[House Hearing, 109 Congress]
[From the U.S. Government Publishing Office]
SENIOR INDEPENDENCE ACT OF 2006
=======================================================================
HEARING
before the
SUBCOMMITTEE ON SELECT EDUCATION
of the
COMMITTEE ON EDUCATION
AND THE WORKFORCE
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
May 2, 2006
__________
Serial No. 109-38
__________
Printed for the use of the Committee on Education and the Workforce
Available via the World Wide Web: http://www.access.gpo.gov/congress/
house
or
Committee address: http://edworkforce.house.gov
_____
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COMMITTEE ON EDUCATION AND THE WORKFORCE
HOWARD P. ``BUCK'' McKEON, California, Chairman
Thomas E. Petri, Wisconsin, Vice George Miller, California,
Chairman Ranking Minority Member
Michael N. Castle, Delaware Dale E. Kildee, Michigan
Sam Johnson, Texas Major R. Owens, New York
Mark E. Souder, Indiana Donald M. Payne, New Jersey
Charlie Norwood, Georgia Robert E. Andrews, New Jersey
Vernon J. Ehlers, Michigan Robert C. Scott, Virginia
Judy Biggert, Illinois Lynn C. Woolsey, California
Todd Russell Platts, Pennsylvania Ruben Hinojosa, Texas
Patrick J. Tiberi, Ohio Carolyn McCarthy, New York
Ric Keller, Florida John F. Tierney, Massachusetts
Tom Osborne, Nebraska Ron Kind, Wisconsin
Joe Wilson, South Carolina Dennis J. Kucinich, Ohio
Jon C. Porter, Nevada David Wu, Oregon
John Kline, Minnesota Rush D. Holt, New Jersey
Marilyn N. Musgrave, Colorado Susan A. Davis, California
Bob Inglis, South Carolina Betty McCollum, Minnesota
Cathy McMorris, Washington Danny K. Davis, Illinois
Kenny Marchant, Texas Raul M. Grijalva, Arizona
Tom Price, Georgia Chris Van Hollen, Maryland
Luis G. Fortuno, Puerto Rico Tim Ryan, Ohio
Bobby Jindal, Louisiana Timothy H. Bishop, New York
Charles W. Boustany, Jr., Louisiana [Vacancy]
Virginia Foxx, North Carolina
Thelma D. Drake, Virginia
John R. ``Randy'' Kuhl, Jr., New
York
[Vacancy]
Vic Klatt, Staff Director
Mark Zuckerman, Minority Staff Director, General Counsel
------
SUBCOMMITTEE ON SELECT EDUCATION
PATRICK J. TIBERI, Ohio, Chairman
Cathy McMorris, Washington Vice Ruben Hinojosa, Texas
Chairman Ranking Minority Member
Mark E. Souder, Indiana Danny K. Davis, Illinois
Jon C. Porter, Nevada Chris Van Hollen, Maryland
Bob Inglis, South Carolina Tim Ryan, Ohio
Luis P. Fortuno, Puerto Rico George Miller, California, ex
Howard P. ``Buck'' McKeon, officio
California,
ex officio
C O N T E N T S
----------
Page
Hearing held on May 2, 2006...................................... 1
Statement of Members:
Hinojosa, Hon. Ruben, Ranking Minority Member, Subcommittee
on Select Education, Committee on Education and the
Workforce.................................................. 4
Prepared statement of.................................... 5
Porter, Hon. Jon C., a Representative in Congress from the
State of Nevada, prepared statement of..................... 1
Tiberi, Hon. Patrick J., Chairman, Subcommittee on Select
Education, Committee on Education and the Workforce........ 2
Prepared statement of.................................... 3
Statement of Witnesses:
Bauer, Andre, Lieutenant Governor, State of South Carolina... 37
Prepared statement of.................................... 39
Response to Chairman Tiberi's questions concerning SCSEP
and WIA................................................ 61
Bishop, Mason M., Deputy Assistant Secretary of Labor for
Employment and Training, U.S. Department of Labor.......... 15
Prepared statement of.................................... 17
Responses supplied to Messrs. Hinojosa and Van Hollen.... 27
Browdie, Richard, president and CEO, the Benjamin Rose
Institute.................................................. 49
Prepared statement of.................................... 51
Response to Mr. Hinojosa's questions concerning the
Senior Independence Act of 2006........................ 58
Carbonell, Josefina, Assistant Secretary for Aging, U.S.
Department of Health and Human Services.................... 6
Prepared statement of.................................... 9
Cheung, Ling, president, Chinese American Senior Services
Association, Montgomery County, MD......................... 47
Prepared statement of.................................... 48
Faris, Vinsen, executive director, Meals-on-Wheels of Johnson
and Ellis Counties, TX..................................... 44
Prepared statement of.................................... 45
Additional Testimony Submitted:
Minnix, William L., Jr., president and chief executive
officer, American Association of Homes and Services for the
Aging, prepared statement of............................... 64
Woody, Gayla S., aging program administrator, Centralina
Council of Governments, statement before the U.S. Senate
Special Committee on Aging................................. 66
SENIOR INDEPENDENCE ACT OF 2006
----------
Tuesday, May 2, 2006
U.S. House of Representatives
Subcommittee on Select Education
Committee on Education and the Workforce
Washington, DC
----------
The subcommittee met, pursuant to call, at 2:35 p.m., in
room 2175, Rayburn House Office Building, Hon. Patrick Tiberi
[chairman of the subcommittee] presiding.
Present: Representatives Tiberi, Porter, Inglis, McKeon (ex
officio), Hinojosa, and Van Hollen.
Staff Present: James Bergeron, Counselor to the Chairman;
Jessica Gross, Press Assistant; Richard Hoar, Professional
Staff Member; Lucy House, Legislative Assistant; Kimberly
Ketchel, Deputy Press Secretary; Stephanie Milburn,
Professional Staff Member; Susan Ross, Director of Education
and Human Resources Policy; Deborah L. Emerson Samantar,
Committee Clerk/Intern Coordinator; and Rich Stombres, Deputy
Director of Education and Human Resources Policy; Toyin Alli,
Minority Staff Assistant; Ricardo Martinez, Minority
Legislative Associate; Cheryl Johnson, Minority Counsel;
Michele Varnhagen, Minority Labor Counsel/Coordinator; and
Denise Forte, Minority Legislative Associate.
Chairman Tiberi. A quorum being present, the Subcommittee
on Select Education of the Committee on Education and the
Workforce will come to order.
We are meeting today to hear testimony on the Senior
Independence Act of 2006, and I ask for unanimous consent for
the hearing record to remain open 14 days to allow member
statements and other extraneous material referenced during the
hearing today to be submitted in the official hearing record.
Without objection, so ordered.
[The information referred to follows:]
Prepared Statement of Hon. Jon C. Porter, a Representative in Congress
From the State of Nevada
Mr. Chairman, I thank you for holding this hearing today on the
Senior Independence Act of 2006.
I look forward to the following testimony as it should help us
identify strategies for improving systems serving the rapidly growing
aging population.
This is an area of particular concern for me as I represent the 3rd
district of Nevada which has seen a population growth which is 400
times that of the national average. Since 2000 my district has seen a
16.8% population increase, many of those persons being over the age of
65. During this same time period the rest of the United States
witnessed 4.3% growth.
American's are living longer, healthier lives by 2030, it is
projected that one out of every five Americans will be over the age of
65 representing the fastest growing segment of our older population.
Today individuals age 85 and older represent 4 million people and are
expected to grow to 19 million by 2050. In Nevada alone, there will be
more than 34,000 seniors over the age of 85 by the year 2030.
In addition, I am interested in identifying ways in which the Older
Americans Act is improving the lives of seniors, and ways in which
seniors' quality of life may be further enhanced.
I thank the witnesses for their testimony today, and I look forward
to hearing their expert opinions of the successes and shortcomings of
this valuable program. I yield back.
______
Chairman Tiberi. Good afternoon and welcome to today's
hearing. Thank you all for being here today and to our
witnesses, especially for agreeing to testify. Today's hearing
is intended to seek comment on the Senior Independence Act of
2006, draft legislation to reauthorize the Older Americans Act.
The month of May, as most of you in the audience I am sure
know, is Older Americans Month. So it is most timely for the
committee to consider legislation to reauthorize this very
important piece of legislation.
I have prepared a formal opening statement that I will ask
to be submitted into the record. I and other members of the
committee on both sides of the aisle take seriously the
recommendations derived from the White House Conference on
Aging this past December, especially the delegates' No. 1
resolution to reauthorize the Older Americans Act.
I am pleased that we have made available to the public a
draft bill for discussion today. I want to emphasize that the
legislation that is the topic of today's hearing is a
discussion draft.
This open approach demonstrates our desire to work
cooperatively with interested parties as the bill moves forward
during the legislative process. This approach also allows us to
obtain feedback and consider additional suggestions that we may
introduce, an agreeable bipartisan bill later this week, and
set the pace for, I will say, a speedy approval process through
this subcommittee and full committee. We really do want to get
this act reauthorized this year.
It is a great pleasure to have Mr. Hinojosa, my colleague
from Texas, as a partner in this process. We have worked
together well in the past, and I know we will well in the
future as well.
The Senior Independence Act of 2006 builds on the successes
of the programs authorized under the Older Americans Act by
strengthening services that can improve the quality of life for
aging Americans. Our aging population, involving status and
changing needs, require that Congress carefully and
thoughtfully proceed with the reauthorization of the Older
Americans Act. The Education and Workforce Committee will
strive to make the necessary reforms to make the most of the
Federal investment in programs to assist older Americans, while
ensuring that the growing senior population is served by the
same quality of programs established in the 1965 law. I look
forward to working with all of you throughout this process.
Today we are honored to have with us a talented panel of
experts to help us examine the issues for this hearing. I look
forward to hearing your recommendations on the draft bill and
actions for this subcommittee's consideration.
Before I introduce our first panel of witnesses, I will
recognize my colleague from Texas, Mr. Hinojosa, for his
opening statement.
[The prepared statement of Mr. Tiberi follows:]
Prepared Statement of Hon. Patrick Tiberi, Chairman, Subcommittee on
Select Education, Committee on Education and the Workforce
Good afternoon and welcome. Thank you all for being here today, and
to our witnesses for agreeing to testify. Today's hearing is intended
to seek comment on the Senior Independence Act of 2006, draft
legislation to reauthorize the Older Americans Act. The month of May is
Older Americans Month, so it the most timely for the Committee to
consider legislation to reauthorize this very important law.
I, and the other members of the Committee on both sides of the
aisle, take seriously the recommendations derived from the White House
Conference on Aging this past December, especially the delegates'
number one resolution to reauthorize the Older American Act.
I am very pleased that we have made available to the public a draft
bill for discussion today. I want to emphasize that the legislation
that is the topic of today's hearing is a discussion draft. This open
approach demonstrates our desire to work cooperatively with interested
parties as the bill moves forward in the legislative process. This
approach also allows us to obtain feedback and consider additional
suggestions so that we may introduce an agreeable, bipartisan bill
later this week and set the pace for speedy action.
Over the past several months, this Subcommittee has been examining
the current program, learning about the evolving issues facing older
Americans, listening to seniors in their own words, and laying out a
plan for strengthening services to seniors that are authorized by this
Act and relied upon by millions of aging Americans each year. It is a
great pleasure to have Mr. Hinojosa as a partner in this process. I am
also pleased that each of you, and many advocates for older Americans
nationwide, is contributing to our effort.
The Senior Independence Act builds on the successes of the programs
authorized under the Older Americans Act by strengthening services that
can improve the quality of life for aging Americans. With this
reauthorization, we aim to promote the development and implementation
of comprehensive, coordinated systems at the Federal, State, and local
levels to streamline access to program benefits and help individuals
avoid institutional care; we advance the mission of evidence-based
programs to assist older individuals and their family caregivers in
learning about and making behavioral changes intended to reduce the
risk of injury, disease, and disability among seniors; and we support
and strengthen endeavors by the aging services network to expand
services to care for the aging baby boom populations by allowing for
private pay opportunities while maintaining important safeguards to
ensure that local providers adhere to the public purpose mission and
targeting provisions of the Act. Among other things, this draft bill
encourages providers to deliver services in a manner responsive to the
needs and preferences of older individuals and their family caregivers,
including improved program access to individuals with limited English
proficiency; it recognizes the critical link between nutrition and the
prevention of chronic disease, and supports efforts to reduce the
incidence of obesity, which is a growing problem among all segments of
the population, including the elderly.
The Senior Independence Act also strengthens the Community Service
Employment-Based Training Program for older Americans. The draft
legislation maintains the current program structure, while promoting
coordination with programs and services authorized under the Workforce
Investment Act of 1998, and encouraging private sector partnerships; it
allows for greater flexibility with funds for additional supportive
services such as on-the-job training, and ensures accountability of pay
for work and benefits required by law; it focuses the priority of
service to persons 65 and older while allowing persons age 55-64 with
special barriers to employment to continue to be served; it also
requires a 10 percent increase in unsubsidized employment placement
with technical assistance made available to meet the goal, and a two
year participation limit for most participants so that more individuals
can be served by the program.
Our aging population's evolving status and changing needs require
that Congress carefully and thoughtfully proceed with the
reauthorization of the Older Americans Act. The Education & the
Workforce Committee will strive to make the necessary reforms to make
the most of the federal investment in programs to assist older
Americans, while ensuring that the growing senior population is served
by the same quality programs established by the 1965 law. I look
forward to working with all of you throughout the process.
Today we are honored to have with us a talented panel of experts to
help us examine the issues for this hearing. I look forward to hearing
your recommendations on the draft bill and actions for this
Subcommittee's consideration. Before I introduce our witnesses, I yield
to the Ranking Member of the Subcommittee, Mr. Hinojosa, for his
opening statement.
______
Mr. Hinojosa. Thank you, Chairman Tiberi.
I would like to join the Chairman in welcoming the
witnesses today. I was pleased to hear him say that something
very unusual is what we are trying to do, and that is to have a
speedy passage of this act. But knowing the Chairman and how
persuasive he can be with members of the other side of the
aisle, I will do the same on my side and try to make this
happen as he wishes.
The Older Americans Act is the cornerstone of our national
network of support for older Americans. It represents our
country at its very best.
We believe that all individuals, no matter how old, should
be able to live their full lives with dignity. The Older
Americans Act has built the aging network that makes that
possible. The voices of the aging network have come through
loud and clear: Reauthorize the Older Americans Act. We are
working together to do that. I would like to thank the Chairman
for the openness of this process.
I share the goals of producing a consensus bill that will
enable this legislation to serve a new and larger generation of
older Americans. It is up to us to build the capacity of our
aging network to meet the demands of the future. We have just
learned that the outlook for the solvency of Social Security
and Medicare has been downgraded again.
Medicare is projected to be insolvent by year 2018. The
projection for Social Security is 2040. The aging network
supported by the Older Americans Act faces similar challenges.
In our field hearing in the Chairman's district in Ohio, we
learned that the buying power of the Older Americans Act has
dropped by 50 percent since 1980. In constant dollars, in 1980
we were investing $15.82 per older American. Today that figure
has dropped to $7.90. We cannot allow the aging network that
has been so successful in improving the quality of life for our
seniors to become frayed beyond repair because of lack of
financial resources.
I am looking forward to hearing the witnesses' response to
the draft legislation that was released. I think that it was a
good start. However, it is essential that we get feedback about
how the proposed changes will work in concert. One area of
particular concern to me is the senior community employment
program. The aging network has been steadfast in its support
for the dual community service and employment nature of the
program. We need to maintain that.
However, many of the changes advocated by the Department of
Labor would move us away from the dual purpose and 40-year
history of that program. Legislative changes, coupled with
regulatory changes to eligibility, could put that program out
of reach of many seniors who need it, and have the combined
effect of making it very difficult for grantees to meet
performance targets.
We must be sure that any changes that we make to the Senior
Community Service Employment program do not undermine a
successful program that has served this community and our
seniors so well for over 40 years.
Mr. Chairman, I want to say thank you to everyone who is
here today. This is important work, and I am looking forward to
working with Chairman Tiberi to move this process forward
speedily, as he said, and continue the great legacy of
bipartisan support for the Older Americans Act.
Thank you, and I yield back.
Chairman Tiberi. Thank you, Mr. Hinojosa.
[The prepared statement of Mr. Hinojosa follows:]
Prepared Statement of Hon. Ruben Hinojosa, Ranking Minority Member,
Subcommittee on Select Education, Committee on Education and the
Workforce
Thank you, Chairman Tiberi. I would like to join the chairman in
welcoming the witnesses today.
The Older Americans Act is the cornerstone of our national network
of support for older Americans. It represents our country at its best.
We believe that all individuals--no matter how old--should be able to
live their full lives with dignity. The Older Americans Act has built
the aging network that makes that possible.
The voices of the aging network have come through loud and clear.
Reauthorize the Older Americans Act. We are working together to do
that.
I would like to thank the Chairman for the openness of this
process. I share his goal of producing a consensus bill that will
enable this legislation to serve a new and larger generation of Older
Americans.
It is up to us to build the capacity of our aging network to meet
the demands of the future. We have just learned that the outlook for
the solvency of Social Security and Medicare has been downgraded again.
Medicare is projected to be insolvent by 2018. The projection for
Social Security is 2040. The aging network supported by the Older
Americans Act faces similar challenges. At our field hearing in the
Chairman's district, we learned that the buying power of the Older
Americans Act has dropped by 50 percent since 1980. In constant
dollars, in 1980, we were investing $15.82 per older American. Today,
that figure is $7.90. We cannot allow the aging network that has been
so successful in improving the quality of life for our seniors to
become frayed beyond repair because of lack of resources.
I am looking forward to hearing the witnesses' response to the
draft legislation that was released. I think that it was a good start.
However, it is essential that we get feedback about how the proposed
changes will work in concert.
One area of particular concern is the Senior Community Employment
Program. The aging network has been steadfast in its support for the
dual--community service and employment--nature of the program. We need
to maintain that.
However, many of the changes advocated by the Department of Labor
would move us away from the dual purpose and 40-year history of the
program. Legislative changes coupled with regulatory changes to
eligibility could put the program out of reach of many seniors who need
it and have the combined effect of making it very difficult for
grantees to meet performance targets. We must be sure that any changes
that we make to the Senior Community Employment Program do not
undermine a successful program that has served the community and our
seniors so well for over 40 years.
Thank you for joining us today. This is important work. I am
looking forward to working with the chairman to move the process
forward and continue the great legacy of bipartisan support for the
Older Americans Act.
Thank you and I yield back.
______
Chairman Tiberi. We are very pleased to have two expert
witnesses before us on our first panel. I will introduce them
now.
The Honorable Josefina Carbonell was appointed by the
President and sworn in as Assistant Secretary for Aging at the
U.S. Department of Health and Human Services in August of 2001.
In this position, the Assistant Secretary presides over the
Administration on Aging which is the Federal focal point, an
advocacy agency, for older Americans and their concerns.
Through the aging network, AOA reaches into every community
providing services and support such as information and referral
for adult services, adult day care, elder abuse prevention,
home-delivered meals, in-home care and transportation services
for caregivers.
Prior to joining HHS, Ms. Carbonell was president and CEO
of the largest geriatric health and human services organization
in the country, Little Havana Activities and Nutrition Centers
in Dade County, Florida. Welcome.
Our second witness, the Honorable Mason Bishop, is Deputy
Assistant Secretary of the Employment and Training
Administration of the Department of Labor. In his position, Mr.
Bishop is responsible for overseeing key workforce investment,
developing and implementing workforce policies and priorities,
and assisting with congressional relations and legislative
issues.
The Employment and Training Administration implements
Senior Community Services, an employment program authored by
the Older Americans Act. Prior to coming to the Department of
Labor, Mr. Bishop was the legislative and marketing director
for the National Association of State Workforce Agencies where
he assisted the States with outreach efforts to employers and
to the public.
He also served as the Public Affairs Director for the newly
created Utah Department of Workforce Services, a combined
agency that integrated the services delivery of all public
assistance programs, employment services, and job training
programs into one department.
Thank you, Mr. Bishop, for coming.
I will remind our witnesses that your written testimony
will be submitted for the record, for the entire committee and
for the public. If you could give a 5-minute overview, followed
by questions and answers from the subcommittee.
The lights will turn on. Green means go, red means stop, or
at least wrap up as quickly as you can.
We are also privileged to have today with us the Chairman
of the full committee, a good friend of mine, who hails from
California. We won't hold that against him today, but I just
want to recognize Chairman McKeon at the end. Thank you,
Chairman, for coming today.
With this, Assistant Director, we are going to start with--
actually, why don't we start with the Assistant Secretary and
then we will move on to the Assistant Director.
Ms. Carbonell.
STATEMENT OF JOSEFINA CARBONELL, ASSISTANT SECRETARY FOR AGING,
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Ms. Carbonell. Thank you, Mr. Chairman. Chairman Tiberi,
Congressman Hinojosa, distinguished members of the committee,
thank you for inviting me here today to discuss the
reauthorization of the Older Americans Act. I appreciate very
much your efforts to develop a bipartisan reauthorization bill,
and I am pleased with the direction you have taken to modernize
the act for the 21st century. I look forward to continuing to
work with you on this important piece of legislation.
This act embodies our Nation's known lest aspirations to
ensure the dignity and independence of our older citizens and
to support their overwhelming desire to live in their own homes
and communities for as long as possible.
For more than 40 years, it has guided the development of
the national aging services network that today reaches into
every community in the nation, and each year provides direct
support to 8 million seniors or 17 percent of older
individuals, and over 600,000 family caregivers.
Our successful implementation of the 2003 reauthorization
focused on the new caregiver program and on bringing vision,
strategic planning and performance accountability to the day-
to-day management of the Older Americans Act programs. We are
improving our efficiency every year and we are maintaining high
consumer satisfaction.
Over the past few years, the Administration on Aging has
devoted resources toward the pursuit of program efficiency and
long-term care, enhancing our core programs and improving the
well-being of elderly clients through the science of
prevention. We have also repeatedly listened to our consumers
and to those who serve them, and they have called for the
modernization of the Older Americans Act; also called for the
increased program flexibility and the integration of long-term
care programs and funding streams to create a more seamless
system of community-based long-term care.
These combined strategic efforts have resulted in the
Choices for Independence, which is the centerpiece of our
proposals for this reauthorization. It aims to educate and
provide more accessible community-based long-term care options
to the elderly. It targets the nonMedicaid elderly to take
greater control of their long-term care. It will help them make
better use of their own personal resources, thereby avoiding
unnecessary nursing home placement.
Choices will also empower middle-aged individuals to plan
ahead for their long-term care. Our Choices proposal embodies
three key strategies for advancing systems change: empowering
consumers to make informed decisions by streamlining access to
needed care; helping those at high risk avoid unnecessary
nursing home placement; and assisting older people reduce the
risk of disease and disability through proven lifestyle and
behavioral changes.
The empowerment component of Choices builds on two
complementary initiatives: outreach campaigns which educate
younger adults about long-term care planning; and the aging and
disability resource centers which help States and communities
integrate and streamline access to community-based long-term
care.
Our goal is to have the aging and disability resource
centers serve as a visible and trusted source where people of
any age or income can turn to get information and personalized
assistance on community care. By streamlining access, we cans
also reduce the confusion and frustration people encounter with
the current fragmented systems of care. Our partnership with
the Centers for Medicare and Medicaid Services on the tested
ADRC, or the aging and distance resource grants, is providing
the flexibility and the results for States.
Ohio, for instance, is using the ADRC to create multiple
avenues by which consumers can access comprehensive information
and services, including housing, transportation. And
employment. South Carolina, you will hear later from Lieutenant
Governor Bauer, is using the ADRC model to develop a ``no wrong
door'' approach where consumers can access an integrated array
of home and community-based supports.
Choices will provide States and communities greater
flexibility to help individuals who are at high risk of
institutional placement but not yet eligible for Medicaid to
remain at home and delay their premature entry into nursing
homes.
The community-living incentive component of Choices will
help people before they go into nursing homes and it implements
CMS' Money Follows the Person Initiative that has targeted
people who are already in nursing homes. With this incentive,
program dollars will be tied directly to consumers and their
unique functional needs and circumstances and help them stay at
home.
This cash and counseling approach will give clients control
over individualized budgets and specialized counseling to
manage the types and services of support they need and the
manner in which they are provided, including the option of
hiring a member of their family, a friend, or a neighbor.
Choices will also test strategies that empower older
individuals to make lifestyle changes to reduce the risk of
disease, disability, and injury, which really can be mitigated,
even for people who are very old, through lifestyle changes and
disease management programs.
