with increasing demand for nutrition
services and sustained higher operating costs.
Providing additional resources for enhanced nutrition
services and requiring that state agencies, AAAs, and local
providers be aware of the definitions, uses, and importance of
culturally appropriate meals, medically tailored meals, fresh
produce, and locally sourced food, as included in the statute.
Prioritizing community-based organizations and public
entities, such as AAAs, county governments, tribes, nonprofit
service providers, or volunteer organizations, to receive grant
awards and/or enter contracts to provide Title III services.
Thank you again for the opportunity to submit these comments
and for considering our concerns and recommendations for the
forthcoming OAA reauthorization. A strong reauthorization of
the Act is critically needed to improve the delivery, access,
and long-term sustainability of services and supports for
seniors. Local Meals on Wheels and other OAA programs are
essential, effective, and work well to meet the nutritional,
health, and social needs of older adults, but they need more
support from Congress to better serve older adults in need.
Please do not hesitate to reach out with any questions as you
continue this critical work for older Americans, their
families, and caregivers.
Sincerely,
/s/
Ellie Hollander
President and CEO
Contact Information:
Julia Martinez Harrington
Senior Director, Government Relations
julia.harrington@mealsonwheelsamerica.org
(303) 514 5751
1550 Crystal Drive, Suite 1004
Arlington, VA 22202
571-339-1622
www.mealsonwheelsamerica.org
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