In acute care we have learned the importance of prevention.
And prevention should be equally important in long-term care.
The reauthorization of the Older Americans Act provides a
unique and timely vehicle to accelerate the changes needed in
long-term care policy to help our Nation fully prepare for the
aging of the baby boom and the emergence of long-term living as
a common experience of life.
Many States have already looked to their aging network to
lead the development of their long-term care systems. The
network is one of the largest providers of home community-based
care and manages between $3- and $4 billion a year in public
and private resources.
The aging services network is well positioned to help
ensure the modernization of long-term care in this country. I
have tremendous respect and confidence in this network. The
administration supports your efforts to reauthorize the act,
and I again commend the committee for producing the bipartisan
draft legislation that will further strengthen programs and
services for older Americans and their caregivers.
I am particularly pleased that the draft legislation
promotes home and community-based supports for older people,
avoiding expensive institutional care so they may age in place,
which is, after all, what people want.
While the draft does not include the administration's
proposed demonstration program by incorporating the principles
of choices, the Choices proposal, it will advance the ongoing
efforts to streamline access to information benefits, help
promote the health and reduce the risk of disease, disability,
and injury and, most importantly, empower older people to make
informed decisions about their care options.
The committee's draft legislation, the Senior Independence
Act, reflects the changing needs of the Older Americans Act
service delivery system and the people that it serves.
As you move forward in your deliberations, we will work
with you to modernize and strengthen our Nation's home and
community-based long-term care system. I am proud to have
served in this network for more than 34 of the 41 years in
existence, and I truly believe, with the support of Congress,
that this reauthorization will give consumers the choices they
need to lead more healthy and productive lives.
Thank you, Mr. Chairman, for the opportunity to speak to
you today about the reauthorization of the act. I would be
pleased to answer some questions later on.
Chairman Tiberi. Thank you.
[The prepared statement of Ms. Carbonell follows:]
Prepared Statement of Josefina Carbonell, Assistant Secretary for
Aging, U.S. Department of Health and Human Services
Introduction
Chairman Tiberi, Congressman Hinojosa, distinguished members of the
Committee, thank you for inviting me here today to discuss the
reauthorization of the Older Americans Act (OAA). I appreciate all of
your efforts to develop a bi-partisan reauthorization bill for the
Older Americans Act. I am pleased with the direction you have taken to
modernize the OAA for the 21st century. I look forward to continuing to
work with you on this important piece of legislation.
The OAA embodies our nation's noblest aspirations for ensuring the
dignity and independence of our older citizens by promoting older
people's full participation in society, and supporting their
overwhelming desire to remain living in their own homes and communities
for as long as possible.
Last July we celebrated the fortieth anniversary of the OAA. For
four decades, the OAA has guided the development of the national aging
services network (aging services network) that today consists of the
Administration on Aging, 56 State Agencies on Aging, 655 Area Agencies
on Aging, almost 237 tribal organizations, 29,000 community-based
provider organizations, over 500,000 volunteers, and a wide variety of
national and local non-profit organizations. This network reaches into
every community in this nation, and each year provides direct support
to 8,000,000 older individuals and 600,000 family caregivers.
The OAA and the aging services network accomplished a lot in forty
years. It produced a wide array of innovative programs to help older
Americans retain their independence in the community. It brought
Federal support to meals-on-wheels, making it one of the most
significant and worthwhile volunteer ventures in the history of this
nation. It brought consistency and quality to senior center programs
across the country, providing seniors an opportunity to socialize with
each other, to improve their nutritional status with healthy meals, and
to see other aspects of their health status addressed through health
screening, medication management, and physical activity programs. More
recently, through the National Family Caregiver Support Program
(NFCSP), the OAA brought recognition and support to family caregivers,
who to this day account for some two-thirds of all of the long-term
care provided to elderly and disabled people across the U.S.
As we move ahead to reauthorize the OAA we can look back with pride
on our accomplishments, but that is not enough. We must look forward to
the changing realities facing our nation. In January, the baby boom
generation started turning age 60, and over the next 25 years, the
number of Americans over the age of 65 will double. By 2050, when the
baby boomers will be age 85 and older, there will be over 86 million
people age 65+ living in the United States, compared to 35 million
today.
Not only is the number of older Americans increasing at
unprecedented rates, but those reaching age 65 are living longer than
ever before. This increase in age will dramatically expand the demand
for long-term care. Long-term care is what people need to accommodate
their inability to perform basic activities of daily living, such as
bathing, cooking, and cleaning the house. Among those over the age of
85, the proportion of people who are impaired and require long-term
care is about 55 percent. While the precise number of people who will
need long-term care in the future could be affected by numerous
variables, including possible declines in rates of impairment, the
expected increase in the number of seniors is so great that most
experts agree that there will be far more people in need of home and
community-based long-term care in the future than there are today.
These unprecedented shifts in the size and composition of our
population are creating both challenges and opportunities for our
society, our families and our individual citizens. Since the last
reauthorization, AoA and the Department of Health and Human Services
(HHS) have recognized this reality and laid the groundwork for the
current reauthorization of the OAA.
Older Americans Act Accomplishments Since Reauthorization in 2000
Strategic Planning
The successful implementation of the provisions of reauthorization
of 2000 focused closely on the implementation of the caregiver program
and brought vision, strategic planning, and performance accountability
to the day-to-day management of the program. With new information about
the capacity of AoA and the aging network to assist frail elderly
people with long-term care services, AoA steered our discretionary
innovation resources toward the pursuit of program efficiency in long-
term care, enhancing core programs, and toward improving the well-being
of elderly clients through the science of prevention. AoA did this in
partnership with the other Federal agencies, the private sector and our
nationwide network.
In this strategic planning process, AoA repeatedly and formally
listened to our consumers and to those who serve them to ensure that we
can move OAA programs forward in a way that will efficiently serve
elders, including the baby boom generation for years to come. Many
called for flexibility in implementing the OAA. Nearly half of the
comments were ideas for future amendments to the OAA. These also
focused on flexibility, particularly with regard to allowing greater
integration of long-term care programs and funding streams to create a
more seamless program of services for elderly people and caregivers.
These efforts yielded a focused set of strategies to modernize the
OAA to better serve the current and emerging needs of this country for
efficient and cost-effective home and community-based long-term care.
These strategies are designed to strengthen the OAA capacity to promote
the dignity and independence of older people, and they build on the OAA
unique mission and capabilities. They include: 1) empowering people to
make informed decisions about their health and long-term care options,
and making it easier for consumers to access the care they need; 2)
helping older people who are at high-risk of nursing home placement to
remain at home; and 3) empowering seniors to stay active and healthy.
AoA program activities have a fundamental common purpose reflecting the
primary legislative intent of the OAA: to promote the development of a
comprehensive and coordinated system of support at the Federal, State
and local level making community-based services available to elders,
especially those who are at risk of losing their independence; to help
prevent disease and disability through community-based activities; and
to support the efforts of family caregivers who are struggling to keep
their loved ones at home.
Performance Accountability
OAA services are delivered through efficient, high-quality,
compassionate programs that help maintain independence for older
people. The core OAA home and community-based long-term care services
such as in-home services, congregate and home delivered meals,
transportation, information and referral, outreach, and caregiver
services have made living at home a real choice for many older adults.
This nationwide infrastructure provides these services across the
United States, U.S. Territories and the Tribes to more than 8 million
elderly persons age 60 and over each year--which is 17 percent of all
people aged 60 and older--including 3 million individuals who require
intensive services, many of whom meet the functional requirements for
nursing home care. These services improve quality of life, create
community connections, make people safer and healthier, and are the
foundation of this nation's long-term care system.
A comprehensive set of performance measures consistently indicates
that OAA services make a positive difference in the lives of older
adults. The results of these performance measures show that OAA
programs serve those most in need, including people who are poor, who
live in rural areas, and who historically were disadvantaged. The
results also show OAA programs are cost-effective and maintain high
consumer satisfaction. For example, AoA and the aging network increased
the number of clients served per million dollars of AoA funding by 15
percent in the last two years. AoA achieved a 16 percent increase in
complaint resolutions per million dollars of ombudsman funds. AoA
maintained client satisfaction rates for home-delivered meals in the
mid-80 to low-90 percentiles, and equally high percentages of elderly
people report each year that the meals programs help them remain
independent in their own homes.
The need and expectation for successful performance was also a
critical factor for AoA with the implementation of the National Family
Caregiver Support Program (NFCSP). Providing service to caregivers is
critical because we recognize that they are the backbone of long-term
care in this country. Sixty-four percent of people with Medicare who
receive personal care support receive that care only from informal or
family caregivers. Fewer than 10 percent of people with Medicare who
receive personal care receive that care only from professionals.
Fortunately, the implementation of the NFCSP provides a fine example of
the results that are being produced by the aging network to help
elderly people maintain their independence. Because of State and local
efforts, we now serve approximately 600,000 caregivers each year. This
occurred in large part because of very successful outreach campaigns by
State and local programs that provided information about caregiving to
over 12 million people in the last two years alone.
AoA includes family caregivers in annual performance outcome
measures surveys. The surveys show that over 85 percent of caregivers
reported that AoA services help them care longer for family and
friends. Improvements in information and access surveys reduced to
below 50 percent the number of caregivers reporting difficulty in
getting the information they need. A number of States have developed
programs to make it easier for consumers and their family caregivers to
learn about the options that are available in their communities, and to
assess the care they need. We have built on these best practices to
develop our Aging and Disability Resource Center initiative, which
fosters one-stop shops for information and access to community-based
long-term care discussed later in the testimony.
One of the most significant accomplishments of the OAA is the
emergence of a community-based, cost-effective, nationwide network that
is now one of the largest providers of home and community-based long-
term care for the elderly in the U.S. In addition to administering OAA
investments in long-term care and related State and community-funded
programs, this network also administers and manages over 60 percent of
the funding made available under Medicaid home and community-based
waiver programs for the elderly and disabled. Many States used their
OAA program as the foundation for their home and community-based long-
term care systems.
Emerging Solutions
Just as the OAA was the solution for so many significant policy
challenges affecting frail elderly people in the past, the OAA may be a
vehicle for addressing emerging long-term care challenges that we now
face as a result of our rapidly growing older population. Building on
policies that the President and the Secretary of HHS have already
instituted, the OAA has the potential to increase the quality of life
for our seniors and also make our system of care more cost-efficient.
President Bush's vision for the future of long-term care is
outlined in his 2001 New Freedom Initiative (NFI). This Initiative aims
to create a system of care that is responsive to the needs and
preferences of Americans of all ages with disabilities, and the values
of choice, control and independence. Since 2001, HHS and Congress
provided the States and communities with a variety of new tools to help
them advance the goals and values embedded in the NFI. These tools
included: the Real Choice Systems Change grants, new Medicaid waiver
options, implementation of the NFCSP, replication of the successful
Cash and Counseling model, the Aging and Disability Resource Center
(ADRC) Initiative, and the Own Your Future Campaign.
Most recently, HHS and the Congress took significant steps forward
to modernize Medicaid long-term care working with the nation's
governors and the Congress. Major Medicaid changes contained in the
recent Deficit Reduction Act, such as Money Follows the Person,
empowers consumers and gives more support to community-living options.
Congress recognized through the expansion of the Long-Term Care
Partnership program and other changes that our long-term care policy
strategies must go beyond the parameters of the Medicaid program. This
is especially important for our nation's older population.
The Choices for Independence demonstration (Choices) aims to
educate and provide community-based long-term care options to the
elderly. Specifically, the demonstration targets non-Medicaid eligible
elderly take greater control of their long-term care by helping them
make better use of their personal resources, thereby avoiding
unnecessary nursing home placement. Choices also will empower middle-
aged individuals to plan ahead for their long-term care.
The Choices demonstration will test ways to help States and
communities be more consumer-directed, more supportive of community
living, and more cost-effective. Choices builds on recent HHS
initiatives and the unique assets inherent in the OAA, including the
ability to reach people while they are still healthy.
This demonstration funds implementation of Choices in a limited
number of States and is intended to test and document the potential
impact of Choices on the health and well-being of older people, their
family caregivers, and on health care costs under Medicaid and
Medicare. I was pleased to see that many of the Administration's
concepts as well as our clarifying technical amendments are embedded in
the Committee's proposed legislation.
As noted previously, Choices embodies three interrelated strategies
for advancing systems change at the State and community level and is
intended to test the effectiveness of this combined set of strategies.
The demonstration builds on the unique assets of the aging network, its
core programs and the best practices that have come from AoA's
strategic investments since the last reauthorization. These strategies
include: empowering consumers to make informed decisions, including
streamlining access to needed care; helping high-risk individuals avoid
unnecessary nursing home placement; and, assisting older people with
lifestyle and behavioral changes proven to reduce their risk of disease
and disability.
Empowering Consumers
The Empowerment component of Choices will build upon two
complementary initiatives launched by the AoA in partnership with CMS
and other HHS agencies to help people to make informed decisions about
their support options, and easily access the supports they need.
One initiative, the Own Your Future Campaign, launched this past
year, encourages more people to plan ahead for their long-term care.
The project is a joint effort of the AoA, the Assistant Secretary for
Planning and Evaluation (ASPE), the CMS, the National Governors
Association, and the National Conference of State Legislatures. It was
piloted in five States (Arkansas, Idaho, Nevada, New Jersey, and
Virginia), and is currently being expanded to three additional States
(Kansas, Maryland, and Rhode Island). The Campaign involves a variety
of outreach activities, including the targeted mailing of a letter from
the governor of each State to every household headed by an individual
between the ages of 50 and 70. To date, almost eight percent of the
individuals receiving letters requested a free Long-Term Care Planning
Kit made available by HHS. This response rate is significantly higher
than comparable private sector direct mail campaigns which might see
responses of 0.5-2.0 percent.
The concepts of the Own Your Future Campaign were incorporated into
the Choices demonstration because studies show that many people do not
think about their future long-term care needs and therefore fail to
plan appropriately. If individuals and families are more aware of their
potential need for long-term care, they are more likely to take steps
to prepare for the future. From a public policy perspective, increased
planning for long-term care is likely to increase people's ability to
remain at home with better use of their own resources, and may also
reduce pressures on public programs.
The second initiative, the Aging and Disability Resource Center
program, was launched in 2003 by the AoA and CMS, to help people plan
ahead for their long-term care, and address the immediate problems
consumers face when they try to learn about and access needed care.
This program builds on the strength and experience of the extensive
aging network by providing competitive grants to States to assist them
in developing and implementing coordinated access to information,
individualized advice to consumers on their options, and streamlined
eligibility determination for publicly supported programs, including
OAA, State revenue programs and Medicaid long-term care services. The
goal is to have ADRCs serving as ``visible and trusted'' sources where
people of any age or income can turn to get information and
personalized assistance on options that are available in their
community. By streamlining access to publicly supported care options,
ADRCs also reduce the confusion and frustration people encounter when
they try to access the various programs with different, and often
duplicative, eligibility forms, requirements, and procedures.
To date, AoA and CMS have provided close to $40 million to fund
ADRC projects in 43 States. In the first 24 funded States, 66 pilot
sites opened and now provide specialized information and assistance to
the elderly and people with disabilities. All of the pilot sites are
now implementing activities that streamline access to publicly funded
long-term care. These activities include: the use of uniform assessment
and eligibility determination processes; using integrated management
information systems; developing websites to streamline access to
information and eligibility determination; developing electronic
applications for Medicaid eligibility; co-location of aging services
and Medicaid eligibility staff; and outreach to hospitals and nursing
homes to divert or transition consumers from institutional placement.
Under this joint initiative, AoA and CMS are giving States
considerable flexibility in how to best implement their ADRC programs.
For example, Ohio is using the ADRC to create multiple avenues by which
consumers and their caregivers can access the ADRC network, via
internet, phone or in-person. These new consumers and their caregivers
will experience a seamless process in accessing information and
services, including long-term care and related services such as
housing, transportation, and employment. The South Carolina ADRC
efforts are being spearheaded by the Lt. Governor's Office on Aging
which is piloting an ADRC in two counties, Aiken and Barnwell. One of
the most exciting efforts underway in the South Carolina project is the
launching of Medicaid eligibility e-forms and the co-location of
Medicaid staff at the local level. As a result of the successful
development of an electronic application for Medicaid, the State is now
considering developing e-forms for other applications. South Carolina
is also using the ADRC model to develop a ``No Wrong Door'' approach
where consumers can access an integrated array of home and community-
based supports accessible by telephone, internet and personal
appointments.
Targeting High-Risk Individuals
Choices will test ways to provide States and communities greater
flexibility under the OAA to help individuals who are at high risk of
institutional placement but not eligible for Medicaid to remain at home
and delay their premature entry into nursing homes. The Community-
Living Incentive (CLI) component of Choices is similar to ``Money
Follows the Person''--with the difference being that CLI will help
people before they go into nursing homes, while the recently enacted
``Money Follows the Person'' initiative is targeted at people who are
already in nursing facilities.
Currently, OAA dollars are allocated to specific service
categories. Under the CLI, program dollars will be tied directly to
consumers and their unique functional needs and circumstances. This
way, States and communities will have the flexibility to provide the
necessary assistance to help a senior stay at home. CLI will
incorporate the Cash and Counseling approach into the OAA.
The Cash and Counseling model has been tested through a controlled
experiment conducted over several years in New Jersey, Arkansas and
Florida with funding from the HHS Assistant Secretary for Planning and
Evaluation and the Robert Wood Johnson Foundation. This model gives
clients control over individualized budgets to manage the types of
services and supports they received and the manner in which they were
provided. This included the option of hiring a member of their family,
a friend or a neighbor. The results showed three major positive
outcomes when compared to those achieved under the traditional model of
care: enhanced consumer satisfaction; improved quality of care; and an
absence of fraud and abuse. HHS made it a policy to encourage States to
use the Cash and Counseling option under their Medicaid home and
community-based care programs, and now want to do the same with the OAA
program.
Prevention into Long-Term Care
Choices will also test strategies that best empower older
individuals to make lifestyle changes to reduce their risk of disease,
disability and injury. Most long-term care needs emerge from chronic
diseases and other conditions, such as arthritis, diabetes, heart or
lung disease, stroke and dementia, as well as from injuries suffered as
a result of a fall or other accident. These conditions and their
effects can be mitigated, even for people who are very old, through
life-style changes and disease management programs. In acute care we
have learned the importance of prevention. Prevention is equally
important in the long-term care system.
There is a growing body of scientific research from the National
Institutes of Health, the Centers for Disease Control and Prevention,
and the Agency for Healthcare Research and Quality and others,
documenting the effectiveness of evidence-based programs in reducing
the risk of disease, disability and injury among the elderly. To
reinforce the utility of the aging services network as a vehicle for
making these evidence-based programs more widely available at the
community level, the AoA launched an Evidence-Based Prevention Program
in 2003 in partnership with NIA, CDC, AHRQ, CMS and the John A.
Hartford, Robert Wood Johnson, and several smaller foundations. AoA
funded more than a dozen local projects with models that focus on
disease self-management, fall prevention, nutrition, physical activity,
medication management, and depression. These models hold considerable
potential for long-term improvement in the quality of life and lowered
health care costs.
One example of a very successful model is the Chronic Disease Self-
Management Program developed at Stanford University. This program
begins with a six week workshop designed to empower and educate people
with various chronic diseases to better mitigate and control their
symptoms. The program significantly improves participant health status
and reduces the use of hospital care and physician services. Another
evidenced-based model is a program developed at Yale University to
prevent falls. Falls are a leading cause of serious injury and death
among the elderly and are a major contributor to health costs. The Yale
program uses a multifaceted approach to help older individuals cope
with key risk factors. Participants are trained to improve balance,
gait and posture, better manage their medication, and to remove home
hazards. The program significantly reduces the incidence of falls among
participants.
A culturally sensitive nutrition program launched by the Alamo Area
Council of Governments in San Antonio, Texas is another model program
that is helping low-income, Hispanic seniors head off diabetes before
it starts. The program is based on a landmark study by the Diabetes
Prevention Research Group which showed that diet and exercise could
effectively delay the onset of Type 2 diabetes--even in adults who are
already showing glucose intolerance. Participants in the program
receive regular health monitoring and eat specially prepared ``tex-
mex'' lunches at their local nutrition center. They also take part in a
three-day-a-week education program that promotes physical activity,
healthy cooking practices and better disease self-management. Sponsors
have set a goal that participants will increase their physical activity
to at least 150 minutes per week and experience a seven percent weight
loss.
Finally, the Partners in Care Foundation in Burbank, California is
helping low-income older adults who are homebound improve their health
through an evidence-based exercise program. The activity portion of
this intervention is modeled after a research-tested approach called
``LifeSpan: A Physical Assessment Study Benefiting Older Adults.'' The
approach was developed by researchers at California State University at
Fullerton. After an initial assessment, clients are taught a variety of
easy exercises by professional care managers and receive ongoing
support and encouragement from volunteer peer coaches. The care
managers monitor clients' participation during regularly scheduled
appointments and reassess them at six-month intervals.
Reauthorization of the Older Americans Act: Another Opportunity for
Long-Term Care Systems Change
The reauthorization of the OAA provides a unique and timely vehicle
to accelerate the changes needed in long-term care policy to help our
nation fully prepare for the aging of the baby boom and the emergence
of long-term living as a common experience of life. When the OAA was
passed in 1965, Congress charted out a vision for a nationwide network
of public and private agencies organized around the common purpose of
promoting the dignity and independence of older people through a
coordinated system of services and supports to help them live in their
own homes and communities for as long as possible.
The network envisioned in the OAA is now a reality. It is a
consumer-driven, locally designed, nationwide infrastructure, supported
by multiple funding streams, and capable of reaching people with low-
cost social interventions long before they need intensive services. OAA
programs have reached people of all income levels, while targeting its
limited resources to those most in need, including low-income minority,
rural or isolated populations. Early reauthorizations of the OAA
created area agencies on aging and fostered the principle of local
flexibility through a ``bottoms-up'' planning process that ensures OAA
programs continually reflect local needs and conditions.
Many States have looked to their aging network to lead the
development of their long-term care systems, including States with the
most balanced and cost-efficient systems of care such as Oregon,
Washington and Vermont. The OAA network is one of the largest providers
of home and community-based care and manages between $3 and $4 billion
each year in public and private resources. All State Agencies on Aging
have the responsibility to administer State revenue programs; over 30
State agencies administer Medicaid Waiver Programs and State Health
Insurance Assistance Programs; over 25 States have the authority of the
State Aging Agencies to serve younger populations with disabilities.
In short, the aging services network created by the Older Americans
Act and led by the AoA is well positioned to help ensure the
modernization of long-term care in our country. I have tremendous
respect for and confidence in the long-term care network I have spoken
about today. The Administration supports your efforts to reauthorize
the OAA and I commend the Committee for producing bipartisan, draft
legislation that will further strengthen programs and services for
older Americans and their caregivers. I am particularly pleased that
the draft legislation promotes home and community-based supports to
help older individuals avoid expensive institutional care so that they
can age in place as all older individuals desire to do. While the draft
does not include the Administration's proposed demonstration program,
by incorporating the principles of the Choices proposal, the draft
legislation will advance ongoing efforts to streamline access to
information and benefits, help promote health by reducing risk of
disease, disability, and injury, and most important, empower older
individuals to make informed decisions about their care options. The
Committee's draft legislation reflects the changing needs of the aging
system and the older individuals it serves. As you move forward in the
reauthorization of the reauthorize the OAA, I and looks forward to
continue working with you to modernize and strengthen our nation's home
and community-based long-term care system.
I am proud to have served in this network for more than 34 of its
41 years. I truly believe, with the support of Congress, our
reauthorization proposal and principles will give consumers the choices
they need to lead more healthy and productive lives.
Thank you, Mr. Chairman, for the opportunity to speak to you today
about the reauthorization of the Older Americans Act. I would be
pleased to answer any questions you may have.
______
Chairman Tiberi. Mr. Bishop.
STATEMENT OF MASON BISHOP, DEPUTY ASSISTANT SECRETARY FOR
EMPLOYMENT TRAINING ADMINISTRATION, U.S. DEPARTMENT OF LABOR
Mr. Bishop. Mr. Chairman, and members of the subcommittee,
I am pleased as well to have the opportunity to testify before
you today to discuss reauthorization of the Older Americans
Act, and the Senior Community Service Employment Program as
authorized by Title V of the act. The Department of Labor's
flagship program in serving older workers with barriers to
employment is SCSEP, the workforce investment program targeted
exclusively to low-income seniors.
SCSEP serves persons 55 years of age or older, whose family
incomes are no more than 125 percent of the Federal poverty
level. Participants are placed in a part-time community service
assignment in a local nonprofit agency so that they can gain
on-the-job experience and prepare for unsubsidized employment.
There are currently 69 SCSEP grantees, including 13
national grantees and 56 units of State and territorial
governments. The draft bill on which we have been asked to
comment incorporates a number of key features of the
administration's legislative proposal, and we do appreciate the
bipartisan efforts of this subcommittee.
Let me talk about some of the principles that this bill
reflects that we also have in the reauthorization of the SCSEP
program. First is increasing the minimum age for eligibility.
Like the draft bill, our proposal increases the minimum
eligibility for the SCSEP program from age 55 to 65. The
Workforce Investment system is capably serving the workforce
needs of individuals under age 64 through the Workforce
Investment Act and other sources, and we feel that limited
SCSEP resources should be targeted to an older age group of
Americans.
The draft bill, consistent with our proposal, also sets
aside 1.5 percent of appropriated SCSEP funds for outreach to
businesses and older workers, demonstrations and pilots,
training and technical assistance, as well as dissemination of
best practices. The Department also proposes to clarify the
income eligibility standard and stipulate what type of
participant income should count when the income eligibility
test is applied to each applicant. We believe the
standardization will increase applicant and public confidence
that the program is being administered in a consistent and
equitable manner.
Second, the bill does focus on employment outcomes. Both
the draft bill and your proposal do enhance the employment
focus of the program by, first, increasing the percentage of
grant funds that grantees may spend on training to provide
participants with the skills needed to obtain unsubsidized
employment.
Second, it authorizes occupational training before or
concurrent with community service.
Third, it does limit to 2 years the transition from
community service to unsubsidized employment to encourage
grantees to prepare their participants for work, to invest in
skills development, and to work closely with local employers
with a need for skilled, experienced workers. Finally, it does
eliminate most fringe benefits that are inconsistent with a
short-term taxpayer-funded employment and training program.
Next, the bill does strengthen performance accountability
and, like our proposal, uses the common performance measures
for workforce programs, holding grantees accountable for three
basic measurements: first, entered employment; second,
retention in employment; and, third, earnings. Grantees would
also track additional outcomes unique to SCSEP, such as
provision of community service.
Next, the one feature of the administration's proposal that
isn't included in the draft bill is to streamline the program
structure by allocating funds for the SCSEP program to States
according to a statutory formula.
Under our proposal, each State would compete their funds
among nonprofit entities, for-profit entities, and agencies of
State government to operate the program in their State. No
national competition would be necessary.
Separate grant awards would be retained for Indian and
Asian Pacific islander organizations. We believe this method of
soliciting applicants in awarding grants would simplify
administration, eliminate duplication, reduce overhead costs
and create a more cohesive program.
We do believe the draft bill makes significant improvements
to the SCSEP program. It better targets the eligibility to
those most in need, enhances the employment focus of the
program, strengthens the performance accountability system and
better coordinates the program with the Workforce Investment
System.
Mr. Chairman, this concludes my prepared statement, and we
do look forward to working with you on reauthorizing the Older
Americans Act. We are hopeful that, working together, this
important legislation can be enacted later this year.
I would be happy to answer any questions that the committee
might have.
[The prepared statement of Mr. Bishop follows:]
Prepared Statement of Mason M. Bishop, Deputy Assistant Secretary of
Labor for Employment and Training, U.S. Department of Labor
Mr. Chairman and Members of the Committee: I am pleased to have the
opportunity to testify before you today to discuss the reauthorization
of the Older Americans Act (OAA). For over 40 years, the Department of
Labor has administered the Senior Community Service Employment Program
(SCSEP), authorized by Title V of the Older Americans Act.
Before discussing our efforts to employ older workers and the draft
legislative proposal for reauthorizing Title V, I would like to say a
few words about America's aging population and workforce, and provide
context on where SCSEP fits in the broader workforce investment system.
The Aging Population and Workforce
The U.S. economy is entering a period of dramatic demographic
change as our population ages. According to the Census Bureau's
American Community Survey, 12 percent of the total population in 2004
was aged 65 or over, and this percentage is set to expand rapidly in
the coming decades. After the first Baby Boomers turn 65 in 2011, the
older population will become twice as large by 2030 as it was in 2000.
Further, as a result of lower birth rates in recent years, combined
with the aging and retirement of the baby boom generation, the American
workforce is growing at a slower rate. The changing demographics of the
labor force, in combination with the ever-increasing skill demands of
employers, have made it more critical that every available worker,
including older Americans, be able to join or remain in the workforce
to enable the continued competitiveness of American businesses in the
21st century.
Barriers to Employment Faced by Older Workers
The Baby Boomer cohort of older workers has different
characteristics than in years past. Far more women have experience in
the workforce than their counterparts a generation ago. More of this
cohort are caring for grandchildren, and most envision a very different
retirement than that of their parents--one that includes at least some
work, whether for social engagement, intellectual stimulation, or
because of financial necessity. However, despite a need for their
skills and their desire to remain in or re-enter the workforce, many
older Americans find themselves unable to find suitable work. Limited
opportunities for flexible work schedules, outdated technology skills,
pension plan disincentives, and a reluctance by some employers to hire
older workers all limit the full potential of this productive,
experienced cadre of workers.
There is a resource available to help. The workforce investment
system, which includes SCSEP, plays an important role in helping older
workers gain the necessary skills and access the employment
opportunities that will enable them to continue working. The workforce
investment system also helps connect employers to the experienced and
skilled workforce they need, including older workers, in order to
compete in the 21st century global marketplace.
Response by the Department of Labor to an Aging Population
Some employers already recognize the value that older workers bring
to the workplace. They know that older workers are a human capital
asset, serving as effective mentors to younger employees and bringing
responsibility, loyalty, dedication, experience and skills to the
workplace.
Still, more needs to be done to provide older workers with job
training opportunities and better connections to employers looking to
hire them. At the Department of Labor, we are taking steps to enhance
the effectiveness of our programs as well as brokering better
relationships with partner federal agencies and other organizations
serving older American workers.
Protocol for Serving Older Workers
In January 2005, the Employment and Training Administration (ETA)
issued a national ``Protocol for Serving Older Workers.'' This
important step in enhancing services to older workers was disseminated
throughout the workforce investment system. The protocol seeks to
enhance the services provided to older workers, and inspire the
workforce investment system to pursue innovative strategies for tapping
into this labor pool and connecting them with the job market. The
protocol outlines a set of action steps that key stakeholders can take
to achieve the goal of connecting employers with older workers. The
stakeholder groups addressed in the protocol are: (1) the U.S.
Department of Labor; (2) State and Local Workforce Investment Boards;
(3) One-Stop Career Centers; (4) mature worker intermediaries and
service providers; and (5) business and industry.
Older Worker Projects and Initiatives
Older Worker Task Force
To build on the Protocol for Serving Older Workers, the Employment
and Training Administration convened a DOL-wide Older Worker Task Force
last year to explore the key issues related to the participation of
older workers in the labor market. To continue the work of that task
force, and in response to a GAO recommendation and a request from the
Senate Special Committee on Aging, the Department of Labor is convening
an inter-agency federal task force to focus on the aging of the
American workforce and the impact of this demographic change. The Task
Force on the Aging of the American Workforce brings together agencies
from across the federal government to work collectively to address the
workforce challenges posed by an aging population. The first meeting of
the task force is May 5.
Assistant Secretary for Employment and Training Emily Stover
DeRocco will chair the task force, which will identify and assess ways
to address the barriers that prevent older workers from remaining in,
or re-entering, the labor market and the impediments that prevent
businesses from taking full advantage of this skilled labor pool. The
task force's recommendations will be submitted to the Secretaries of
all the participating federal agencies, and may form the basis for
future recommendations for the President and members of Congress.
Now I would like to turn to the Senior Community Service Employment
Program (SCSEP), a workforce investment program targeted exclusively to
low-income seniors.
Title V: The Senior Community Service Employment Program
SCSEP serves persons 55 years of age or older whose family incomes
are no more than 125 percent of the federal poverty level. Participants
are placed in a part-time community service assignment in a local non-
profit agency so that they can gain on-the-job experience, and prepare
for unsubsidized employment.
The Fiscal Year 2006 appropriation for SCSEP is $432 million. This
funding will result in approximately 92,300 people participating during
Program Year 2006 (July 1, 2006-June 30, 2007). There are currently 69
SCSEP grantees, including 13 national grantees, and 56 units of state
and territorial governments.
Program participants receive training and work experience in a wide
variety of occupations, including nurse's aides, teacher aides,
librarians, gardeners, clerical workers, and day care assistants at
non-profit 501(c)(3) organizations and public agencies. Program
participants also work in the health care industry, such as in
hospitals, as well as in recreation parks and forests, education,
housing and home rehabilitation, senior centers, and nutrition
programs. They are paid the highest applicable minimum wage, be it
federal, state or local, or the prevailing wage for persons employed in
similar public occupations by the same employer.
Before I turn to the SCSEP reauthorization proposal, I'd like to
discuss two of the recent developments in our management of SCSEP: 1)
the implementation of electronic performance reporting, and 2) the
competition for SCSEP national grants.
Electronic Performance Reporting
Electronic performance reporting has improved the accuracy and
timeliness of our performance information, providing more immediate
feedback on the outcomes of SCSEP participants and enhancing our
management of the program. To accommodate the collection of data for
the SCSEP statutory performance measures as well as the common measures
for federal job training programs, the Department provided grantees
with a software program that has allowed them to collect performance
data through their existing management information systems. Each
quarter, grantees electronically submit performance data files, which
are then consolidated into a single database.
The next step in the evolution of SCSEP performance reporting is
the Internet-based SCSEP Performance and Results Quarterly Performance
Report system (SPARQ), to be launched in May. This system will allow
grantees to maintain their records via the Internet, reduce grantees'
reporting burden and enhance report accuracy.
SCSEP Grant Competition
In addition to electronic reporting, the other significant
development in our management of SCSEP is the current grant
competition. On March 2, 2006, the Department announced a grant
competition for the SCSEP national grantees. This is the second time we
have competed the SCSEP national grants; the first was three years ago.
That competition opened the door for four new national grantees, and
spurred innovation in service delivery and program administration among
the other national grantees. Grants funded by the current Solicitation
for Grant Applications (SGA) will be for Program Year (PY) 2006, which
begins on July 1, 2006. This SGA is designed to strengthen program
administration, including management systems, service delivery and
program performance.
The SGA is designed to improve program efficiency by encouraging a
regional service delivery architecture in order to reduce fragmentation
of service delivery areas. For instance, rather than having multiple
grantees per county, which creates confusion for participants as well
as unnecessary administrative burdens and expenses, a grantee must
serve an entire county except in very large urban counties. In
addition, we have provided enough time for an orderly transition, and
we remain confident that this competition will promote better services
to participants and foster additional program improvements.
I'd like to now discuss the Administration's proposal for SCSEP
reauthorization.
Legislative Proposal for SCSEP Reauthorization
The draft bill on which we have been asked to comment incorporates
a number of the key features of the Administration's legislative
proposal. The draft bill is an important step in improving the SCSEP
program for the needs of the 21st century labor market. We look forward
to working with the Committee on this important piece of legislation.
The Department's key reform principles are largely reflected in the
draft bill by 1) increasing the minimum age for eligibility, 2)
enhancing the focus on employment outcomes and training for
participants, 3) strengthening the capacity of the One-Stop Career
Center system to serve older workers, 4) strengthening performance
accountability, and 5) streamlining the program structure.
Increasing the Minimum Age for Eligibility
The draft bill, like the Administration's proposal, increases the
minimum eligibility age from 55 to 65, while allowing for exceptions
for individuals aged 55-64 with certain barriers to employment.
Currently, 56% of SCSEP participants are aged 55-64. We believe the
workforce investment system should be the primary deliverer of services
for individuals age 55-64, and in fact, our One-Stop Career Centers are
already serving this population. To facilitate a smooth transition to
the new age minimums, we also support the exceptions to allow SCSEP
programs to assist those individuals aged 55-64 who have barriers to
employment.
In order to enhance the capacity of the One-Stop Career Centers to
effectively serve individuals age 55-64, the draft bill, consistent
with our proposal, sets aside 1.5 percent of funds for national
activities to provide policy guidance, fund demonstrations and pilots,
and disseminate best practices on serving older workers.
The Department also proposes to clarify the income eligibility
standard for SCSEP, and calls for specifying what participant income
should be considered when the income eligibility test is applied.
Standardizing the income eligibility for SCSEP assures that the program
is administered in a consistent and equitable manner.
Focusing on Employment Outcomes
The draft bill also reflects the Department's legislative principle
of enhancing the employment focus of the program. Included in the draft
bill is a provision to limit to two years, with a limited exception,
the time for participants to obtain unsubsidized employment. The time
limit encourages grantees to prepare their participants for work,
invest in skills development, and work closely with local employers to
provide meaningful work opportunities.
In order to reinforce the short-term training aspects of the
program, the draft bill, consistent with the Administration's proposal,
eliminates most of the participant fringe benefits that are allowable
expenditures under current law. The exceptions to this prohibition
include benefits that are required by law (such as workers'
compensation), the costs of physical examinations, and necessary sick
leave that is not part of an accumulated sick leave program. Funds
under the proposed legislation cannot be used for the cost of pension
benefits, annual leave, accumulated sick leave or bonuses. It should be
noted that many grantees have already eliminated fringe benefits, such
as annual leave and cash outs of leave benefits. With that said, this
provision brings SCSEP in line with other short-term training and
employment programs administered by the Department, allowing for a more
effective and cost-efficient administration of the program.
The bill also incorporates the Department's proposal to allow a
greater proportion of grant funds to be used for training and
supportive services. Specifically, the current law requirement that
``no less than'' 75 percent of grant funds be expended on wages is
lowered to 65 percent, providing grantees with greater flexibility to
use those funds to provide training to enhance workers skills and
provide related services.
Strengthen Performance Accountability
The draft bill also incorporates the Department's proposal to
include the use of common performance measures, which holds all
grantees accountable for entered employment, retention in employment,
and earnings. Grantees would also track additional outcomes, such as
the provision of community services that are unique to SCSEP. The
common measures are currently being implemented under administrative
authority. This change ensures that the statutory requirements reflect
current administrative practice.
Streamline Program Structure
One feature of the Administration's proposal not included in the
draft bill is to streamline program structure by allocating funds
exclusively to states according to a statutory formula. Under our
proposal, each state would then competitively select one or more
grantees to operate the program in their state. A competition would
have to take place at least once during each three-year period. This
method of awarding grants would simplify administration, eliminate
duplication, reduce overhead costs, and create a more cohesive program.
It also is consistent with the management recommendations included in
the Program Assessment Rating Tool (PART) review of the SCSEP program.
Eligible entities for state grants would include non-profit entities,
for-profit entities, agencies of state government, or a consortia of
agencies and/or organizations, including political subdivisions.
The Department envisions that national aging organizations would
continue to play a major role in operating the SCSEP program in the
states. However, the program would be streamlined by avoiding the
current situation of having multiple national sponsors and the state
program operating side-by-side in a state, sometimes administering
programs with small numbers of positions.
Closing
Mr. Chairman and Members of this Committee, we believe the draft
bill makes significant improvements to the SCSEP program. It better
targets eligibility to those most in need, enhances the employment
focus of the program, strengthens the performance accountability
system, and better coordinates the program with the workforce
investment system. We look forward to working with you and the Senate
on reauthorizing Title V of the Older Americans Act. Working together,
we are hopeful that this important legislation can be enacted this
year.
Mr. Chairman, this concludes my prepared statement. At this time I
would be pleased to answer any questions that you or other Committee
members may have.
______
Chairman Tiberi. Thank you both for your testimony. I want
to defer my time or exchange my time with my colleague from
Nevada, Mr. Porter.
Mr. Porter. Thank you, Mr. Chairman. I appreciate the
hearing today and all the work that has been put into this
legislation on both sides of the aisle. I appreciate it
greatly. Thank you for your testimony.
I do have a couple of questions. There seems to be a strong
consensus that our collective goal should be to minimize
nursing home care in favor of community-based care. What are
the top two or three actions that you think should be taken to
achieve this goal?
Ms. Carbonell. Congressman, I think that what we are doing
right now--first of all, I think I want to say, to begin with,
that the act is one of the most important pieces of legislation
that exists and has transpired over the last 40 years to
create. The only piece of legislation that the main mission is
to keep people at home in their communities.
I think that building up to what--the system of care that
we have built throughout the entire Nation serves as a very
important core as we move forward.
I think that if we look at the kinds of things that we need
to do, first is we really need to modernize the way that we
provide long-term care access and assistance in this country. I
think that at present there is an institutional bias to long-
term care access. People are really often denied a less
expensive community care option at the expense of institutional
placement.
I think that the experience in the 4 years that we have
been funding and investing in aging and disability resource
centers have really given us the opportunity to foster that
integration of both the information and the access systems for
long-term care between CMS or ourselves.
I think the second way that we can improve the ability to
achieve a better access, or in favor of home and community-
based care, is really allowing the Older Americans Act network
to serve private-pay clients. Currently we have restrictions
that really deny high-risk individuals of a viable low-cost
option to prevent spend-down to Medicaid. So we really need to
target high-risk people and serve them before they are placed
in nursing homes and spend-down to Medicaid.
Giving us the authority to be able to serve those private-
paid clients and add them to the core that we are able to serve
is a second viable way.
I think the third piece is the prevention piece. I think
building our best science, our evidence-based health promotion
programs, and modernizing the way that we focus our health
promotion programs through nutrition and through other very
important chronic disease management vehicles that have been
tested at the Institutes of Health and our best research
institutions is the third way.
If we can delay and help delay the onset of those chronic
conditions, or being able assist people with common simple
tools to assist them with their lifestyle changes and
management of their chronic conditions, I think that is the
third-most important piece that we need to build into an
integrated system. It is both modernizing the way we access, or
people access, from a fragmented system right now to a more
consumer-driven single point or ``no wrong door'' kind of
approach; secondarily, giving us the ability to serve people
that have the ability to pay before they spend out and end up
in nursing homes.
What we are doing is virtually giving us the ability to
have those people spend their money in home and community-based
care so they can remain at home, which is what they wish to do.
Mr. Porter. Thank you. I don't have an additional question
but just a comment on how successful the program has been in
our State of Nevada and communities in the past. Not only the
program, but a unique caliber of individuals who help with
these programs. They are very special as they touch and provide
such a change in lives for seniors.
I applaud you and look forward to this bill being passed.
Thank you.
Chairman Tiberi. Mr. Hinojosa.
Mr. Hinojosa. Thank you, Mr. Chairman.
Ms. Carbonell, you have really supported the act with all
of your comments. I appreciate listening to your presentation.
You have praised program efforts that are successfully
operating within limited budgets.
Only last Friday, at our field hearing in Ohio, we heard
the tremendous increase in population that is coming into this
program. We also heard a strong, very emphatic call for
additional financial resources.
What is your recommendation to the administration in this
regard?
Ms. Carbonell. Well, the President's budget has been
submitted and it stands there for the record. We would be
pleased to talk to you about that if you need further details.
I think the most important--the most important issue at
hand is that we have built this network and that we manage--
that this network not only manages $1.2 billion of Older
Americans Act funds, but actually manages a total of about $4
billion both in Older Americans Act and Medicaid waiver dollars
and other State- and community-based programs. So that means
that the Older Americans Act was never intended to be the sole
source of funding for aging programs in our communities.
The beauty of this act--and I think that all of us that
have worked from the community level into all the levels of
involvement at the State and the Federal level--the beauty of
the act has been the network that we have created. It leverages
$2 for every dollar of Federal investment that we put in
communities. For specialized and home and community-based
services, we leverage $3 for every dollar we invest.
Mr. Hinojosa. Ms. Carbonell, I am going to interrupt you
because I want to ask some questions of Mr. Bishop also.
I have to agree to disagree with you. I gave in my remarks
that the amount of the money that is being spent today, based
on 1980 figures, is cut in half. So if the purchasing power is
cut in half, and the population coming into the programs is
rising at about 50 percent during the last 20 years, it doesn't
square to hear what you are just telling me. So I am just going
to agree to disagree with you, and my recommendations are going
to be that we find the additional resources.
I would like to ask Mr. Bishop--I also wish to thank you
for your comments. It is interesting that you haven't included
any statements on why the Department wants to increase the
placement of clients from 20 percent to 30 percent. We have
asked for data as to the placement rates regarding the younger
age, 55, to the older workers, age 65.
Do you have any data that would give us a better
understanding of what this legislation is trying to do and what
it would--indeed, what the impact would be?
Mr. Bishop. Thank you, Congressman. I apologize if there is
data you feel you have asked for that you haven't received. We
have tried to be responsive to the committee and each of the
individual members. If there are some particular data points or
sets that you have not received, we will make sure we get those
up here right away.
Let me just overall--that this particular law is a
balancing act in Title V. The balancing act is between the goal
of providing community service and the inherent positives as a
result to communities of those activities, and then also
helping the individual participants within the program in terms
of their personal economic needs and employment goals.
What we essentially are trying to craft here is a better
balance between those two principles. In no way do we feel that
our legislative proposals in any way restrict or hurt the
community service part of this legislation. In fact, we don't
get rid of it, we don't diminish it in any way. What we try to
do, then, is enhance the employment side, in that we see
community service as one important avenue by which many
individuals can gain the skills necessary to them to enter into
unsubsidized employment.
We feel it is important in two respects why we need to help
on the employment side. First is that for that individual
participant, it is more likely that he or she can make higher
wages in the unsubsidized market than they can on minimum wage
in the program over a long period of time.
Second, for every individual who stays on the program,
there is another individual sitting behind that person who
can't get into the program because that person is staying in a
slot. So what we have tried to do through issues like raising
the minimum threshold to 30 percent and some of the other
things I talked about in my testimony, is assure that those
individuals have the best opportunity to gain higher wages
through unsubsidized employment to meet their own personal
economic goals and needs, while at the same time not
diminishing the community service part of the program.
Mr. Hinojosa. Mr. Chairman, my time has run out. But if
there is an opportunity before this panel leaves, I would
certainly like to ask another question.
With that, I yield to give other members an opportunity to
ask questions.
Chairman Tiberi. Yes, thank you. I thank you, Mr. Hinojosa.
It would be my intent to come back around to you, depending on
the time limit of the witnesses.
Kind of just piggybacking on the comments that Mr. Hinojosa
just talked about with respect to the issue of SCSEP, how does
DOL work with AOA on administering that program?
Mr. Bishop. Well, we have the primary responsibilities,
obviously, for administering the program, but we try to
coordinate, when necessary and where necessary, with AOA. I
think we have had a very positive working relationship during
the time we have both been in the administration. Josefina, the
Assistant Secretary, has been there 4 or 5 years now, and I
think we have been there--my assistant secretary and myself
have been. It was one of our early connections. We have tried
to stay in touch and contact and coordinate issues as we have
gone along.
Ms. Carbonell. If I may add, Mr. Chairman, the other
vehicle that we also use is, of course, at the regional level
and the State plans, both our State plans under the Older
Americans Act on the program side, but also on the employment
side, we coordinate to make sure that it is in line with the
overall direction of the State to make sure that we include the
opportunities for additional employment opportunity, so that if
we access individuals through our network that are in need of
employment, that we make sure that we refer them to the
appropriate channels to the employment programs present in the
State for employment; that we also serve as hosts, serve as
hosts for the community service part, creating a whole array of
training opportunities and on-the-job training for these
individuals, particularly in limited English-speaking minority
communities where we know that this is a very important vehicle
to transition from low skills to some kind of average skills,
so people can access employment, other employment training
skills. Then, of course, with being able to coordinate at the
local level between the employment and training of the
Workforce Investment Act network and our aging network, our
aging services network.
Chairman Tiberi. Thank you. Ms. Carbonell, you have made a
pretty strong case to me, previous to this hearing, that
reauthorization of the Older Americans Act can have significant
savings to mandatory programs like Medicaid and Medicare
through a variety of avenues of prevention and delaying or
maybe preventing someone from going into a nursing home.
Can you talk to the committee for the record a little bit
about that, stand upon your testimony?
Ms. Carbonell. I think if you look at the Choices for
Independence proposal, of course our Choices for Independence
proposal is a reasonable proposal with, of course--in the
limited financial times that we are living here, the
President's budget for the Choices for Independence is included
at the tune of $28 million as a starting point. But it builds
upon some of the strategic investments that we have been doing
in our discretionary line item of Title IV for 5 years now.
Again, we believe that the Choices has the same kind of
potential to expand the use of low-cost community care options
without increasing public cost, particularly over the long run.
Of course, assigned work in a strategic period of time, we are
using Choices that are really based on the same, the kind of
best practices and cost savings potential that underpinned the
changes now occurring in Medicaid, including the changes
contained in the Deficit Reduction Act just recently passed.
Choices is not a new policy direction. At its core, the
reality is that the strategy for leveraging the unique assets
of the act and of the services network already in place in
communities across the country is to support our current
rebalancing agenda; again, assisting people to provide people
with more options to remain at home. We will do this also
through the private-pay individuals, allowing people to have
the ability to pay and to use their own resources. And, again,
for the three very important integrated approaches--the
activities, the access point, the assistance and the
prevention--to evidence-based programs for maintaining chronic
conditions, and then a targeting of the highest risk of
institutionalization and spend-down.
Again, we also believe that once a private-pay individual
really reaches a nursing home or ends up in a nursing home,
there goes all the money for that individual. We want to have
the ability to be able to reach those people and intervene at
that point in time and provide them with the opportunity to
choose home- and community-based care options, which is what
they want to do right now.
Chairman Tiberi. Thank you. My time has expired. I
recognize the gentleman from Maryland, Mr. Van Hollen.
Mr. Van Hollen. Thank you, Mr. Chairman, thank you and Mr.
Hinojosa for your leadership on that. I just want to associate
myself with the earlier comments both of you made about the
importance of the Older Americans Act and thank our witnesses
out here for their testimony.
Mr. Bishop, I would like to focus a little on the proposed
changes to SCSEP. As I am sure you are aware, they have
generated some concerns in communities, certainly in my
district and other places around the country.
First, let me sure I get my math straight. As I understand
from your testimony, with the current appropriation the funding
results in approximately 92,300 people right now; that is from
55 on up. Is that correct?
Mr. Bishop. Correct.
Mr. Van Hollen. Your proposal is to change the eligibility
from 55 to 65. I understand from your testimony about 56
percent are currently between 55 and 64.
Mr. Bishop. That is correct, yes.
Mr. Van Hollen. Rough math says about 50,000 people who are
currently eligible, and part of the program will no longer be
part of the program under your proposal; is that right?
Mr. Bishop. Correct.
Mr. Van Hollen. Do you have any accommodation in here for
people? In other words, if you are 57 years old now and you are
in the program, under your proposal are you out, or is there
some accommodation for a transition period?
Mr. Bishop. There are accommodations for a transition. In
fact, the draft bill that we are discussing has some of those
accommodations, and we are in concurrence with those kinds of
discussions around making accommodations, both in terms of a
transition--in fact, in terms of permanently in the program,
there may be situations where it makes sense for an individual
55 to 64 who may need to access the program. But under our
proposal, and really reflected in the draft bill, those would
be on--there is a list of exceptions as to those individuals.
Mr. Van Hollen. Right. I know there are some exceptions.
Those will continue even under the existing bill; I mean, under
the proposed changes. But if you are, for example, 57 years old
now, are you assured, assuming you meet all the other
requirements, are you assured that you can continue in the
program. Or would your proposal knock you off?
Mr. Bishop. We would propose a transition period so that
individuals in that age group currently in the program could
complete their program. We wouldn't just kick those people off.
Mr. Van Hollen. Beyond the 2-year period you are talking
about.
Mr. Bishop. Well, that would be up to Congress in the draft
bill to decide how they wanted to handle that transition. That
is something we could discuss. We could propose a 2-year time
limit. If there was a 2-year time limit implemented, you could
start the clock at that point upon enactment of the
legislation, or there could be a transition period indefinitely
for those individuals.
Mr. Van Hollen. Right. I am not sure I am persuaded it is a
good idea to knock off these people. If we did, I think there
should be a transition to the program.
In terms of the group that are now currently over 65 years
old, do you have a--what kind of waiting list do you have in
terms of the slots?
Mr. Bishop. I don't have any data on exact waiting lists.
Again, we propose 65 years and older. As you have to do in many
of these programs, you have to make decisions in terms of
targeting. We just feel that, given the fact that we have a One
Stop Career system that does serve older workers, it has the
capacity to server more older workers--that those that are in
our country are really thought of from 55 to 64 as being
working age; that those individuals, many of those individuals,
could access and need access to services at One Stop Career
Centers system.
Currently the program, even with 55 to 64, only serves
about 1 percent of the eligible population. It really is a
question of given finite resources, given limited resources and
targeting, who should the program be targeted at? We think
those low-income seniors 65 or older are the ones that we
should be targeting.
Mr. Van Hollen. Just so I understand your testimony, the
rationale for this change is more because you think there is an
existing system in place, rather than to free up resources to
make room for more people over 65--is that right--because you
don't have any data on a waiting list?
Mr. Bishop. We don't keep a national waiting list per se.
We can go to each of the grantees and ask them, do you have a
waiting list for that age cohort, and get that information for
you if you would like us to. We don't keep a national waiting
list per se.
But you are correct in saying that the main premise behind
our proposal is that we ought to target those that are 65 and
older because we do have a comprehensive existing One Stop
program. Again, 99 percent of the individuals will need those
services potentially anyway. We feel that the program should be
targeted to 65 and older. OK.
Mr. Van Hollen. But it is very possible, as I understand
your testimony, that once these changes go into place, a lot
fewer people will be participating in the SCSEP program?
Mr. Bishop. No, we don't believe that actually. We would
maintain funding that would allow for 90,000-plus participants
that would continue to be served, but they would need to be 65
and older, with some limited exceptions potentially for 55 to
64.
Mr. Van Hollen. You have a 2-year provision in here now
that you go off after 2 years.
Mr. Bishop. Correct.
Mr. Van Hollen. So you believe today, you have got 92,300
or 55 to 64, you believe there are at least 50,000, 65 and up?
Mr. Bishop. I do. But we have currently right now, 9
million Americans who are within that total age cohort who are
potentially eligible for the program. So I think probably our
grantees could find 50,000 people out there that need services.
I do believe those individuals are there and could be served.
Chairman Tiberi. Thank you.
Can you all stay for a second round? You are so popular. I
am going to call on my Ranking Member here from Texas, Mr.
Hinojosa.
Mr. Hinojosa. Thank you, Mr. Chairman. I will try to be
shorter than the first 5-minute period you gave us. But I would
like to remind Mr. Bishop that you said that if we weren't
getting enough information, you would get it to us.
Mr. Bishop. Yes.
Mr. Hinojosa. That is the requirement with regard to the
questions that I asked about the placement from 20 to 30
percent. And then the second one was the placement rates,
changing the age from 55 to 65. I would like to get that in
writing so that I can see your analyses.
Mr. Bishop. OK.
Mr. Hinojosa. If you will, please, add a third request from
me. That is, I like computer-generated what-if scenarios that
would show me what it would do if we could improve this
legislation by phasing in that 55 to 65 over a 5-year period,
so that we would start with the 57, 59, 61s, all the way to 65,
every year moving it up too, so that it is phased in rather
than making that giant step from 55 to 65. I would like to see
what the impact is financially.
Mr. Bishop. From a data perspective; numbers?
Mr. Hinojosa. Yes.
[The information referred to follows:]
U.S. Department of Labor Responses to Follow-Up Questions From Messrs.
Hinojosa and Van Hollen
Question 1. Unsubsidized Employment Performance
Mr. Hinojosa: How many grantees meet 20% and 30% unsubsidized
employment performance measures for age groups 55-64 and 65+?
ETA response:
The common measure for ``entered employment''* is based on data
collected during Program Year (PY) 2004 (July 1, 2004-June 30, 2005)
and represents the most recent data for a complete program year
available:
---------------------------------------------------------------------------
*This response provides the information requested under the common
measure definition of entered employment, which differs from the
current SCSEP performance definition of placement. The difference
between the definitions is that the current SCSEP placement performance
measure has a duration requirement whereas the entered employment
common measure does not.
---------------------------------------------------------------------------
Seven of the 13 national grantees were within 5 percent of
the 30 percent threshold.
Forty-three of the 56 state and territorial grantees were
within 5 percent of the 30 percent threshold.
The average entered employment rate for all national
grantees was 36.7 percent.
The average entered employment rate for all state and
territorial grantees was 35 percent.
Attachment A details PY 2004 common measure entered employment
rates for all SCSEP grantees, by age group.
Question 2. Waiting Lists
Mr. Van Hollen: What is the number of people on SCSEP grantees
waiting lists, by age group?
ETA response:
SCSEP grantees are not required to maintain waiting lists. Although
some grantees do maintain waiting lists, their lists are not
necessarily comparable because DOL does not require a standardized
method of tracking. However, some SCSEP grantees have been voluntarily
keeping track of their waiting lists and reporting them along with
their required performance metrics. As of June 30, 2005, the last day
of the most recently completed Program Year, there were over 2,100
people on these waiting lists. Grantees do not track waiting lists by
age.
WAIT-LISTED SCSEP PARTICIPANTS AT THE END OF PROGRAM YEAR 2004
------------------------------------------------------------------------
Grantee Waiting list
------------------------------------------------------------------------
State grantee waitlist total............................ 914
National grantee waitlist total......................... 1,254
---------------
Nationwide waitlist total......................... 2,168
------------------------------------------------------------------------
It is important to note that the waiting lists are not a reflection
of the number of people who could be served by a reauthorized SCSEP
targeting resources to those older than 65. Waiting lists only reflect,
for grantees that maintain such lists, those eligible individuals who
approach a grantee for a placement and do not reflect the thousands of
individuals that could be reached by grantees through outreach efforts
to underserved populations and other recruitment strategies. In 2000, 9
million people were eligible for SCSEP programs, a number that has
since increased due to overall demographic trends.
Question 3. Phased-in Age Eligibility
Mr. Hinojosa: In order to construct a ``what if'' scenario where
SCSEP age eligibility was phased in from 55 to 65 over 5 years, what is
the unsubsidized employment rate for individuals 55-57, 57-59, 59-61,
61-63, and 63-65?
ETA response:
The table below illustrates one possible result of phasing-in age
eligibility. The first row presents the rate of exits for unsubsidized
employment under the current eligibility rules, using all exiters from
the first two quarters of this program year (July 1, 2005 through
December 31, 2005). Each succeeding row presents the change in the rate
of exits for unsubsidized employment when the age range is made two
years older. As evident from the table, there is approximately a 2
percentage point decrease in exits for unsubsidized employment for each
2 year increment in the lower age limit.
EXITS FOR UNSUBSIDIZED EMPLOYMENT
------------------------------------------------------------------------
Age ranges Number Percent
------------------------------------------------------------------------
55 and older............................ 9,199 41.2%
57 and older............................ 7,308 39.1%
59 and older............................ 5,690 36.6%
61 and older............................ 4,455 34.5%
63 and older............................ 3,391 32.1%
65 and older............................ 2,577 30.3%
------------------------------------------------------------------------
Please note that these figures are based on current participants,
grantees, and program structure. A reauthorized SCSEP program under the
draft bill will provide more flexibility to grantees to provide the
training needed for older workers to move into unsubsidized employment,
and will hold grantees accountable for their performance.
Question 4. Unsubsidized Employment Performance
Mr. Van Hollen: How many exiters move into unsubsidized employment,
by age?
ETA response:
Forty-eight percent of SCSEP program participants aged 55-64.99
move into unsubsidized employment upon exit of the program. Thirty
percent of participants who are older than 65 move into unsubsidized
employment upon exit of the program. Note that as the current SCSEP
program does not have a time limit, many participants who exit without
finding an unsubsidized employment placement do so because of failing
health or death.
Attachment A provides unsubsidized employment rates by grantee.
Attachment A
SCSEP PARTICIPANTS WHO ENTERED UNSUBSIDIZED EMPLOYMENT AFTER PROGRAM EXIT
[First half of program year 2005--July 1, 2005-Dec 31, 2005]
----------------------------------------------------------------------------------------------------------------
55-64.99 55-64.99 65+
(count) (percent) 65+ (count) (percent)
----------------------------------------------------------------------------------------------------------------
NATIONAL GRANTEES
National Council on the Aging, Inc.......................... 395 0.578 184 0.394
Forest Service.............................................. 143 0.500 68 0.360
AARP Foundation............................................. 2163 0.508 720 0.347
Senior Service America, Inc................................. 813 0.502 350 0.329
National ABLE Network....................................... 59 0.399 33 0.324
National Caucus & Ctr on Black Aged......................... 147 0.420 91 0.311
Experience Works............................................ 1161 0.451 435 0.269
Mature Services............................................. 54 0.545 18 0.261
Easter Seals................................................ 128 0.456 77 0.247
SER--Jobs for Progress National............................. 223 0.415 85 0.211
Asociacion Nacional pro Personas Mayores.................... 106 0.533 22 0.210
National Asian Pacific Center on Aging...................... 78 0.451 18 0.167
National Indian Council on Aging............................ 49 0.345 15 0.165
---------------------------------------------------
Total Nat'l Grantees.................................. 5519 0.486 2116 0.307
===================================================
STATE
Rhode Island................................................ 3 0.429 8 0.800
Oregon...................................................... 14 0.269 12 0.667
Iowa........................................................ 28 0.718 7 0.538
Virginia.................................................... 25 0.510 14 0.467
Mississippi................................................. 9 0.429 7 0.438
South Carolina.............................................. 13 0.500 6 0.429
New Mexico.................................................. 1 0.167 3 0.429
North Carolina.............................................. 26 0.510 17 0.415
Texas....................................................... 79 0.622 33 0.413
Colorado.................................................... 12 0.632 5 0.385
Alabama..................................................... 23 0.575 14 0.359
Guam........................................................ 4 0.250 8 0.348
Georgia..................................................... 41 0.519 18 0.340
Maine....................................................... 7 0.412 7 0.333
Tennessee................................................... 16 0.444 8 0.320
New York.................................................... 34 0.382 31 0.320
Connecticut................................................. 21 0.500 6 0.316
Delaware.................................................... 30 0.536 11 0.306
Maryland.................................................... 7 0.318 3 0.300
Oklahoma.................................................... 11 0.478 11 0.297
Ohio........................................................ 33 0.440 17 0.288
Wyoming..................................................... 14 0.560 2 0.286
Alaska...................................................... 50 0.476 8 0.286
District of Columbia........................................ 9 0.474 2 0.286
Indiana..................................................... 28 0.424 10 0.286
Illinois.................................................... 30 0.455 15 0.283
Florida..................................................... 92 0.455 46 0.275
Washington.................................................. 24 0.615 3 0.273
Arizona..................................................... 8 0.267 6 0.273
Wisconsin................................................... 33 0.440 8 0.267
Hawaii...................................................... 14 0.424 9 0.265
Kansas...................................................... 7 0.500 5 0.263
Pennsylvania................................................ 61 0.442 23 0.258
Massachusetts............................................... 24 0.511 9 0.250
Arkansas.................................................... 12 0.387 3 0.250
Utah........................................................ 17 0.378 4 0.250
Nevada...................................................... 18 0.340 12 0.245
Nebraska.................................................... 6 0.400 3 0.231
Montana..................................................... 7 0.350 3 0.231
Minnesota................................................... 14 0.341 4 0.222
Kentucky.................................................... 16 0.271 8 0.222
New Jersey.................................................. 10 0.303 6 0.207
Virgin Islands.............................................. 1 0.167 1 0.200
West Virginia............................................... 8 0.421 2 0.182
Michigan.................................................... 26 0.406 5 0.172
California.................................................. 85 0.464 15 0.161
Louisiana................................................... 14 0.424 2 0.100
Missouri.................................................... 12 0.293 3 0.083
South Dakota................................................ 8 0.333 1 0.067
Idaho....................................................... 5 0.455 0 0.000
New Hampshire............................................... 2 0.400 0 0.000
Vermont..................................................... 5 0.294 0 0.000
Puerto Rico................................................. 1 0.083 0 0.000
American Samoa.............................................. 0 0.000 0 0.000
Mariana Islands............................................. 0 0.000 0 0.000
North Dakota................................................ 0 0.000 0 0.000
---------------------------------------------------
State grantees........................................ 1098 0.445 464 0.287
===================================================
Nationwide............................................ 6617 0.479 2580 0.303
----------------------------------------------------------------------------------------------------------------
Numbers in bold indicate that the grantee failed to meet the 20% unsubsidized employment rate performance target
for participants older than 65. Numbers in italic indicate that the grantee exceeded 30% unsubsidized
employment for participants older than 65.
AVERAGE DURATION IN PROGRAM FOR NATIONAL GRANTEES BY AGE CATEGORY
[Exiters only*]
------------------------------------------------------------------------
Average
Grantee Age category Number days
------------------------------------------------------------------------
AARP........................ 55-59.99 4,491 181
60-64.99 2,994 218
65 and over 3,651 387
------------------------------------------------------------------------
National Able Network....... 55-59.99 151 215
60-64.99 107 306
65 and over 189 379
------------------------------------------------------------------------
Asociacion Nacional Pro 55-59.99 221 413
Personas Mayores...........
60-64.99 172 534
65 and over 190 434
------------------------------------------------------------------------
Easter Seals................ 55-59.99 390 202
60-64.99 291 262
65 and over 669 326
------------------------------------------------------------------------
Experience Works............ 55-59.99 2,340 578
60-64.99 1,752 782
65 and over 2,884 1,008
------------------------------------------------------------------------
Forest Service.............. 55-59.99 394 490
60-64.99 338 682
65 and over 510 653
------------------------------------------------------------------------
Mature Services............. 55-59.99 181 231
60-64.99 144 265
65 and over 248 392
------------------------------------------------------------------------
National Asian Pacific 55-59.99 154 381
Center on Aging............
60-64.99 161 564
65 and over 184 642
------------------------------------------------------------------------
National Caucus and Center 55-59.99 306 428
on Black Aged..............
60-64.99 337 650
65 and over 788 671
------------------------------------------------------------------------
National Council on the 55-59.99 694 282
Aging......................
60-64.99 566 419
65 and over 840 548
------------------------------------------------------------------------
National Indian Council on 55-59.99 203 404
Aging......................
60-64.99 136 404
65 and over 199 446
------------------------------------------------------------------------
SER-Jobs for Progress....... 55-59.99 485 245
60-64.99 494 303
65 and over 867 409
------------------------------------------------------------------------
Senior Service America...... 55-59.99 1,813 278
60-64.99 1,378 363
65 and over 2,436 446
------------------------------------------------------------------------
All National Grantees....... 55-59.99 11,823 312
60-64.99 8,870 422
65 and over 13,655 568
------------------------------------------------------------------------
*Numbers include only those who have exited the program, based on PY2004
data. Numbers in bold indicate duration higher than national average.
AVERAGE DURATION IN PROGRAM FOR NATIONAL GRANTEES BY AGE CATEGORY
[All participants*]
------------------------------------------------------------------------
Average
Grantee Age category Count days
------------------------------------------------------------------------
AARP........................ 55-59.99 3,208 302
60-64.99 2,237 371
65 and over 3,516 479
------------------------------------------------------------------------
National Able Network....... 55-59.99 142 231
60-64.99 111 361
65 and over 196 448
------------------------------------------------------------------------
Asociacion Nacional Pro 55-59.99 216 664
Personas Mayores...........
60-64.99 222 756
65 and over 246 777
------------------------------------------------------------------------
Easter Seals................ 55-59.99 331 308
60-64.99 370 381
65 and over 980 452
------------------------------------------------------------------------
Experience Works............ 55-59.99 2,921 750
60-64.99 2,360 1,090
65 and over 4,689 1,216
------------------------------------------------------------------------
Forest Service.............. 55-59.99 491 1,273
60-64.99 590 1,198
65 and over 1,022 988
------------------------------------------------------------------------
Mature Services............. 55-59.99 132 306
60-64.99 96 453
65 and over 265 516
------------------------------------------------------------------------
National Asian Pacific 55-59.99 198 444
Center on Aging............
60-64.99 210 536
65 and over 294 509
------------------------------------------------------------------------
National Caucus and Center 55-59.99 241 815
on Black Aged..............
60-64.99 332 925
65 and over 781 869
------------------------------------------------------------------------
National Council on the 55-59.99 570 507
Aging......................
60-64.99 474 770
65 and over 1,101 775
------------------------------------------------------------------------
National Indian Council on 55-59.99 185 371
Aging......................
60-64.99 164 392
65 and over 252 442
------------------------------------------------------------------------
SER-Jobs for Progress....... 55-59.99 517 317
60-64.99 514 403
65 and over 1,195 522
------------------------------------------------------------------------
Senior Service America...... 55-59.99 1,344 377
60-64.99 1,231 445
65 and over 2,365 505
------------------------------------------------------------------------
All National Grantees....... 55-59.99 10,496 516
60-64.99 8,911 685
65 and over 16,902 761
------------------------------------------------------------------------
*Includes all participants still active as of June 30, 2005. Numbers in
bold indicate duration higher than national average.
NATIONAL GRANTEES WITH AVERAGE DURATION OVER TWO YEARS
[All participants*]
------------------------------------------------------------------------
Percent over 2
Grantee years
------------------------------------------------------------------------
AARP.................................................... 26.00
National Able Network................................... 39.70
Asociacion Nacional Pro Personas Mayores................ 40.30
Easter Seals............................................ 32.20
Experience Works........................................ 51.10
Forest Service.......................................... 48.70
Mature Services......................................... 44.30
National Asian Pacific Center on Aging.................. 38.60
National Caucus and Center on Black Aged................ 47.70
National Council on the Aging........................... 37.20
National Indian Council on Aging........................ 36.30
SER-Jobs for Progress................................... 48.00
Senior Service America.................................. 37.40
National Grantee Average................................ 38.90
------------------------------------------------------------------------
*Includes all participants still active as of June 30, 2005. Numbers in
bold indicate duration higher than national average.
------
Mr. Hinojosa. Then my question to Ms. Carbonell is that I
have a great deal of interest in the nutrition program that is
used in your program. So I believe in your remarks you
mentioned San Antonio Texas, which is in my great State of
Texas, where diabetes is such a serious issue in our State,
particularly to our Hispanic community. I want to know if you
have evaluated this program and if yes, what are the results?
Ms. Carbonell. Yes. As a matter of fact, one of the most
important strategic investments that we have done in the last
few years have been particularly funding evidence-based
programs in areas, including nutrition, diabetes and chronic
disease management, targeting particularly minority
communities. As a matter of fact, we are funding 13 grants
across this country with an additional 66 sites in other parts
of the country.
You have one right there in San Antonio, in your district.
They are doing a terrific job. What is happening is that we are
using the best science and implementing and bringing that
science to bear, not by scientists but by our community
providers, the ones that--trusted sources, where people turn
for help in day-to-day activities, our aging services network--
and translating that best science into short week programs and
intervention programs to prevent diabetes and to manage
diabetes, chronic conditions in the community.
We are seeing terrific results. The initial results will be
in at the end of the year. We would be delighted to provide
some additional information and the kinds of results that we
are getting in San Antonio and other parts of the country by
just targeting the best science; instead of leaving it off of
the shelf, translating that into simple tools that people can
manage.
Mr. Hinojosa. I am a member of the Diabetes Caucus, and
what I hear is different than what I am hearing you say: that
the numbers are increasing. If you say we are doing a wonderful
job in my State, would you provide me the data that supports
the improvement so that I can study that?
Ms. Carbonell. Absolutely. We would be delighted to be able
to give in more detail the kind of work that we are
strategically investing in those 13 sites.
Mr. Hinojosa. I would like to see how it is being done, as
you just mentioned, but I also want to see the numbers for the
past 10 years, because our caucus is getting different
information, and it is alarming. It is not just in the minority
Hispanic and African American community. Central Texas, where I
also represent counties like Bastrop, Colorado County, Fayette
County, we have a huge European descent population, a lot of
Polish, Czechoslovakian, German American. They have just as
serious a problem with diabetes, many deaths.
I am really concerned. I would like to see how your program
is addressing this problem for all older Americans.
Thank you, Mr. Chairman. That is all the questions I have,
because I know we have another panel and I want to be fair to
them. Thank you.
Chairman Tiberi. I just have one question, kind of
following up on the dialog earlier on older Americans'
employment to you, Mr. Bishop.
The Government Accountability Office has reported that the
One Stop delivery system created under the Workforce Investment
Act has not served older Americans well.
How do you respond to concerns raised by GAO and others
that WIA performance goals create a disincentive for One Stops
for older workers in our country.
Mr. Bishop. Thank you, Mr. Chairman. As you are well aware,
over the last 3 years we have been working on how to improve
the One Stop system with this committee and others, on how to
improve the Workforce Investment System overall and strengthen
it.
But in the interim, what we have been doing as well is,
again, we have to assume that the SCSEP program can only serve
a finite number of individuals. So we have to get it right on
the One Stop system side. The Government Accountability Office
did point out that one of the issues is performance.
Frankly, performance is probably the most difficult thing
that government does, trying to figure out what it is that we
want to accomplish with our programs. Really, the big issue
around performance had to do with our earnings measure which I
spoke about earlier. We used to measure really, historically,
pre- and post-earnings.
We used to look at what did somebody make prior to the
program and what did they make after the program. Often,
because they were maybe in wages--jobs before layoff that they
could not achieve after training right away, that somehow the
programs weren't successful, and it would make individuals, or
providers, afraid to enroll people because of that earnings
measure.
We have fundamentally changed that earnings measure. We now
look at average earnings, and we peg the expectation on
earnings based on local labor markets rather than on individual
pre- and post. So we think we have already undertaken major
steps to address some of the findings that the Government
Accountability Office found, especially with regard to the
performance measurement system. We do believe the common
measures of employment, retention, and earnings, based on
average earnings, are the kinds of measures in an employment
training program that makes sense.
In addition, it streamlines the performance measurement
system from what it is currently as well. So actually the
reporting burden on grantees would be easier under our proposal
than it is currently.
Chairman Tiberi. Thank you. The final series of questions
for this panel, the gentleman from Maryland, Mr. Van Hollen.
Mr. Van Hollen. Thank you, Mr. Chairman. Just to piggyback
on the Chairman's point and the GAO report that I came out a
number of years ago that did say that the Workforce Investment
Act, the One Stops were not well designed to help this sort of
contingent Americans, the age group. I do think that is a
serious concern.
I would also point out that as part of the administration's
budget submission there, this year for WIA if you look at the
request, there is a proposed 13.1 percent cut in funds. You are
putting more people into the One Stop/ WIA system and asking
them to take more with less funds.
If I could ask you, Mr. Bishop, about this 2-year timetable
now. As I understand it, if you limit the program to over 65,
you are now saying if you are 66 years old, you get on the
program; you are out at 68. Is that right?
Mr. Bishop. Right.
Mr. Van Hollen. What data do we have on the current
graduation rate? If people are 65 and older, which we now limit
it to, how many of them after 2 years, or within 2 years, are
now going into nonsubsidized employment, private sector
employment. Do we have those figures?
Mr. Bishop. How many 65 and older are going in----
Mr. Van Hollen. Within the 2-year----
Mr. Bishop. We actually have the breakdown by grantee. If
you look at exiters right now, under our current participants
we have 65 and over, average days are about 568 days on the
program, which is less than 2 years.
Mr. Van Hollen. But do we know that those are all people
going into unsubsidized employment, or are those just people
who drop out of the program?
Mr. Bishop. It is exiters from the program.
Mr. Van Hollen. So that includes someone who just no longer
participates as well.
Mr. Bishop. It is a mix. Yes, it is a mix. So we would have
to break that down further for you in terms of getting the
unsubsidized employment.
Mr. Van Hollen. I just want to understand the theory here.
As you have pointed out, you already have an incentive to move
on to nonsubsidized employment because typically that is above
minimum wage as opposed to the pay you are getting, minimum
wage. As I understand your theory, by sort of creating the
cliff after 2 years, you are going to provide some added
incentive that is not already out there in the marketplace?
Mr. Bishop. Well, our proposal, again, we look at the 2-
year time limit, the fringe benefit piece and some of the other
proposals as a package. Really what we are essentially trying
to say is, this is a training program that leads to something
else.
We still have situations, a number of situations where we
have individuals who are staying on for a longer period of time
and view the community service assignment as their final job.
For instance, if you are volunteering at a library as part of
the community service assignment part-time, and you are staying
on 5, 6, 7 years--and we have gotten letters of correspondence
from Members of Congress asking about these kinds of
situations--those individuals are viewing that as their end, as
their job.
Frankly, the library should be--if that employee is that
valuable to that library, they should hire them as a full-time
employee for the library, not have them continue on a program,
because it does two things: One, it does keep that individual
out of a potential labor market program where they might be
better off. Second, it keeps other individuals from being able
to access that slot and the opportunities that that community
service assignment might provide to them.
Again, what we are trying to do as a whole package is say
let us enhance the employment and training focus of the program
and assure that these are temporary assignments that lead to a
permanent future and a permanent solution, rather than in some
cases a permanent solution, that the individual may assume and,
frankly, the host agency may like, because they are saying
well, as long as this person is being paid out of Community
Service funds or SCSEP, we will keep them on indefinitely and I
don't have to pick up the H.R. cost of that individual.
Mr. Van Hollen. If you could, if you could provide the
committee with two figures, Mr. Chairman. One is if you have
got any data regarding the waiting lists, 55 to 65, and 65 and
up, that would be helpful. Because the overall assumption you
are making here, which may prove to be true, is we want to
provide these resources and target them in the areas of most
need. I just want to find out whether or not the statistics
support that.
Second, if you are able to disaggregate the data with
respect to people who are 65 and up, how many are currently
going into new employment, nonsubsidized employment, as opposed
to just leaving the program? That would be helpful in trying to
make decisions on this.
Thank you. I thank you, Mr. Chairman.
Chairman Tiberi. Thank you both for your time and testimony
and expertise today. We look forward to continuing to work
forward through this process with you and both of your offices.
Have a great day.
We will now have our second panel of witnesses. I would ask
them to please take their seats at the witness table. I will
have some name tags there in front.
Chairman Tiberi. The second panel is seated, and we are
honored to have another distinguished panel with us today.
First, with us from my left, the audience's right, we have with
us the Governor of South Carolina--or, excuse me, not the
Governor yet--the Lieutenant Governor of South Carolina, Andre
Bauer.
He is also a passionate advocate for the aging. In July of
2004, the South Carolina General Assembly and the Governor
transferred responsibility for South Carolina's Older Americans
Act programs to the Lieutenant Governor's office. The
Lieutenant Governor's Office on Aging is now South Carolina's
State unit responsible for overseeing and strengthening the
State's active aging network.
The Lieutenant Governor was instrumental in the successful
enactment of legislation that can serve as a national model for
attracting more models to the field of geriatrics. The South
Carolina Office of Aging uses an annual fund to support the
education of physicians who specialize in geriatric medicine or
psychiatry and agree to serve seniors within the State of South
Carolina for at least 5 years.
Thank you, Lieutenant Governor, for being here today.
Mr. Vinsen Faris is the Executive Director of Meals-on-
Wheels of Johnson and Ellis Counties in Cleburne, Texas. He has
served in this capacity for 18 years and has a long history of
involvement in meal programs authorized by the Older Americans
Act.
He is a past member of the board and executive committees
of the Meals-on-Wheels Association of America, the past
president of the Texas Association of Nutrition and Aging
Services Programs, and a member of the Tarrant Area Gerontology
Society in the Texas Association of Aging programs. Mr. Faris
has attended and presented at numerous workshops and seminars
on aging services and nutrition. You have a great advocate,
fellow Texan here to my right, as well.
Mr. Richard Browdie, to my far right, is the president and
CEO of the Benjamin Rose Institute in Cleveland, Ohio. The
Benjamin Rose Institute is an organization that provides
quality services, research and advocacy on issues related to
the elderly, their families, and other caregivers.
Mr. Browdie has a distinguished career in serving older
Americans that spans over 3 decades. He served as the Secretary
of Aging for the Commonwealth of Pennsylvania for 7 years, and
is the Executive Director for the National Association on Aging
in Washington, D.C.
He has represented the States of Pennsylvania and Ohio in
the 1995 to 2005 White House Conference on Aging. He was
chairman on the Pennsylvania delegation to the 2000 U.N.
Conference on Aging and a member of the U.S. Delegation to the
2000 World Congress on Aging.
You know, Mr. Hinojosa, if we were going to have a Texan on
the panel, we had to balance it out with an Ohioan. That is an
inside joke.
To introduce our final witness, I will turn to the
gentleman from Maryland.
Mr. Van Hollen. Thank you, Mr. Chairman. And Dr. Cheung, I
just want to make sure you knew the Chairman wasn't skipping
over you because he missed you. It is because I asked for the
honor of introducing you because of your work in Montgomery
County and the Washington area in the congressional district I
represent.
Dr. Ling Cheung coordinates the Chinese American Senior
Service Association, which is a nonprofit coalition of five
Chinese senior groups in the greater Washington, D.C. Area and
serves all senior organizations and seniors.
Dr. Cheung graduated from Beijing University Medical School
in 1956 and emigrated to the United States in 1977. She retired
from the National Institutes of Health in 1997 and became a
volunteer for senior services in Montgomery County. Dr. Cheung
has worked with the Evergreen Senior Program, the Pan Asian
Volunteer Health Clinic, and as I said, she is currently
coordinating the Chinese American Senior Service Association.
Chairman Tiberi. Welcome, Dr. Cheung.
We will begin from my left with the Lieutenant Governor. I
would like to remind everybody before the Lieutenant
Governorbegins that you will have 5 minutes to recap your
written testimony. Your written testimony will be submitted for
the official record for the subcommittee.
You will have a series of lights that you will see,
beginning with green; then you will see an orangish-yellowish
color, which will mean you begin to wrap up; and then when the
red button occurs, if you could try to wrap it up as quickly as
possible. I am pretty lenient on that, but we do have four
panelist, and we have Members here who I know have busy
schedules.
So if we can begin, and then we will have a series of
questions and answers as well.
Lieutenant Governor.
STATEMENT OF HON. ANDRE BAUER, LIEUTENANT GOVERNOR, STATE OF
SOUTH CAROLINA
Mr. Bauer. Chairman Tiberi, distinguished members of the
subcommittee, I want to thank you for allowing me to be here.
Every day is a great day, and I am honored to discuss the
reauthorization of the Older Americans Act.
I would like to share a few stories with you beginning with
the elder-ready community of Chesnee, which is located in
Spartanburg County in the northwest part of our State. Chesnee
has about 2,300 residents, and more than 600 of these are
members of the VSP Club, which is a local senior center that I
have actually gotten to visit on several occasions in
conjunction with the national You Can Steps for Healthier Aging
Program, which is sponsored by the Administration on Aging.
We have held a dozen or more You Can events throughout our
State, and last year we urged seniors to take personal
responsibility to improve their health and quality of life. It
is really simple. It allows making better lifestyle decisions
about tobacco, exercise and nutrition. Leaders in Spartanburg,
which is actually in Representative Inglis' district, have
converted the bottom floor of a high-rise senior apartment
building into a senior center. They are now talking about
working with Medicare and Medicaid to bring home- and
community-based services to seniors served by the Spartanburg
Housing Authority. They want to help seniors living in public
housing maintain their independence and avoid going into far
more costly nursing homes.
That is the type of forward-thinking that is woven into the
President's proposed reauthorization of the Older Americans
Act, which was the No. 1 priority of the White House Council on
Aging, and I actually was able to attend on behalf of our
State.
Now, do not misunderstand me. Nursing homes play a valuable
role, but we simply cannot afford to pay for a nursing home bed
for everyone who might actually need one. So when we find
innovative thinking occurring like in Spartanburg, let's open
the gates whenever and wherever we can.
Dr. Michael Stogner is also here with me today. Dr. Stogner
is the AAA director who is not only involved with the Chesnee
and Spartanburg projects, but he is providing leadership to
build South Carolina's third Aging and Disability Resource
Center, which I was fortunate to be around in when South
Carolina opened its first one in Aiken, South Carolina. Almost
as soon as they opened that, over one-third of the calls were
coming from outside their service areas. In the meantime, that
same area has a marvelous what I think is an innovation in
transportation being attempted by a lady named Miss Basham of
the AAA, and she is working with a multitude of different
agencies that receive tax dollars to provide transportation to
the public. But what she is doing different is she has taken an
idea funded with seed money from the Administration on Aging
and CMS, and she is harnessing technology to coordinate all
publicly funded transportation so the empty seats can be
filled, and we do not have actually any empty seats anymore.
I said South Carolina is building for the future by
positioning for their senior boom, and currently they are the
fifth biggest State in the country for the influx of seniors.
We believe technology, data, research can allow us to make
evidence-based decisions to give us the best results as we
invest our scarce tax dollars. South Carolina may be unique in
its creation of a senior data cube, which links together large
data bases so they may be cross-referenced, and we have done
this with a lot of private funding.
Preliminary conclusions are showing us the direct
correlation between the intensity of Older American services
and the avoidance of ER visits and in-patient admissions, which
I think is very, very important. While we can project the cost
savings to our State in the Medicaid program, I think there is
a tremendous savings not only to Medicaid, but Medicare
programs as well at the Federal Government level.
As we talk about reauthorizing the Older Americans Act,
perhaps the major message is while Older Americans Act services
are not expensive programs as a whole, they are the foundation
for programs and services that can save tax dollars.
Your invitation to me today to testify asked for a
description about what the State of South Carolina is doing to
help older Americans live a more healthy and independent life.
And you asked me to discuss proposed amendments to strengthen
programs and services for older Americans administered by the
Administration on Aging. I have got some specific
recommendations as well as a genuine endorsement for the Older
Americans Act. I have included those, but just a brief summary.
First I want to endorse Choices for Independence, the
centerpiece of the reauthorization proposal. Not only does
Choices for Independence give seniors more control, but we have
experienced in South Carolina through our waiver an annual
Medicaid savings of $1,713 per participant.
Second, we want to endorse cost sharing. It allows greater
flexibility at the local level and will encourage innovative
ways of service delivery.
Third, we recommend the Senior Community Service Employment
Program be reauthorized. We would ask you to maintain the age
of 55 because the sooner we can provide job-training skills to
help people be independent, the better off they are.
Fourth, we recommend clarification within the Nutritional
Services Incentive Program and recommend consolidation of
services funded under Part C to reduce unnecessary
administrative expense and paperwork.
Fifth, we would support increase in Title VII to protect
our most vulnerable institutionalized seniors.
Finally, we recommend a technical change regarding grant
income, recommending the same language in the regulation be
placed within the act.
In conclusion, I want to thank you, Mr. Chairman, members
of the committee. I know you have a busy schedule, and I want
to urge you to think all of these over, and I would be willing
to take any questions. But thank you for what you are doing for
our country's seniors. We have been very blessed in South
Carolina with the money that you have passed down to help them.
Chairman Tiberi. Thank you, Lieutenant Governor.
[The prepared statement of Mr. Bauer follows:]
Prepared Statement of Andre Bauer, Lieutenant Governor, State of South
Carolina
Introduction
Chairman Tiberi, distinguished Members of the subcommittee, thank
you for inviting me here today to discuss the reauthorization of the
Older Americans Act. I am honored to have been invited to testify about
how South Carolina is building the future by positioning for the senior
boom. I am Andre Bauer, the Lieutenant Governor of South Carolina, and
since July 1, 2004, head of the State Unit on Aging, the Lt. Governor's
Office on Aging.
I'd like to share a few stories, beginning with the ``elder-ready''
community of Chesnee, which is located in eastern Spartanburg County in
the northwest part of our state. Chesnee has about 2,300 residents and
more than 600 are members of the VSP Club, a local Senior Center I have
visited several times to exercise with the seniors in our continuing
efforts in conjunction with the national You Can Steps to Healthier
Aging program sponsored by the Administration on Aging and the Centers
for Disease Control. We have held a dozen or more You Can events
throughout our state in the last year where we urge seniors to take
personal responsibility to improve their health and quality of life. It
is really simple and involves making better lifestyle decisions about
tobacco, exercise and nutrition. I'll be back there later this month to
help Council on Aging Director Nancy Ogle dedicate the new Archibald
Rutledge Senior Center in downtown Spartanburg. They have converted the
bottom floor of a high-rise senior apartment building into a senior
center. Those people in Spartanburg are now talking about working with
Medicaid and Medicare to bring home and community based services to
seniors served by the Spartanburg Housing Authority. They want to help
seniors living in public housing maintain their independence and avoid
going into a far more costly nursing home setting. That's the type of
forward thinking woven into the President's proposed reauthorization of
the Older Americans Act, which was the No. 1 priority of our national
White House Conference on Aging. Our country needs its nursing homes.
They are a valued health care option, but we simply cannot afford to
pay for a nursing home bed for everyone who might need one. So when we
find innovation like is occurring in Spartanburg, let's open the gates
whenever and wherever we can.
I am told that Dr. Michael Stogner is also here today. I'd like to
introduce him in order to say what I just told you is no fluke. Dr.
Stogner is the AAA director who not only is involved in the Chesnee/
Spartanburg projects but is providing leadership to build South
Carolina's third Aging and Disability Resource Center. I was fortunate
to help open South Carolina's first one in Aiken 18 months ago. Almost
as soon as it opened they found that one-third of their calls were
coming from outside their service area. Meantime, in that same area, a
marvelous innovation in transportation is being attempted by Lynnda
Basham of the AAA. She is working with a multitude of agencies that
receive tax dollars to provide transportation to the public. Her idea,
funded with seed money from the Administration on Aging and the Centers
for Medicare and Medicaid Services, is to harness technology to
coordinate all the publicly funded transportation so empty seats can be
filled. When we find people trying to turn duplication of effort into
services for seniors, let's open these gates whenever and wherever we
can.
Down in Charleston, Rev. Dick Giffin, a member of our state's
Silver Haired Legislature, is working with community leaders to
duplicate the Maine model of an Independent Transportation Network that
allows seniors to donate their cars for credit against the cost of
future rides. Groups like his need seed money, and the proposed
recommendation to permit cost sharing under the Older Americans Act
would open the door for private sector support of this vital service
for seniors. This would give greater flexibility to State Units on
Aging and Area Agencies on Aging in helping city and county governments
prepare for the aging of the baby boomers.
South Carolina has just implemented a new geriatrician loan
forgiveness program after we discovered we had only 30 board certified
geriatric physicians to treat our 500,000 seniors. We worked with the
Silver Haired Legislature, AARP, advocates and many, many more to come
up with a plan to attract new geriatricians. It received unanimous
approval by the General Assembly. Today, after making our first round
of awards, our seniors have eight new doctors specially trained in
geriatrics.
One of my first decisions as head of the Office on Aging was to
bring together a group of distinguished business leaders and community
leaders to serve on my Commission for Aging Research and Evaluation.
They were backed up by an equally distinguished group of academics and
advocates known as the Coalition for Successful Aging that prepared
position papers for the issues South Carolina discussed at its state
White House Conference on Aging. Together, these groups helped increase
awareness of senior issues in South Carolina, especially within the
business community.
One thing I have found everywhere is a willingness to join together
to build the future by positioning for the senior boom. I think we all
know that the future we build for today's seniors is also our future,
and conversely, the future we deny our seniors is the one we lose
ourselves.
I said South Carolina was building for the future by positioning
for the senior boom. We believe technology, data and research can allow
us to make evidence-based decisions to give us the best results as we
invest our scarce tax dollars. South Carolina may be unique in its
creation of a senior data cube, which links together large data bases
so they may be cross referenced. We are early in this process, and have
been helped, as always, by creating partnerships and being alert to
private sector and foundation funding. Preliminary conclusions are
showing a direct correlation between the intensity of OAA services and
the avoidance of hospital ER use and in-patient admission. While we can
project a cost savings to our state in its Medicaid program, I think
there will be tremendous cost savings to the federal government,
especially in the Medicare and Medicaid programs. As we talk about
reauthorizing the Older Americans Act, perhaps the major message is
that while Older Americans Act services are not expensive programs they
are the foundation for programs and services that can save tax dollars.
From our standpoint, the prevalence of obesity-related conditions such
as coronary heart disease, stroke, and diabetes is disproportionately
high in South Carolina. One in four adults is obese in our state, and
more than three out of five is overweight. We must find ways to prevent
obesity and chronic diseases by encouraging the use of evidence-based
health promotion and disease prevention programs at the community-level
through local aging services provider organizations such as senior
centers, nutrition programs, senior housing projects, and faith-based
groups. Like I said at the outset, we have begun this process by
emphasizing the You Can program.
Your invitation to me to testify today asked for a description of
what the State of South Carolina is doing to help older Americans live
a more healthy and independent life, and you asked to me to discuss
proposed amendments to strengthen programs and services for older
Americans administered by the Administration on Aging. I have some
specific recommendations, as well as a genuine endorsement of the
reauthorization of the Older Americans Act.
I have specific recommendations in my written remarks, but if it
pleases the committee, I will summarize my recommendations.
First, I want to endorse Choices for Independence, the centerpiece
of the reauthorization proposal. Not only does Choices give seniors
more control, but we have experienced in South Carolina through our
waiver, an annual Medicaid cost savings of $1,713 per participant.
Second, we endorse cost sharing. It will allow greater flexibility
at the local level and will encourage innovative ways of service
delivery.
Third, we recommend the Senior Community Service Employment program
be reauthorized. We would ask you to maintain the minimum age of 55
because the sooner we can provide job training skills to help people be
independent, the better.
Fourth, we recommend clarification within the nutritional services
incentive program and recommend a consolidation of services funded
under Part C to reduce unnecessary administrative expense and
paperwork.
Fifth, we support increase in Title VII to protect our most
vulnerable institutionalized seniors.
Sixth, we do not support designation of a single statewide planning
and service area.
Finally, we recommend a technical change regarding grant income,
recommending the same language in the regulation be replaced within the
act.
In conclusion, I want to thank you, Mr. Chairman, for the
opportunity to speak to you today about the reauthorization of the
Older Americans Act. I have tremendous respect for and confidence in
South Carolina's senior community.
More specifically, I want to endorse Choices for Independence, the
centerpiece of the reauthorization proposal for modernizing the Older
Americans Act, which will be important to enhancing systems change
efforts in South Carolina. The new Choices proposal focuses on the non-
Medicaid side of the long term care equation. Many older South
Carolinians become Medicaid eligible after spending their lifetime
savings on nursing home care. Most prefer to remain at home and in the
community as long as possible. If Congress enacts and funds the
proposed Choices program, more seniors can receive the community based
services needed to prevent or delay the more expensive institutional
based care. Choices for Independence will help the non-Medicaid senior
population to exercise more control over long term care options, make
better use of their own resources, and avoid, or delay, nursing home
placement.
South Carolina is facing growing fiscal pressures in our Medicaid
budgets. As we note that the baby boom generation will soon be reaching
retirement age, we are growing increasingly concerned about how we will
meet long term care needs while keeping our Medicaid budgets contained.
Helping seniors who are not Medicaid eligible to optimize the use of
their own private resources can help them delay, or better yet avoid,
spending down to Medicaid. Expanding the Older Americans Act to provide
more choices for community based care and more options for cost sharing
has the potential to better serve our seniors and to contain costs for
long term care.
In South Carolina we have allowed caregivers served through our
Title III-E Family Caregiver Support program to specify what they most
need to help them in providing care to a loved one over the age of 60.
Experience has shown that the caregivers can make a little bit of money
go a long way when they have more control over how it is used. We would
welcome the opportunity to test increased consumer control and choice
in other OAA services. Currently, most OAA dollars are tied to specific
service categories. The Choices proposal would allow the OAA dollars to
instead be tied to people's needs.
Within our Medicaid program, South Carolina has documented benefits
of consumer choice and control through SC Choice, our Independence Plus
Waiver. There was an average annual Medicaid savings of $1,713 per SC
Choice participant in the pilot project. After a successful pilot, SC
Choice was implemented statewide as of January 2006.
To support informed decision making and to provide comprehensive
service information, and with grants from CMS and AoA, we have
developed SC Access, a website with information on over 12,000
services. Trained and certified Information and Assistance specialists
are available by phone to provide the important human component to the
SC Access system.
Through our Aging and Disability Resource Center (ADRC) pilot
program, we are working closely with our Medicaid program for long term
care services. We now provide support to persons who are placed on the
waiting list for the elderly disabled community based services waiver.
Identifying persons at high risk of institutional placement who prefer
to remain in the community is one step in keeping the Medicaid budget
in check. Having more options for long term care services in the
community would be an important next step.
Additionally, we would welcome funding for activities that will
integrate our three ADRC with statewide public education campaigns to
help people begin to plan for their future, like the programs AOA is
promoting under the Own Your Future initiative. We will help private
pay individuals use low cost community based alternatives, such as
adult day care and respite care programs, and utilize private financing
options such as private long-term care insurance and home equity
instruments.
We strongly endorse cost sharing. Past regulations have tied the
hands of service contractors by disallowing cost sharing, for example,
in home delivered meal and group dining programs. In these times of
diminishing resources, aging organizations must market their programs
to a broader spectrum of seniors to obtain needed revenue. This can be
expanded through changes in the cost sharing portion of the statute.
Seniors that can afford to pay for services should be allowed to
contribute to those services. Organizations should then have the
flexibility to use those funds where there are waiting lists for
services, or to improve current service. We support the AoA proposed
changes to the OAA that would permit states to institute cost sharing
for all OAA services, except for certain programs that will retain
their exemption. The President's New Freedom Initiative has provided a
national vision for reforming the long term care system by empowering
consumers and honoring a strong desire to live in a community and to
contribute to the community. We support efforts to modernize the Older
Americans Act to bring us closer to this vision. The proposed changes
will provide opportunities for states to implement a new approach and
to evaluate the impact on the health and well-being of older people,
their family caregivers, and health care costs. The President's 2007
Budget Request includes resources to begin implementation. We hope to
see Congress enact a bill that will include the Choices Initiative. In
South Carolina we want to do all we can to provide the highest possible
quality of life for all of our seniors. We are proud of what we have
done for seniors since the state office on aging moved to the Lt.
Governor's Office. We think this legislation will help states prepare
to better serve the growing population of seniors and we look forward
to working with the Administration on Aging on a new vision for
prevention, choice and greater consumer control within the long term
care system.
We strongly recommend that the Senior Community Service Employment
program be re-authorized with particular emphasis on maintaining two
important features of the program. First, maintain the minimum
eligibility age at 55 because the sooner we can provide job training
skills to help people be independent, the better. Research projects
that 9 million seniors will be eligible for SCSEP in 10 years,
according to current guidelines with an eligibility age of 55. If SCSEP
did not already exist as it has for over 40 years, experts on aging
today most likely would be calling for creating a new program just like
SCSEP as part of a larger, comprehensive national response to our aging
society. Secondly, continue to allow participants to provide community
service to their host agency during their training period. Host
agencies would be greatly diminished if paid community service were
reduced. Among agencies that would be affected are Meals on Wheels,
senior centers and elder-care services, as well as rural libraries and
One-Stop Career Centers where SCSEP participants often serve as
specialists for all older job seekers.
We support provisions under Title V requiring comprehensive study
of current and future senior employment needs, including examination of
Title V, Workforce Investment Act programs and all federal employment
programs. We recommend procedures to coordinate those programs.
We recommend clarification within the nutritional services
incentive program. Disbursements of NSIP funds should be made based on
the meals reported in the most recent NAPIS report submitted to the
Administration on Aging. The current wording requires that funds be
distributed based on the meals served in the preceding fiscal year.
Since the funds are appropriated in October and the report for the
preceding fiscal year is not submitted until January, at the beginning
of the grant period the states have no idea how much NSIP revenue will
be awarded. The Area Agencies on Aging have contractors who are
providing meals with an expectation of reimbursement that may not be
met, if the state receives less NSIP than projected. Waiting until the
final quarter of the current federal fiscal year to determine the total
amount of NSIP for each state does not do what the program intends.
Without a firm number to work with, some providers are over expending
and others may hold back services that could have been provided if the
amount of NSIP revenue was assured at the beginning of the grant
period. NSIP funding for October 1, 2006 though September 30, 2007
should be distributed based on the NAPIS report due to the
Administration on Aging in January 2006 and not on the report due in
January 2007.
We recommend that there be a consolidation of services so that
nutritional services are funded as Part C only. This would reduce
unnecessary administration and related paperwork. With one
authorization and appropriation for Part C, more flexibility would be
allowed throughout the grant period, thereby making the program more
responsive to consumer needs.
We support increase in authorization of Title VII provisions and
services to enhance capacity to increase training of law enforcement
and medical staff, broaden public education and community involvement,
and facilitate coordination amongst all the professionals and
volunteers involved with prevention, intervention, detection
investigation and treatment of abuse, neglect and exploitation of
vulnerable older adults. Statistics nationwide state 1 in 14 persons
report incidences of elder abuse. The OAA under Title VII has a
provision for the prevention of abuse, neglect and exploitation of
older persons for both community and institutional settings. Limited
dollars are allocated to this provision, however we must begin to think
of the new population entering the aging sector; baby boomers who have
more discretionary dollars. Many of these persons will be targeted for
abuse, neglect and/or exploitation. In order to meet the needs of this
incoming population, formers of the OAA must examine current and future
allocations to adequately provide education and training activities. I
would also ask for review for the addition of legal assistance dollars
in Title VII. The initial allocation of legal assistance dollars
included in Title III are quickly eroded by older persons in the
community, thereby leaving few if any dollars for persons in
institutions who may need legal representation/assistance. This issue
``bubbles over'' to areas of Choice, Nursing Home Transition (Home
Again), etc. as seniors move throughout the continuum of care.
We recommend this specific action regarding grant income. Several
years ago the Office of the Inspector General issued a report that
resulted in changes in the use of grant related income. Prior to that
report, states operated on the provisions that are still in the
official Federal regulations for the Older Americans Act [CFR 45
1321.67(b)(1) and (2)] that allow grant related income to be used as
match, to expand services, or both. We recommend that the same language
in the regulation cited above replace the language of the Older
Americans Act at Section 315 (a)(5)(C) and (b)(4)(E). This would allow
AAAs to expand services to areas where there may not be sufficient
local sources of revenue to meet the required level of local match. It
would also allow local resources to be used for consumer directed
services for which there are no Older Americans Act funding.
We do not support the proposed designation of single statewide
planning and service areas. The current service delivery and planning
structure at the regional level is well established, and is working
very well in South Carolina. Current law already provides a process by
which individual states can reduce their number of planning and service
areas if they so choose, and those states with a single planning and
service area were designed that way for specific reasons within those
states.
______
Chairman Tiberi. Just a side note. I have never seen this
as long as I have been here this 6 years. We have four
witnesses, one from South Carolina, one from Texas, one from
Maryland, one from Ohio. We have four Members up here, one from
Maryland, one from Texas, one from Ohio, and one from South
Carolina.
Mr. Bauer. Mr. Chairman, that means hopefully you will be
gentle to us on your questions.
Chairman Tiberi. That, too.
Mr. Faris.
STATEMENT OF VINSEN FARIS, EXECUTIVE DIRECTOR, MEALS-ON-WHEELS
OF JOHNSON AND ELLIS COUNTIES, TX
Mr. Faris. Chairman Tiberi, Mr. Hinojosa, members of the
subcommittee, good afternoon. I am Vincent Faris, and it is my
privilege to serve as executive director of Meals-on-Wheels of
Johnson and Ellis Counties in Texas. I thank you for the
opportunity to speak to you today regarding the reauthorization
of the Older Americans Act, and I will direct my comments to
some of those provisions in the act that affect my program
directly.
I am not an expert in legislation, so I will not pretend to
be one; however, I am a person who works every day in the heart
of communities, many diverse communities, to feed needy
seniors. Our service area covers over 1,700 square miles
immediately south of Dallas and Ft. Worth. Roughly half of our
area is becoming more and more suburban, while the remainder is
still very rural in nature.
I want to begin my remarks by telling you a story. We were
attempting to get a meal route started in one particular small
community that has a very large number of needy elderly people
residing there. It is one of the poorest communities in the
county. Most of the elders had lived and worked on the farms
and dairies for years. Oftentimes they were self-employed, so
their Social Security checks were small, and SSI checks were
almost nonexistent. Many in the community were concerned about
them and made referrals to us. Yet when we contacted these
needy seniors, they politely declined. They generally answered,
there are others out there that are needier than we are. They
were proud people, and while we knew they needed our services,
they would not accept them because they regarded Meals-on-
Wheels as a poverty program.
Next we directed our efforts to the churches and to the
pastors, who got the message out from the pulpits that Meals-
on-Wheels was, in fact, a terrific program about neighbor
helping neighbor, and it was not a government handout. People
could even make donations for the meals they received. Soon we
had a meal route up and running, with most of the people making
at least some sort of donation for their meals.
Meals-on-Wheels learned from this experience. We learned
that many of the elders in our community are proud people. Even
though they have limited incomes, they do not want a handout.
We learned that by giving people an opportunity to do their
part, the welfare stigma can be alleviated.
Last time Congress reauthorized the Older Americans Act,
you changed the law to allow us to actively solicit
contributions. This has made a real difference. The change that
you are now proposing will now enable us to be even more
effective about bringing those seniors who need our services,
but who also have the ability to pay, into our program, and it
will assist our program in encouraging contributions from them.
Because the Older Americans Act requires that services be
targeted first to those in greatest need, in some areas of the
country only the poor are being served by Title III programs,
but need among our seniors is not about finances alone. I can
tell you that from experience.
I told you my program service area includes a diverse group
of communities. All are very unique in cultures and their
heritage, but all are alike because of their growing elderly
populations who are all faced with the many difficulties and
struggles that come with old age. Frail, disabled and isolated
seniors who are not poor need our services, too. The change
that you are proposing to make recognizes that. It sends a
signal to the whole aging services community that we should be
expanding our services to all in need, no matter where they
fall in the social services ladder. It also helps the program
collect the revenues that we need so we can provide services to
these individuals.
Let me mention a couple of other points before I close. I
told you that my program has been successful in soliciting
client contributions. I should let you know that there has been
a certain downside to this because my program's Title III
allocation has been essentially reduced as our contributions
have increased. This is wrong, and I am pleased that you will
address this in your bill.
It also gives a strong incentive to programs that do not
utilize voluntary contributions to begin doing so, and it
leaves decisionmaking about how to implement this as a local
one. People in the local communities know their neighbors best.
I do not have the time to mention every change the
subcommittee is suggesting, but I do want to express my support
for several. You emphasized the critical link between nutrition
and the prevention of chronic disease. Meal programs have known
this for a very, very long time. Before the promotion of
wellness was a popular concept, we were doing it. Our programs
keep people healthy. They are an excellent investment of
Federal dollars. I am encouraged that you include options like
allowing our programs to provide meals to individuals who would
not be eligible for Title III if they will pay for the cost of
the meal. This is a win-win.
My program has been providing Older Americans Act nutrition
services for all of our 29 years. When I tell you we are
serving the oldest, frailest, neediest people we have ever
served, that is not an overstatement. Just when we think they
cannot be more poor or more frail or more isolated,
unfortunately we are proved wrong.
Let me end my remarks by thanking you. You have worked
together in a bipartisan way to listen to our particular
request. You are proposing changes to the law that will help us
maintain, maximize and leverage more resources. That is what we
need to meet the challenges of the future. So again I thank you
for the opportunity to appear before you today and appreciate
the work that you are doing. Thank you.
Chairman Tiberi. Thank you, sir.
[The prepared statement of Mr. Faris follows:]
Prepared Statement of Vinsen Faris, Executive Director, Meals-on-Wheels
of Johnson and Ellis Counties, TX
Chairman Tiberi, Mr. Hinojosa, and Members of the Subcommittee--
good afternoon! I am Vinsen Faris. It is my privilege to serve as
executive director of Meals-on-Wheels of Johnson and Ellis Counties in
Texas. I thank you for the opportunity to speak to you today regarding
the reauthorization of the Older Americans Act, and particularly ``The
Senior Independence Act of 2006,''which your Subcommittee has recently
developed. I will direct my comments to some of those Title III
provisions that affect my program directly. But let me tell you from
the start that I am not an expert in legislation, so I will not pretend
to be one. I am a man who works everyday in the heart of communities,
many diverse communities, to feed needy seniors. Our service area
covers over 1700 square miles, immediately south of Dallas and Fort
Worth. Roughly half of our area is becoming more and more suburban,
while the remainder is still very rural in nature. I want to begin by
telling you a story about one of these communities.
It's a story that I have told and retold many times. We were
attempting to get a meal route started in one particular community that
was small, but that had a very large number of needy elderly people
residing there. Demographically, it was one of the poorest communities
in the county. Because it was a farming community, most of the elders
had lived and worked on the farms and dairies for years, often times
they were self employed. So their Social Security checks were small and
SSI checks were almost nonexistent.
Our program knew who needed Meals on Wheels, where they lived, and
that it was no longer safe for many of them to be driving. Others in
the community were all too glad to make the referrals to us. Yet, when
we called upon these people, they politely declined. Their answers
generally went along the lines of ``there are others out there that are
needier than we are.'' They were proud people, and while we knew they
needed our services, they would not accept them because they regarded
Meals On Wheels as poverty programs.
Discouraged we were, but defeated we were not. We met with several
ministers and asked for their help with our challenge. From that
meeting, we directed our efforts to the churches and to the pastors. It
was from the pulpits that the message went out that Meals On Wheels was
a terrific program about neighbor helping neighbor. And it was not a
government handout! People could make donations for the meals they
received. And wouldn't it be great, to just visit with someone around
the noon hour every day? Soon we had a meal route up and running, with
some people donating $5.00 a month for their meals.
Meals On Wheels learned from this experience. We learned that many
of the elders in our community are proud people. Even though they have
limited incomes, they do not want a handout. We learned that by giving
people an opportunity to do their part, the welfare stigma can be
alleviated.
We also learned several other important lessons from that
experience. We learned that senior meal programs are misunderstood by
many in the community and thought to be only for low income people. We
learned that voluntary contributions are essential to expanding our
program. Our success at encouraging donations from clients has been
great. In fact, our client donations have generally accounted for seven
to ten percent of our overall revenue. Client contributions have been
one of our largest single sources of revenue in our budget each year.
Last time Congress reauthorized the Older Americans Act, you helped
us accomplish this by changing the law to allow us to actively solicit
contributions. It has made a real difference. I believe the change that
you are proposing in your reauthorization bill will have the same
effect. It will enable us to be more effective about bringing those
seniors who need our services, but also have the ability to pay, into
our program. And it will assist our program in encouraging
contributions from them.
Because the Older Americans Act requires that services be targeted
first to those in greatest need, in some areas of the country only the
poor are being served by Title III programs. But ``need'' among our
seniors is not about finances alone. I can tell you that from
experience. At the beginning, I told you my program's service area was
large, and it includes a diversity of our communities. All are unique
in their cultures, heritage, religions, workforce, and workplaces. In
this diversity, we see challenges and opportunities to strengthen our
communities to make them all better places to live.
A commonality in all of the communities is a growing elderly
population that is faced with the many difficulties and struggles that
come with age: health issues, disabilities, isolation, hunger, limited
income, and lack of family. The list goes on and differs from group to
group. But each thing I mentioned is a need.
Frail, disabled and isolated seniors who are not poor need our
services too. The change that you are proposing to make recognizes
that. It sends a signal to the whole aging community that we should be
expanding our services to all in need. It also helps programs collect
the revenues that we need, so that we can provide services to these
individuals.
Let me mention a couple of other points before I close. I told you
that my program has been successful in soliciting client contributions
and I discussed the value to us and to seniors. I should let you know
that there has been a certain downside to this, because my program's
Title III allocation has been essentially reduced as our contributions
have increased. This is wrong, and I am pleased that you address this
in your bill. Not only does that benefit programs like mine, but it
also gives a strong incentive to programs that do not utilize voluntary
contributions to begin doing so. And the proposal in your bill leaves
decision making about how to implement this as a local one. People in
the local communities know their neighbors best.
I do not have the time to mention every change the Subcommittee is
suggesting, even if I knew them all. But I do want to express my
support for several. You emphasize the critical link between nutrition
and the prevention of chronic disease. Meal programs have known this
for a very long time. Before the promotion of wellness was a popular
concept, we were doing it. Our programs keep people healthy! They are
an excellent investment of federal dollars.
Speaking of dollars, let me return to the issue of resources again,
because we depend on sufficient resources to do our jobs. I am
encouraged that you include options like allowing our programs to
provide meals to individuals who would not be eligible for Title III,
like caregivers for example, if they will pay for the cost of the meal.
This is a win-win. It gets meals to people who need them and it
increases program resources.
Title III of the Older Americans Act has been providing financial
support to our organization for all of our twenty-nine years. During
that time, we have evolved from an organization that served primarily
ambulatory well-elderly people at a senior center, to an organization
that focuses our efforts on needy homebound individuals. When I tell
you we are serving the oldest, frailest, neediest people we have ever
served, that is not an overstatement. Just when we think they cannot be
more poor, or more frail and more isolated, unfortunately we are proved
wrong. Each year there are more hungry seniors who need our services.
We know this trend is going to continue and get worse.
This is true across the country. It is particularly true in my
State of Texas, which the USDA has identified as being among the top
five in the country for food insecurity. Just to define that term, it
means that food is either inaccessible, unavailable or unaffordable. In
plain Texas talk, it means hungry people cannot get food. Congress
makes money available for Older Americans Act senior nutrition programs
through Title III C. You also make money available for supportive
services in Title III B. My food insecure state has transferred money
away from nutrition services and into supportive services. In 2004,
they moved nearly $5.8 million out of nutrition, and that is the
equivalent of at least a million meals. All of the services furnished
under the Act are important. Don't get me wrong. But food is essential
for life and health. While meal programs have waiting lists, which
means that seniors are going without meals, this transfer should be
prohibited. Your reauthorization bill does not address this issue. I am
disappointed and on behalf of hungry seniors across the country, I ask
you to reconsider this.
But let me end my remarks by thanking you. That thanks is not only
for my program, but on behalf of senior meal programs across the
country and for the individuals they serve and families they touch. You
have worked together in a bipartisan way to listen to our particular
requests. You are proposing changes to the law that will help us
maintain, maximize and leverage more resources. That is what we need to
meet the challenges of the future. So, again, I thank you for the
opportunity to appear before you today to express my program's support
for these changes.
______
Chairman Tiberi. Doctor.
STATEMENT OF LING CHEUNG, PRESIDENT, CHINESE AMERICAN SENIOR
SERVICES ASSOCIATION, MONTGOMERY COUNTY, MD
Dr. Cheung. Chairman and members of the subcommittee, thank
you for this opportunity to present more than 1,000 Chinese
seniors' thoughts of the Older Americans Act. My name is Ling
Cheung. I was introduced to the Older Americans Act Senior
Nutrition Program 7 years ago, when I was a volunteer at the
Rockville senior center. There are about 40 Chinese seniors,
but only a few attended the senior lunch because of the
cultural barriers. So I speak with the county's program
director Mrs. Mower, who is here, and I asked if there is
possibility of serving Chinese food once a week. I know many
people like Chinese food, not only Chinese. But she said, no, I
cannot, because the county's cook could not make Chinese food.
And she said to me, but you can do it. She said county has
contract with ethnic groups, but we could get Chinese meals
through a contract with the county. She helped me apply for the
contract and made an arrangement with the Chinese restaurants
for meals.
The first year we served 1,500 meals in 1 site to 40
seniors. Then we doubled our service every year. For this year
the Senior Nutrition Program in Montgomery County is serving
more than 500 seniors with 23,000 Chinese meals in 6 lunch
sites. This program not only provides balanced nutrition for
seniors, but has attracted them to attend the activities such
as Tai Chi, dancing, ping pong, and the classes of English,
computers, citizenship and a Chinese cooking class. Of course
they play a lot of Mahjong.
We also provide service to introduce 260 county service
programs to the seniors. And the more important, the Senior
Nutrition Program has provided the opportunity for senior
volunteering. That make things really happen.
Many seniors come to our centers for the first time because
of the lunch. As they come to the new transitionsite, they find
out there are so many activities they like, so many friends to
meet, and there are so many services they never know. They help
each other like a family, and they never feel lonely and
depressed again.
Eight years ago an old Chinese man in great despair killed
his wife and committed suicide because he was isolated and had
depression; but after we have the Senior Nutrition Program,
that never happen again. Instead, for instance, Mr. and Mrs. Xu
immigrated to the country 10 years ago to take care of their
grandkids. They always wanted to go back to China because they
feel lonely here. After they join the lunch program, they
attended the activities, they become very active volunteers.
Mrs. Xu is lunch site manager, and Mr. Xu is our accountant. He
had cancer 5 years ago. He is very healthy and happy for his
life here. Now they are U.S. Citizens.
In Montgomery County and across the country, the Older
Americans Act Senior Nutrition Programs allow seniors to find
happiness and health. I hope Congress will reauthorize the
Older American Act this year and to strengthen the nutrition
program so they may continue to serve seniors now and in the
future. Thank you very much.
Chairman Tiberi. Thank you, Doctor. And count me in as a
lover of Chinese food as well.
[The prepared statement of Dr. Cheung follows:]
Prepared Statement of Ling Cheung, Director, Chinese American Senior
Service Association of Montgomery County, MD
Chairman Tiberi and Members of the Subcommittee: Thank you for this
opportunity to present my thoughts on the Older Americans Act. My name
is Ling Cheung. I coordinate the Chinese American Senior Service
Association (CASSA). CASSA is a non-profit coalition of five Chinese
senior groups in the Greater Washington, D.C., area and serves all
senior organizations and seniors.
I graduated from Beijing University Medical School in 1956 and
immigrated to the United States in 1977. I retired from the National
Institutes of Health in 1997 and became a volunteer for senior services
in Montgomery County. I have worked with the Evergreen Senior program,
Pan Asian Volunteer Health Clinic, and CASSA. In 2003, I received
Montgomery County's Path of Achievement Award.
I was introduced to the Older Americans Act Senior Nutrition
Program in Montgomery County seven years ago. I was a volunteer in the
Rockville Senior Center. There are about 60 Chinese seniors, but only a
few attend the senior lunch because of the cultural barriers-many
Chinese seniors do not like the American food served. During one visit
to the lunch site, I spoke with Senior Nutrition Program Director
Marilyn Mower about the possibility of serving Chinese food once a
week, as I know many people like Chinese food, not only the Chinese
seniors. She said that the county's cook couldn't make Chinese food,
but that the county has contracts for ethnic organizations to have
nutrition sites and that we could get Chinese meals through a contract
with the county.
First, I applied for a contract and made an agreement with a local
Chinese restaurant for meals. They delivered the lunch to our activity
center. The first year, we served 1,500 meals in one site to 40
seniors. The second year, we served 3,000 meals to 60 seniors in two
sites. The third year, the numbers more than doubled again with 7,000
meals at three sites. This year, the Senior Nutrition Program in
Montgomery County provided Chinese food through two organizations,
CASSA and CCACC (Chinese Culture & Community Center), and is serving
more than 500 seniors with 23,000 meals in eight lunch sites.
This program not only provides balanced nutrition for seniors once
a day, but has attracted more seniors to attend the activities we
provide. The sites offer exercise programs such as Tai-Chi, line
dancing, folk dance, social dance, and ping pong as well as educational
programs such as classes in English, computers, citizenship,
photography, cooking and Chinese painting. The leisure program gives
seniors the opportunity to enjoy activities like singing, day trips,
and games like Bridge and, of course, Mahjong.
The program also provides the opportunity to introduce seniors to
Montgomery County's other services like health care, housing, and
transportation and helps them to apply for programs that might meet
their needs.
A major part of the Senior Nutrition Program is that it provides
the opportunity for volunteering. CASSA has more than 500 members and
94 volunteers; there is no paid staff. This is a main reason why we can
provide good, nutritious food and have money to support our activities.
Many seniors come to our activity centers for the first time
because of the lunch. They hear through social networks that you can
have a lunch with three dishes, rice and a fruit. As they come to the
activity center, they find there are so many activities they like, so
many friends to meet, and many services about which they may never have
known. They are happier and healthier and for many it reduces their
feelings of loneliness and depression.
There are many examples just in our program. Dr. Wang is 84,
retired from government and lives by himself. He comes to the activity
center five days a week at our different sites and joins the
activities. Mr. and Mrs. Xu immigrated to the United States ten years
ago to take care of their grandchild. They always wanted to go back to
China because they found it lonely here. After they joined the lunch
program and attended the activities, they become U.S. citizens and very
active volunteers. Mr. Xu is our accountant and Mrs. Xu is the Lunch
Site Manager. Mr. and Mrs. Shao recently joined the program and decided
to sell their house in China to stay in the U.S. permanently. They
said, ``The U.S. is the best place to live.''
In Montgomery County and across the country, the Older Americans
Act Senior Nutrition Programs allow seniors to find happiness and
health. I hope Congress will reauthorize the Older Americans Act this
year and strengthen the nutrition programs so they may continue to
serve seniors now and into the future.
______
Chairman Tiberi. Mr. Browdie.
STATEMENT OF RICHARD BROWDIE, PRESIDENT AND CEO, BENJAMIN ROSE
INSTITUTE
Mr. Browdie. Thank you, Mr. Chairman and members of the
subcommittee, for this opportunity to share a few thoughts with
you about the reauthorization of the Older Americans Act.
I have had the privilege of working in the field of aging
services for more than 35 years, and I have come to believe
that the Older Americans Act is, in fact, the most appropriate
vehicle the country has for the expression of national policy
on older people in this country, and the need to modernize this
policy, which occurs as our society evolves, has never been
greater.
The United States has actually been experiencing its aging
revolution for several decades. People over the age of 85
constitute the fastest-growing segment of the population, and
they have for some time. Public awareness is finally catching
up. The people who manage State budgets have been feeling the
pain in their Medicaid budgets for three decades.
Rarely does a meeting of the National Governors Association
with Federal officials, appointed and elected, pass that some
discussion does not arise, sometimes contentious, over what
should be done about long-term care. And while there are
numerous factors to push up the cost of Medicaid, many of which
that do not have anything to do with the elderly, long-term
care expenditures and the older people who use them get the
brunt of the blame and are seen as budget busters around the
country.
From Governors to advocates, people are calling for a
comprehensive systemwide reform. Even the White House
Conference on Aging ranked this issue highest except for one,
the reauthorization of the Older Americans Act.
As much as I would like to see it, it seems unlikely that
an effort to develop a comprehensive policy at this time would
bear fruit. On the other hand, I believe that the
administration's proposal for Choices For Independence, at
least as I understand it, represents a significant opportunity
to take a big step forward. This initiative builds on a series
of demonstration programs that have been sponsored by an array
of Federal agencies, many times with the support of major
foundations.
All of the demonstrations, from Money Follows the Person to
Cash and Counseling, and the capstone of the Aging and
Disability Resource Centers, are considered part of an overall
effort to rebalance the long-term care system in this country.
Key to the success of all of these demonstrations is the effort
to give individuals and their supporting caregivers a greater
voice in determining where they will receive the long-term care
and services they need along with useful objective information.
All evidence shows that when given timely, competent,
independent advice and support, consumers make choices that are
more in accordance with their own preferences, produce good or
as better outcomes, and are more cost-effective than the
predetermined choices offered under Medicare.
The Choices for Independence initiative builds on these
findings of these demonstrations and begins to build key pieces
of what is needed. It also adds another key element that is
missing in many States. The truth about Medicaid nursing home
care is that the vast majority of the recipients were not poor
when they went into the nursing home. On average they spend
down their assets in about 3 to 6 months. These people were
certain to be eligible on a clinical basis to receive Medicaid
waiver services while they were living in the community, but
they are not very likely to be financially eligible because of
the resource limitations of Medicaid. The Choices for
Independence initiative includes a funding mechanism that
offers the kind of flexibility necessary to be effective in
community-based care to meet this level of need as, I might
add, has been demonstrated in yet other demonstrations. It
represents an important step forward administratively.
What is needed is an infrastructure to build on, and the
system of the State Units on Aging and the Area Agencies on
Aging more than meet the requirements. In fact, it is the only
nationally available system based in local communities that
serves older people and is capable of acting like a network.
Widely trusted by consumers and respected by practitioners,
the Aging Network has performed as it was designed to do, and
given the resources it has had over the years, discounted by 50
percent, we are a provider of the services under the Older
Americans Act, it has generated returns on the investments
Congress has made many times over.
Where I respectfully disagree with the administration's
proposal is in its scope. I really do not think we need another
demonstration to show that what we learned in previous
demonstrations will work better if we coordinate it. A well-
thought-out strategy that includes proper technical assistance
and the evaluation regime necessary will take a number of years
anyway, and it seems particularly wasteful since more than 40
States are developing aging and disability resource centers,
and many others are involved in moving their systems forward.
In a related point, I think that the funding change that I
indicated is a good idea also should be on a national basis and
should be funded accordingly.
Thank you, Mr. Chairman. I do have another thought or two,
but perhaps maybe during questioning.
Chairman Tiberi. Thank you. We will try to accommodate your
thoughts.
[The prepared statement of Mr. Browdie follows:]
Prepared Statement of Richard Browdie, President and CEO, the Benjamin
Rose Institute
Thank you, Mr. Chairman and members of the subcommittee for the
opportunity to offer testimony regarding the reauthorization of the
Older Americans Act being considered by the committee. As someone who
has worked in this field for more than thirty-five years, I have come
to believe that the Older Americans Act is the most appropriate vehicle
for the expression of national policy regarding older people in this
country. The need to modernize that policy is greater today than ever.
The United States has actually been experiencing the early stages
of its ``aging revolution'' for decades. The number of people over 85
is the fastest growing segment of the population and has been for some
time. The pressure on state budgets produced by continued growth in
Medicaid long term care expenditures (along with all the other growing
cost drivers that impact Medicaid budgets) is being experienced across
the country. National expenditures have grown accordingly.
Rarely a meeting of the National Governors' Association with
federal elected or appointed officials passes without some exchange
over the burgeoning issue of state and federal spending on Medicaid,
with older people and nursing home care, appropriately or not,
receiving the brunt of the blame. Calls for large scale, system-wide
reform, from governors to advocates, from providers to consumers, will
some day, I believe and hope, lead to a comprehensive effort to build a
long term care and services policy which addresses the whole range of
issues that will have to be a part of it. The recently completed White
House Conference on Aging ranked its recommendation on long term care
policy almost first. Reauthorization of the Older Americans Act was
first. It would seem that we are not yet ready as a nation to take the
step of developing a comprehensive long term care and services policy
and financing strategy. Let us hope that we are ready to reauthorize
the Older Americans Act. I believe that the elements included in the
Administration's ``Choices for Independence'' initiative are critical
elements in moving the nation forward, and are parts upon which any
reasonable comprehensive long term care policy would need to rest. I
also believe that a demonstration program would delay progress
needlessly. We need to get started putting the building blocks in
place.
Advocates for persons with disabilities and their counterparts in
the aging services system have been pressing states to rebalance the
long term care system, and there has been a growing effort to do just
that. Supported by federal initiatives beginning a number of years ago
and continuing through to initiatives in the Deficit Reduction Act and
in many of the Administration's proposals for 2007, the level of
activity regarding ``rebalancing'' has continued to grow.
A continuing series of demonstration programs, funded by several of
federal agencies and often in partnership with national foundations and
state governments, have helped identify strategies and program
approaches that are effective individually in meeting the needs of
consumers who need long term care and services. I was a part of the
National Long Term Care Channeling Demonstration. Despite the confusion
over what the results of the demonstration meant, states that have
achieved real progress in rebalancing their systems have learned to use
the instruments of pre-admission assessment and care management as the
backbone of a community-based care system which can, when properly
funded and supported, supply a cost-effective alternative to nursing
home care for a significant portion of the people who need long term
care and services. Since that time, we have demonstrated the importance
of supporting families who provide the majority of all the care
provided in this country, which led Congress to add the Title III-E,
the National Family Caregiver Support Program, to the Older Americans
Act. This effort, while in need of considerable expansion, bridged a
huge gap in the thinking of policy makers regarding the elements a long
term care system would need.
The ``Money Follows the Person'' and ``Cash and Counseling''
demonstrations, along with related initiatives, constitute the next
wave of efforts to support rebalancing state Medicaid programs. These
projects have added important elements to what is now a growing body of
evidence that can be used to support developing alternative ways to
meet the needs of people that have needs for long term care and
services. The capstone of these demonstrations is the Aging and
Disability Resource Center initiative, which recognizes the central
role that consumer information, the elimination of unnecessary
bureaucratic barriers and help through the maze of needed financial
considerations plays in helping older people and their families sort
through their long term care options.
Policy researchers and analysts reviewing state long term care data
have begun to point to changes in the utilization of nursing home
services to indicate that the changes in nursing home use that are
already underway are evidence that the ``system'' is adjusting itself.
This suggests that more aggressive efforts to rebalance the long term
care system are important to consider as a response to future needs,
but they are not as urgent as first thought, since they will happen
without any additional changes in policies or programs. Yet, in many of
those states, the number of days of care in long term care facilities
paid for by Medicaid has continued to grow.
How can that be? The average length of stay in nursing homes is
dropping because more people are using skilled nursing facilities as
post-acute care settings, which increases admissions and discharges
after relatively short stays. Meanwhile, people with the money to make
choices have been finding their long term care service settings in
places other than nursing homes more frequently. In the private
marketplace, developers of assisted living and senior housing have been
building an increasing number of settings where housing options support
and even facilitate the receipt of care and services that can make
``aging in place'' a part of a personal plan that consumers could
choose and implement. But when people run out of money, or when they or
their families never thought that they had enough money to last very
long in other unsubsidized settings, Medicaid reimbursed nursing home
use remains the default option.
No analysis that I know of has ever fully sorted out exactly how
many people would benefit from each of the alternatives demonstrated by
the initiatives that the government has supported that I have referred
to above. What we do know is that the states that have made concerted
efforts over long periods of time, such as Oregon, Washington, Maine
and a few others, have been successful because they were ready to do a
whole array of things, including making the difficult political
decisions involved, and they stuck with it. It should be noted that
their success took years to accomplish. Further, consumer education, at
the point of actually making a decision about long term care and even
sooner whenever possible, was the lynchpin of their strategy. Efforts
to empower consumers through strategies like Cash and Counseling build
on the same principle. A consumer armed with good information and
supported by high quality independent professional support, will make
cost effective decisions even when the government is paying the bill.
What we also know is that states that have not been able to make
similar decisions and press for similar policies, for whatever reason,
have remained unsuccessful in reforming their systems. The
``unsuccessful'' states outnumber those that have made significant
progress. There are two observations to be drawn that might seem
obvious, but they do not receive much attention.
The first is that the effort to create a national long term care
and services policy is greatly complicated by the fact that states have
the right under the law to manage the Medicaid program in very
different ways. They are free to be innovative, and they are free to
follow the path of least resistance. Their nursing home lobbies
understand that reality better than anyone. Some states manage their
long term care costs under Medicaid by unreasonably curtailing
reimbursement for care in nursing facilities, creating a difficult and
even dangerous challenge for the providers of needed care to very frail
people. That is not a situation that should be supported with federal
funds. At the same time, curtailing people's ability to choose because
they happen to live in a certain state shouldn't be supported with
federal funds either. I believe in the virtue of having national
policy, implemented by state administrative management which recognizes
the unique characteristics of state and local legal and human service
system structures. I also believe in giving local system managers as
much flexibility as possible, since states have tremendous variability
and diversity within them. But, we seem to forget that the Federal
Government and its taxpayers bear about 57% of the costs when a state
that is running a system that makes too few alternatives available and
reimburses for too many days of nursing home care pays it's bills.
Since state taxpayers are for the most part likely to be the same
people who are paying the federal taxes, those taxpayers are paying all
the costs of any inefficiency a state Medicaid program may tolerate,
and doing it while denying people access to alternatives that are less
costly and more consistent with their personal preferences. In short,
as a nation, when it comes to publicly funded long term care, we pay
more for poor performance.
The second observation is that the key to success in all long term
care initiatives is giving the consumer choices and as much influence
over how their services will be offered to them as possible. Given that
he country is facing the fastest growth in the population of people who
are likely to need long term care in its history. The Administration is
to be credited for their several initiatives broadly described under
the banner of the New Freedom Initiative. In many ways, the most
important initiative of all is the Choices for Independence initiative.
Informed consumers have been shown time and again to make decisions
for themselves and their caregivers that use resources wisely and
nearly always result in considerable delay in their use of
institutional alternatives. By assuring that consumers and their
involved caregivers have access to timely and objective information
supplied by a respected resource in their community, consumers will
overwhelmingly choose service venues that support the maximum sense of
independence and dignity possible.
Choices for Independence will support the systematic development of
an infrastructure to do just that. And, using the network of State
Units on Aging and Area Agencies on Aging to do it just makes sense.
The Aging Network has served this country since 1974. It is the only
national system of aging organizations in the United States that is
connected to the communities in which Older Americans live their lives
and is independent from the incentives and biases associated with
ownership of service agencies and their need to attract consumers to
assure their economic viability. And, the Aging Network has for all of
its years the mission of being concerned with the needs and
circumstances of older people across the income spectrum. While
certainly they have historically focused on the needs of the poor and
those with greatest needs, they have years of experience with the
challenges faced by older people who have too much money in the bank to
be Medicaid eligible while living in the community, but too little
money to be able to finance all their long term care needs without ever
relying on Medicaid. This group is the population that it is most
important new policy initiatives to focus on, since this is the group
that makes up the vast majority of people who are recipients of
Medicaid nursing facility care at any point in time. In short, the
Aging Network has proven its reliability and trustworthiness in the
eyes of older people and their families.
I would disagree with the Administration's proposal on a couple of
key points. First, a demonstration program only delays beginning the
critical work of building a national infrastructure to support consumer
information on long term care. We already have demonstrated that long
term care alternatives work. And we have demonstrated that the key to
system change, where there is a tradition of innovation in state
management or not, is informed consumers and families. A national
strategy that includes the sound planning, technical assistance and
evaluation components needed would take a number of years to fully
implement anyway. It seems wasteful, particularly since more than forty
states are already developing Aging and Disability Resource Centers, to
go through yet another demonstration.
Secondly, the initiative includes a new strategy for dispensing
funds that allows states to use Older Americans Act funds without the
historical program constraints that interfere with addressing needs
with maximal flexibility. The capacity for managing resources in this
fashion is already well developed in the Area Agencies in the country
that manage Medicaid waiver services, and it will help states and
communities target those people in the community who are at risk of
needing nursing home care, but whose resources would make them
ineligible for Medicaid. As I mentioned earlier, these people
eventually make up the majority of Medicaid nursing home beneficiaries,
and for that reason, this provision should be generously funded.
There are a few other areas that I would like to touch upon that
may have relevance to the Members as they consider reauthorization of
the OAA. The first is to increase the authorizations under the Act to
levels that reflect both the lost buying power of the Act over the
years and the growth in the population in need. I am a former public
official, so I am well aware of the pressures that the government faces
in restraining the growth in public spending. However, it should be
recognized that the Aging Network has been producing extraordinary
results at very low costs for decades. Indeed, recent decisions made by
OMB because of the lack of ``evidence'' of the benefits of programs
funded by the Act were reflective of years of squeezing every penny for
service output, while being reluctant to spend money on the production
of evidence. What is needed is to have the resources to produce data
and generate evidence while serving those in need, not punishing
agencies that are too busy to evaluate small, but critically important,
programs.
The second is the issue of Elder Abuse. Title VII of the Older
Americans Act has for years provided a set of guiding principles and
policies that have played an important role in this increasingly
important area. Information pulled together by the Elder Justice
Coalition, which has been working with partners across the country,
indicates that as the number of older people grows, there is every
reason to believe that the nature of elder abuse will continue to
diversify and that attempts to abuse older people will grow
correspondingly. Many of the forms that elder abuse takes are in
connection with federally funded programs and services. Yet, there is
no center focal point for policy and research on this issue, and there
is no place to act as a hub to coordinate with all the federal agencies
that should be involved (and often are, in collaboration with their
state counterparts) in dealing with this difficult interdepartmental
and interdisciplinary issue. Consideration should be given to using
Title VII as a vehicle to establish a federal home for this issue that
has gone unaddressed for far too long.
Again, Mr. Chairman, allow me to thank you and the members of the
committee for this opportunity.
______
Chairman Tiberi. I am going to recognize Mr. Hinojosa to
begin a round of questioning.
Mr. Hinojosa. Thank you. My first question will be to Mr.
Faris from the great State of Texas. I liked your presentation,
and it is amazing to me that you have been at this for almost
three decades. I come from a family that has been in the food
service to hotels and restaurants, so some of our clients
happen to be programs like Amigos del Valle down in Texas, and
I can certainly relate to many of the comments that you made.
Your Title III allocation has been reduced as the client
contributions have increased. I made that point to the first
panelists. Is cost sharing an incentive, or do you think it is
a disincentive?
Mr. Faris. I think that voluntary contributions,
encouragement of the clients to make those voluntary
contributions, could be an incentive. I believe that people
feel good about helping other people, and, therefore, every
dollar that we can put into the program can purchase more
meals.
Because of a technical problem that we encountered during
the past 2 years, though, in which we had Federal grant
earnings actually subtracted by the amount of the client
donations coming into the program, that is a disincentive, and
we have seen a lot of programs actually turn away from
encouraging their clients and participants to make those
donations.
Mr. Hinojosa. Would you agree with me that just like there
is a different flavor profile in different regions of our
State, that there are different levels of income by families?
Mr. Faris. Yes.
Mr. Hinojosa. In south Texas, if I were to take a look at
the income per capita of senior citizens versus those I
represent in central Texas close to the State capital, there is
a significant difference. And in central Texas I would say the
stories you shared would be repeated right there in Bastrop and
Fayette County and those areas where the European-descent
ethnic groups are very proud, and they do not like Federal
money. They think we are in their way, to be honest with you.
All this to say that I am very proud of their work ethics
and how they tried to provide for themselves. I really liked
your presentation because I could relate to those in south
Texas versus those 360 miles further north into central Texas
who I represent.
You also recommended that funds transferred between the
Title III(c) and the Title II(b) be prohibited. The Texas case
that you gave is disturbing, but is this happening throughout
the entire country?
Mr. Faris. It is my understanding that there are numerous
transfers being made with the State Units on Aging throughout
the country from (b) services to (c) services. Being a
nutrition provider, we work so hard to alleviate hunger in our
elders. Monies that were originally allocated for our food, in
my deepest heart of hearts those should be spent for food; (b)
services those are important, yes, whether it is transportation
or activities in senior centers, but I hate to see funds that
were allocated for nutrition be moved into other areas.
Mr. Hinojosa. When we go to the committee of the whole in
the Education and Workforce Committee, I certainly will
remember your statement and see if we can get some reaction
from the 55-member committee that that we represent.
I am going to move on to Dr. Cheung. I really liked your
presentation also, and one of your specific findings was that
your efforts have helped older individuals overcome feelings of
loneliness and depression. Do you have some recommendations for
other program administrators to undertake it in this regard? I
really was hit close to the heart here when you made those
statements.
If I may, I can repeat the question.
Ms. Cheung. Actually I do have ideas. I think for the
seniors to keep healthy and happy in the rest of life, they
should live together. You know, the activities center has
helped. You can come to the center in the daytime, but the
transportation is very difficult for them. Our seniors, like
more than 20 seniors, go to the community center. They spend
more than 2 hours on the way. So that is not the way to do.
I think we should make the seniors living together like in
the Leisure World. They have more than 10,000 seniors living
there, so they have activity right there. They do not need to
go anywhere. And they have a clinic and a post office in their
facility. I think that is a way to do. I wish I can see that
day.
Mr. Hinojosa. I agree with you. In listening to the
presenters in Ohio this last week when we were in the
Chairman's district, they talked about the importance of
socialization just equally as important as the nutrition and
the Meals-on-Wheels. So I agree with you.
Ms. Mower. I think she would agree with you completely.
Mr. Hinojosa. Thank you very much.
I yield back, Mr. Chairman.
Chairman Tiberi. Thank you, Mr. Hinojosa.
Lieutenant Governor, you mention in your testimony that
South Carolina supports cost sharing. Has your State
implemented cost sharing for home- and community-based
services? And I have a follow up for that.
Mr. Bauer. I do not know if they have or not. I know we
would like to. I would believe we have actually, judging from
my notes here. But I know that they have experienced problems
where they want to be able to branch out and do more cost
sharing. They feel like the churches are taking care of some of
these things, and there are people that actually have the funds
available, but they do not have the services that are provided.
South Carolina is a more rural State, and there is a lot of
areas of the State where nobody is offering the services except
the government, and so they cannot even go out and purchase
some of these services, and some of them have the means to do
so.
Chairman Tiberi. In your time as Lieutenant Governor and
taking over this program, how important is the broad goal of
flexibility?
Mr. Bauer. Flexibility is key to us. Again, the vital
dollars that you send down to our State, about $29 million, and
then until this previous year we had only allocated 2-. I got
the general assembly to allocate another $2.9 million this year
to help with some of these in-home services because we see just
how vital small little things that we can do, whether it be
transportation, making sure they are getting medical coverage,
making sure they are taking the proper medications.
A lot of times we can keep them in their home, which the
alternative is they would be put in a nursing home, which
really would be a burden on our State. So any time we have any
flexibility in any of these programs, our folks, who are much
more knowledgeable than myself, I am more of a speaker and a
figurehead as a part-time job as Lieutenant Governor, I have
taken on this agency as well. But any time they have latitude
to move around dollars and options, it helps the seniors in our
State.
Chairman Tiberi. Thank you.
Mr. Browdie, I helped create legislation in Ohio or a law
on a consumer guide, an Internet-based consumer guide with the
Department of Aging. So along these lines, with the existing
structure of the Older Americans Act, and utilizing the network
that we have on State Units of--Area Agencies on Aging, how can
the reauthorization that we are going to pass support the
systematic development of a national infrastructure to support
consumer information that you talked about or wrote about in
your testimony?
Mr. Browdie. Mr. Chairman, I guess there are a number of
things that could be done, and it is almost--the number of
things would be relatively numerous. I do not know that we
would want to go through all of them. The key would be to
assist States. States are unevenly prepared to move forward on
their own, and there are lots and lots of the information
systems that are available now were developed with Federal
money. Therefore, it would be not a difficult matter to share
the infrastructure that has been made available in a number of
States, give other States the opportunity to adapt their own
to, if you will, populate the information cells with
information that is State-relevant, and it would cut the lead
time down substantially in evolving those things.
Second, I would say is that a great deal of the information
on the Websites, we had developed one in Pennsylvania as well,
was Federal information. Sometimes there are Federal agencies
that make it easy to gain access to those Websites and to
interface in a way that the consumer would find it easy to
navigate, and sometimes less so. So there could be a
development of some kind of avenue or bridge for States to use
to make that interface better.
But last I would say is that there is little new under the
sun, but there are many of us who live under one shade tree or
another, and it would be an opportunity to offer technical
assistance to States who are having trouble getting traction on
moving their systems forward.
One of the things that we are all impressed by is that we
talk about our opportunities and what we do on a State-by-State
basis. Ohio, Pennsylvania, New York and other places know that
many of our seniors move, and then frequently they will move
back late in their life, so that the opportunities for these
people to be able to plan for their long-term care needs across
that bridge, including information in other locations, is
something that is important to the country as it thinks about
the long-term care across the States.
Chairman Tiberi. You had you some final thoughts before you
stopped before.
Mr. Browdie. Yes, thank you, Mr. Chairman. Two thoughts.
Briefly, Older Americans Act, particularly in Title VII,
strikes me as being a vehicle where one of the other major
unaddressed issues in this country that needs a Federal home,
and that is the issue of elder abuse. And I would ask that the
committee think about some action in that regard.
The last issue is that going to Representative Hinojosa's
points that he made earlier, the purchasing power of the act
has indeed fallen. This is an issue where the opportunity to
serve people before they become Medicaid-eligible is what is so
much going to be so helpful to the State government and also
the Federal Government. The Federal Government pays 60 cents
every time a State spends 40 cents on somebody that does not
need long-term care in a nursing facility. Helping that just
seems to me like good business.
Chairman Tiberi. Thank you.
Mr. Hinojosa.
Mr. Hinojosa. Mr. Browdie, I think we have you on a roll. I
want to ask you another question. I would agree with you that
building a national infrastructure is needed much more than a
pilot program in this regard.
You also mentioned in your remarks a greater need for
resources in this area, so if that is how you feel, do you have
any dollar estimate of how much more the act should provide?
Mr. Browdie. With the Representative's indulgence, I would
be glad to do some calculations. I did not prepare a
statistical--any kind of work to really go to that. Most of the
advocates, as you know, would try to argue for a feasible
number. As a State official, I know that budget pressure comes
from all directions all the time. At the same time, this is an
arena where I think being penny wise is indeed pound foolish. I
would be glad to do an estimate.
[The information referred to follows:]
Response to Mr. Hinojosa's Questions Concerning the Senior Independence
Act of 2006 by Mr. Browdie
Dear Rep. Patrick Tiberi, Chairman; Rep. Ruben Hinojosa, Ranking
Member; and Members of the Committee: Thank you for the opportunity to
submit additional information to the committee in response to questions
regarding the ``Senior Independence Act of 2006,'' and the
Reauthorization of the Older Americans Act. Your work on behalf of the
older people of this country is greatly appreciated.
``Senior Independence Act'' addresses several inter-related aspects
of access of long term care services that are fundamental to how people
are served, which in turn drives a significant portion of Medicaid
spending. As I indicated in my testimony before you, I believe that the
Congress would best serve the nation's interest through a national
effort. Committee members asked what I thought it would take to
implement the program nationally as an alternative to a demonstration.
I would like to answer the question, and then provide my rationale.
A national initiative would begin to make a difference in the way
consumers use long term care and services across the country by helping
to integrate the numerous and sometimes confusing initiatives that are
already in progress. It would help states that are behind in the
``rebalancing'' process get started, and buttress those that are under
way. Any amount that it would take to mount a credible national effort
would seem huge in comparison to the current AoA budget, though it
would seem modest in the context of Medicaid and Medicare spending,
which I believe is the most appropriate point of reference. The
Administration's ``Money Follows the Person'' initiative in selected
states is projected at $1.75 billion over five years, more than the
entire AoA annual budget. As important as that initiative is, all the
evidence indicates that keeping people out of nursing homes in the
first place is more cost-effective and less disruptive to their lives
than trying to get them out after they have gone into a nursing
facility. I believe a similar amount of $1.75 billion over a five year
period is a reasonable place to begin, starting at about $150 million
in the first year (about the size of the Family Caregiver Program) to
accommodate development of program infrastructure at the national and
state levels, and building from there. If resources are properly
targeted to individuals with high levels of clinical need, but with too
many resources to be eligible for Medicaid HCBS, this effort should pay
for itself, through Medicaid and Medicare spending offsets over five
years. It is worth noting that because of the dominant role government
policy plays in the long term care market, a system wide effort to move
long term care and services use to the home and to community settings
would be very likely to influence private spending positively as well.
The ``age wave'' that advocates have been talking about for thirty
years is now here. More importantly, the age group most likely to need
long term care, those over age 85, became the fastest growing sector of
the American population twenty years ago, and that growth continues. It
is not a reasonable goal to reduce the number of people who will need
to be served. The appropriate goal is to serve a larger number of
people at a lower average cost, and to reduce the growth rate of public
long term care expenditures from the present growth rate to a lower and
more affordable one. To do that, we need to address the institutional
bias and ``rebalance'' the system, or more accurately, create a
balanced system of long term care services and supports across the
country.
When states do take steps to rebalance their long term care
systems, they save themselves money, and they save the federal
government even more, since the federal share averages 57%. Conversely,
when they don't, and the great majority of them have not, the federal
government pays more than half the cost of their inefficiency. (It
should be pointed out that the taxpayers in those states are footing
the bill on both levels.) CMS has been making efforts to support those
that want to change as much as they can in the current framework, and
they have recently been joined by AoA, which is appropriate, since
AoA's network of State Units on Aging and Area Agencies on Aging have
been involved in the most successful states since the beginning of
their efforts. Despite these recent initiatives, states that are trying
to make progress are, both politically and in a policy sense, on their
own, with each state being its own battle ground. There are all sorts
of reasons that states don't take steps to move their systems forward.
Meanwhile, as a nation, we are all paying the bill.
To my knowledge, there has never been a comprehensive estimate of
what it would cost to completely re-balance the long term care system,
just as there has never been an estimate of what a balanced long term
care system could actually save the country, in state and federal
Medicaid expenditures. There are all sorts of things that make the
scientifically precise measurement of cause and effect extraordinarily
difficult in the real world, where decisions are being made every year
that change one or more factors that would effect expenditures and
trends. As a result, researchers and budget forecasters can't
confidently apply the results of demonstrations, which themselves are
trying to establish relationships in environments which are constantly
changing, to the nation.
While analysts and researchers debate at the national level, a
number of states that have taken the initiative and initiated a series
of coordinated steps that have had a substantial impact on the growth
rate of their long term care expenditures, and in some cases have
actually decreased them for a period of time. They all have done the
same things, albeit in different ways. They have developed a broad
range of services that can meet the needs of many who would otherwise
be compelled to enter nursing homes and make the services available to
those who need and prefer them. They have established vigorous pre-
admission assessment programs to verify clinical level of need and
provide options counseling opportunities to assure individuals and
their families and caregivers are fully informed of all the
alternatives that could meet their needs before people can enter a
nursing facility under Medicaid. If care in the home is preferred, they
have developed care management systems, and increasingly, family
supports and ``cash and counseling'' options for consumers who wish to
manage their own services. Recently, through Aging and Disability
Resource Centers, they have also begun to coordinate the to their
systems to make the process of getting information about long term care
options easier and earlier in the process, since making decisions at
the point of crisis is always more difficult and oriented towards the
fastest and most medically conservative resolution, which is always a
long term care bed. In these ways, some states are making consumer
preference viable, serving people how they would choose and saving the
taxpayer money in the process.
The sources of funding that go into the long term care system add
to the difficulties faced at the state level and stand in the way of
truly comprehensive and coordinated federal policy initiatives.
Medicaid is an entitlement, with all the attendant restrictions on
federal agency use, while Older Americans Act funds are
``discretionary'', which means more manageable in the context of budget
pressures. State funds connected to Medicaid become part of the
entitlement, while state funds appropriated to serve people who are not
yet Medicaid eligible are not, which has meant that many states can't
see past the demands of Medicaid to ever get to the ``spend down''
population. Those states that have are the states that have been the
most effective in containing cost growth. They have done so by
targeting a combination of Medicaid funds and state non-entitlement
funds (with some OAA funds as well) to maximize their impact on making
alternatives available to people who are eligible for Medicaid and
those who are nearly eligible. The savings realized, or more accurately
the costs avoided, are counted on the Medicaid side of the ledger. The
same will be true with the Senior Independence Act, since the greatest
benefits will occur in Medicaid, and there will be additional benefits
in Medicare, both huge entitlements.
Any national program, particularly one with several complex
components, would take time to develop and then roll out. State
administrators know that new programs can take up to three years take
statewide, so it is reasonable to expect that it would take five years
or more to establish and stabilize a national program of this kind.
States that have not managed many programs of this type will need
substantial technical assistance to develop the necessary management
systems and the service infrastructure. Large programs are best
expanded in a planned and orderly way, allowing for early implementers
to try things out and see what needs to be retooled to work better. It
also gives states that have more preparatory work to do the time to do
it, while learning from the experiences of others. Federal agencies
need the opportunity to develop technical assistance approaches, to
develop reasonable expectations while giving states the needed
flexibility to adapt national programs to their unique state and local
systems, to learn what information is most useful to have reported, and
to develop appropriate performance monitoring methods.
Given all the above, I believe that it would be reasonable to begin
building a program at about the same level as the Administration's
``Money Follows the Person'' proposal. It is large enough to have an
impact, but small enough to be manageable. The idea of giving states
new resources and financial incentives to get people out of nursing
homes has great merit on moral grounds and should be cost-neutral. In
addition, once the public understands that it is possible, it may mean
that a larger proportion of nursing home residents and their families
may more seriously consider return to the community even after a fairly
lengthy stay in a nursing facility.
A comprehensive system of public education coordinated with
enhanced long term care information resources through improved access
systems and a serious attempt to help the near poor afford to stay in
the community, enhanced by evidence-based wellness programs, is very
likely to have an positive effect on state and federal Medicaid and
Medicare expenditures, particularly since it has the effect of knitting
together the ``rebalancing'' efforts already proposed in other parts of
the budget. $2 billion over five years would constitute less than one
percent of the funds that Medicaid alone will spend on long term care
over the same period of time. It seems a modest yet realistic sum to
invest in finally beginning a national effort to begin to turn the tide
on the on the ``institutional bias'' that we have all come to know so
well.
Thank you again for the opportunity to supply information to
support your deliberations on the Older Americans Act. I would be glad
to review this or any other information with your staff at any time.
______
Mr. Hinojosa. I would ask you to try, because my friends in
Ohio, who are not shy, evidently they have done some homework,
and they gave us some pretty strong numbers to increase it, and
I want to try to be on the side of increasing it.
And I will go and ask the Lieutenant Governor a question.
You recommend keeping the age eligibility for services in the
Senior Community Services Program at age 55, and you heard my
interest in trying to see what it would cost to phase it in.
Tell us in your opinion what would be the effect if the age
eligibility was raised to 65, in one jump up to 65. What would
it do to South Carolina?
Mr. Bauer. South Carolina has--the distinct problem is that
we are above the national average in unemployment. We continue
to see manufacturing jobs leaving our State. And these are
people in that age bracket that would substantially suffer if
we did not have that age at 55. And I think making sure that we
get them back in the workforce as quickly as possible is
pivotal.
Mr. Hinojosa. Could you garner support to look at other
alternatives other than just doing that leapfrog to 65 from
your State?
Mr. Bauer. We would entertain a multitude of different
options. And, of course, our State tries to address them at a
State level as best we can in helping these seniors find
gainful employment, but, again, we do have an exceptionally
high unemployment rate in our State, double about what the
national average is.
Mr. Hinojosa. At the top of the hearing, you heard our
Chairman that there is a goal to try to expedite and make this
happen quickly. Take it from me, when you go back, let's see
how fast you can garner some support for me, because I think it
is like a train coming down the track moving fast. So if you
are going to be of help for us to look at other alternatives
other than to make that leapfrog to 65, we need some written
justification for other alternatives.
Mr. Bauer. Well, Representative, coming from the land of
Strom Thurmond, at 55 that is about the halfway mark in South
Carolina.
Mr. Hinojosa. Thank you, Lieutenant Governor.
Mr. Chair, I think I am going to stop here because I think
that I have gotten exactly what I have needed, and that is some
support from an association that can be very vocal and very
active. Now we just need to put it in writing so that the rest
of our committee members will hear just how our South
Carolinians feel.
Thank you very much, Mr. Lieutenant Governor.
Chairman Tiberi. Thank you.
Mr. Lieutenant Governor, your OAA office is not under your
purview, is it?
Mr. Bauer. No, sir.
Chairman Tiberi. Maybe we can follow up with your office
and try to get some of the participant numbers of South
Carolina for both WIA and this program.
Mr. Bauer. Clearly we can get that for you.
Chairman Tiberi. Thank you.
[The information referred to follows:]
Response to Mr. Tiberi's Questions Concerning SCSEP and WIA by Mr.
Bauer
Under the SCSEP program (Title V of the OAA), South Carolinia has
808 total ``slots'' for individuals aged 55 and older for program year
2006 (July 1, 2006--June 30, 2007). Of those slots, 165 are
administered by the Lt. Governor's Office on Aging, 270 are
administered by the AARP--SC, and 373 are administered by the national
non-profit ``Experience Works.'' Experience Works was also the winning
contractor in the LGOA's competitive procurement process for providing
the services for our 165 slots. SCSEP provides training and employment
opportunities for low-income seniors--primarily in rural areas.
Bear in mind that slots do not equal individuals. Because of
turnover and individuals cycling through the program (and hopefully
finding regular employment), SC's 808 slots will actually serve an
estimated 1600-plus individuals during the course of a program year.
The WIA numbers are a bit harder to figure. Like the state's Aging
Programs, the state agency administering our WIA program changed
recently. On April 12, 2005, Governor Mark Sanford issued an executive
order to move the WIA Administrative Entity function from the South
Carolina Employment Security Commission to the South Carolina
Department of Commerce, effective July 1, 2005.
I've attached a state Commerce Department WIA report for program
year 2006 that shows 157,288 total ``customers'' for WIA programs were
served by our state's system of ``One-Stop'' employment centers through
September 2006 (one quarter) My understanding is that the One Stops are
the ``on-ramps'' for all WIA programs and services, so One-Stop usage
should track pretty closely with total program numbers. That 157K would
likely include some of the folks that Lt. Governor Bauer and Chairman
Tiberi were discussing (i.e., older workers displaced by layoffs or
plant closings who need retraining or other employment assistance) but
unfortunately, I do not have an exact breakdown from Commerce of how
many of those individuals would be age 55 or older.
At any rate, it's important to note that while the WIA programs are
indeed critical to South Carolina in helping us deal with the layoffs
our state has encountered during the past decade due in large part to
plant closings in the textile industry, and that many of the workers in
those industries are older workers who have a great need for retraining
assistance, the WIA programs are a separate animal from the SCSEP that
was recently (re)authorized under the Older Americans Act. SCSEP really
targets a different group of people than WIA.
PY 2006 LOCAL AREA COMPARATIVE REPORT SOUTH CAROLINA--LOCAL AREA COMPARATIVE REPORT
[Cumulative thru month of September 2006]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Frequency of one-stop services provided
Services provided -----------------------------------------------------------------------------------------------------------------------------------------------
Total Catawba Greenville LowCntry LowerSav Midlands PeeDee Worklink SanteeLyn Trident UpperSav Upstate Wacc.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Customers (Unduplicated Count).................. 157,288 17,518 9,291 6,618 19,349 15,571 21,090 12,151 3,066 18,479 13,346 3,463 17,346
Customer Visits................................. 318,472 29,608 15,827 17,565 34,488 52,831 50,006 22,518 5,645 34,989 29,415 4,431 21,149
Services to customers:
Job Search Services......................... 297,567 15,741 16,963 19,720 38,093 46,403 52,362 18,285 2,089 34,170 32,150 4,098 17,493
Job Development Attempts/Contacts........... 27,509 573 118 101 15,581 1,990 1,797 434 132 3,132 944 126 2,581
Registration for Work....................... 76,473 6,344 6,092 3,716 10,307 9,798 9,639 6,567 0 9,635 7,134 0 7,241
Entered Employments......................... 27,321 1,933 1,853 3,583 3,171 2,939 2,997 1,886 53 4,084 2,413 44 2,365
Business/employer services:
Employer Job Openings Received.............. 26,715 1,150 3,196 3,161 3,985 3,202 1,984 1,165 132 3,783 1,938 156 2,863
Employer Job Openings Filled................ 12,449 546 759 2,476 1,206 1,389 1,190 704 57 1,862 1,140 5 1,115
On Site Employer Interviews................. 5,373 85 561 1,392 925 370 630 120 49 725 230 0 286
Group activities:
Number of Group Activities.................. 2,683 249 84 201 182 158 276 229 95 381 537 105 186
Number of Attendees............................. 22,522 2,352 781 2,251 1,425 1,640 1,843 915 578 5,596 3,682 369 1,090
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
2006 Edition, Revised 8/18/06.
______
Chairman Tiberi. One final question, Mr. Browdie. You
touched on a subject that came up at the hearing in Ohio as
well, and that is the issue of elderly abuse and neglect. There
are a number of programs and activities obviously authorized by
the act under current law to try to prevent elderly abuse and
neglect. Are there ones that are working better than others,
and do you have any suggestions how we can buildupon what is
good?
Mr. Browdie. I think the first step would be to try to
organize a way of looking at what does work and what does not.
I think one of the issues about elder abuse is there is no
Federal agency responsible for collecting information.
There is a lot of great work that does get done. The
Administration on Aging works with the Department of Justice
and works with other agencies around the country, but there is
no systematic way of collecting that information. There is no
systematic review of the incidents of elder abuse, and there is
no systematic home for collecting information about what does
work, building an evidence base, and then distributing that
information.
So in many respects, I would be able to answer anecdotally,
but I think the issue is growing sufficiently that it is time
for the Federal Government to take it seriously and
systematically.
Chairman Tiberi. I appreciate that.
Well, we would love to work with you and with everybody,
quite frankly, on this and other subjects that are obviously
very important to the act, to reauthorizing the act. As has
been brought up by Mr. Hinojosa, my intent is to--at least in
my small area of influence in this town--is to try to move a
reauthorization, because I think when you look at more globally
here in Washington, D.C., between the Senate and the House, you
have a whole lot of top-of-the-fold, front-page issues that are
going to be dealt with that need to be dealt with, that are in
the process of being dealt with over the next several months.
Just pick up the Washington Post, and you will get a clue of
what I am talking about. And so I think when you have a number
of issues, an election year, typically a long process to get a
bill done between the House and in the Senate, a Senate that
has not had, to my knowledge, a hearing yet--they have had
hearings, not a bill yet--I think it is important for us to
move this process along as quickly as possible and put pressure
on the other body, because it is an important issue to
reauthorize.
It is certainly not everything that I want. I will tell you
that. It is not everything that my mom or dad want, and they
are both seniors, at least not the start of the process, but I
think it is important for us to try to move a reauthorization
bill forward. And I have great confidence in my colleague to
the right that we can move a bill that is going to make a
difference in people's lives.
I want to thank you all, the four of you, for your time and
your testimony today as well. It has been a really good
hearing. The shame of it all is that when we go to the House
floor, only a handful of us get the opportunity to have a
dialog in the question-and-answer session. The entire
committee, subcommittee, will be recorded, but this is so
important, so important for you all to be part of this process
not only on behalf of your own organizations and States, but
also on behalf of seniors throughout the country. So we very
much appreciate you coming today and spending time with us.
So with that, we will conclude this hearing for the day. If
there is no further business before us, the subcommittee stands
adjourned.
[Whereupon, at 4:23 p.m., the subcommittee was adjourned.]
[Additional testimony for the record follows:]
Prepared Statement of William L. Minnix, Jr., President and Chief
Executive Officer, American Association of Homes and Services for the
Aging
On behalf of the American Association of Homes and Services for the
Aging (AAHSA), I appreciate the opportunity to submit written testimony
on the re-authorization of the Older Americans Act. AAHSA members serve
two million people every day through mission-driven, not-for-profit
organizations dedicated to providing the services people need, when
they need them, in the place they call home. Our members offer the
continuum of aging services: assisted living residences, continuing
care retirement communities, nursing homes, home and community based
programs, and senior housing. AAHSA's commitment is to create the
future of aging services through quality people can trust. Our ideals
also include dignity for all persons at every stage of life, advocacy
for the right public policies for the right reasons, and leadership
through shared learning.
AAHSA's Five Big Ideas
We are proposing a national agenda consisting of Five Big Ideas
designed to transform the field of long-term care into a more cost-
effective and efficient system that works for older adults. First,
AAHSA believes that managed care concepts should be expanded in the
field of aging services to meet consumer needs and responsibly contain
costs. Second, affordable housing should be combined with supportive
services to enable older adults to age in place. Third, the development
of new technologies and the innovative applications of existing ones
should be encouraged to improve consumer choice, quality of care,
quality of life, and cost-efficiency. Fourth, the culture of aging
services must change to focus on individual choice and direction. All
segments of aging services need to embrace a quality-of-life, resident-
focused service culture and a continuous quality improvement management
culture. Fifth, the transitions of elders between various settings--the
community, acute and long-term care--must be managed to minimize stress
to the consumer and wasteful and duplicative bureaucratic requirements
for service providers.
The current effort to reauthorize the Older Americans Act to
prepare for upcoming demographic changes should incorporate new ideas,
new solutions and creative approaches to home and community based
services that will modernize the aging services network and increase
choices for consumers. We must begin to explore the ways technological
innovations can impact the aging services network and improve the
quality of care and quality of life of the elderly. We must also expand
on partnerships between affordable housing programs and supportive
services that will enable the frail elderly to receive a more
comprehensive set of services in the place they call home. These
solutions offer a cost-effective approach to home and community based
services.
Innovative Approaches to Home and Community Based Services
The Older Americans Act (OAA) funds a wide variety of social and
nutrition services that enable the frail elderly to maintain their
independence, including senior centers, meals programs, in-home
services, adult day services, transportation, and family caregiver
support programs. Supporting seniors in their homes through community-
based care programs such as the OAA allows a cost-effective alternative
to premature institutional care. A recent Supreme Court decision
requiring States to consider community-based alternatives for the
mentally disabled emphasized the need for States to begin to
``rebalance'' their long-term care delivery systems from an
institutional model of care to one that includes home and community-
based alternatives.
Title IV of the Older Americans Act authorizes the Assistant
Secretary of Aging to award grants for training, research and
demonstration projects designed to test innovative approaches to the
aging services network. Demonstration grants have been used to develop
successful programs such as the Aging and Disability Resource Centers
and Medicare Part D outreach activities. The Older Americans Act should
fund additional demonstration projects to study the effect of linking
affordable housing with supportive services, along with projects
studying the ways technological innovations can be used to meet the
objectives of the Older Americans Act.
Technological Innovation and HCBS
Technology has great potential--across the continuum of aging
services--to help older adults maintain their independence; improve
quality of care and quality of life; support the needs of professional
and family caregivers; increase aging services provider efficiency; and
reduce our nation's health care costs. Technological advancements will
dramatically impact the ability of the frail elderly to age in place.
Recognizing the potential of these developments in our field, AAHSA
launched the Center for Aging Services Technologies (CAST) to explore
ways in which technological developments could be applied to the field
of aging services. We have achieved an exciting collaboration with
corporations such as Intel and Sodexho, universities including MIT and
the University of Virginia, aging services providers, and other
stakeholders such as the Alzheimer's Association and the Robert Wood
Johnson Foundation.
Technological innovations such as in-home monitoring tools,
assistive technologies and advanced communication devices should be
used to improve the efficiency and effectiveness of the aging services
network. Technological innovations such as in-home monitoring tools,
assistive technologies and advanced communication devices should be
used to improve the efficiency and effectiveness of the aging services
network. Technological advancements will dramatically impact the
ability of the frail elderly to age in place, and we must begin to
develop this cost-effective approach to fulfilling the objectives of
the Older Americans Act.
AHHSA recommends that the Older Americans Act include Title IV
demonstration projects to test the ways technological innovations can
be used to assist the frail elderly and strengthen the aging services
network. We must begin to set the framework for developing new models
of home and community based care. Technological innovations can meet
the objectives of the Older Americans Act in the following ways:
Assist the frail elderly with their activities of daily
living through assistive and enabling technologies.
Assist family caregivers by facilitating faster
communication between caregivers and the frail elderly.
Assist the elderly in rural or remote areas through in-
home monitoring technologies and communication devices linked to remote
service providers.
AAHSA proposes adding the following Section to Title IV of the
Older Americans Act.
Section 422. Demonstration Projects for the Study of Technological
Innovations.
(a) Program Authorized.--The Assistant Secretary may award grants
or contracts to institutions of higher education and private non-profit
organizations to implement, in partnership with long term care
providers, pilot projects designed to carry out one or more of the
objectives described in subsection (b).
(b) Activities.--An eligible partnership that receives a grant
under subsection (a) shall use such grant to further one or more of the
following objectives:
1. Develop, implement, and assess technology-based service models
and best practices to improve the aging services network for older
adults both in their communities and in care settings such as adult day
care centers.
2. Develop, implement and assess the use of in-home monitoring and
assessment technologies designed to connect both family and
professional caregivers to the frail elderly.
3. Develop, implement and assess technology-based service delivery
systems designed to meet the needs of frail elderly residing in remote
or rural areas.
Innovative Approaches to Integrating HCBS with Affordable Housing
Subsidized housing facilities currently offer supportive services
on-site, including service coordination, health screening, education,
and activities, meals programs and more advanced health monitoring.
Virtually all of these programs link the Department of Health & Human
Services housing programs with Older Americans Act supportive services
programs. AAHSA's Institute for the Future of Aging Services is
studying ways to improve the integration of housing and services
through the development of innovative models and practices that foster
consumer choice and independence. The re-authorization of the Older
Americans Act is the right time to study and develop the linkages
between affordable housing and supportive services.
Conclusion
The re-authorization of the Older Americans Act is the right time
to develop new ideas that will strengthen the aging services. AAHSA
supports the development of innovative approaches to the home and
community based service delivery system. Technological innovations will
transform the home and community based long-term care delivery system,
and we must develop, implement and assess this model of care.
Affordable housing must be linked to supportive services to offer a
comprehensive approach to care that will meet all of the needs of our
frail elderly. We look forward to working with these proposals.
______
Prepared Statement of Gayla S. Woody, Aging Program Administrator,
Centralina Council of Governments Before the U.S. Senate Special
Committee on Aging
Good morning, Chairman Smith, Ranking Member Kohl, Senator Dole,
and other distinguished members of the Committee. Thank you so much for
this opportunity to talk with you about how my community is preparing
for the demographic changes facing the nation. My name is Gayla Woody
and I am the Program Administrator of the Centralina Area Agency on
Aging (AAA). My region covers nine counties in North Carolina: Anson,
Cabarrus, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly and
Union counties. This is the largest region in the state and includes
Charlotte, the largest city.
While the counties in my agency's planning and service area (PSA)
range from a large, metropolitan area to a very small rural region,
they share at least one characteristic. The aging of our nation's
adults--in particular the demographic cohort known as ``baby boomers''
and the fastest growing population in the country, those 85 years and
older--will present tremendous challenges and opportunities for all of
these communities.
With the first wave of boomers turning 60 this year, and thus
becoming eligible for Older Americans Act (OAA) services, we cannot
afford to sit still and wait. To ensure that America's communities are
prepared to meet the needs of today's and tomorrow's older adults,
preparation and planning must start now.
The Aging of America
The rise in the number of aging citizens will impact the social,
physical and fiscal fabric of our nation's cities and counties,
dramatically affecting local aging, health and human services;
emergency preparedness; land use, housing and transportation; public
safety, workforce and economic development; recreation, education/
lifelong learning; and volunteerism/civic engagement policies and
programs.
An organized, informed and thoughtful community planning process to
prepare for the aging of this nation's population is needed at every
level. Preparedness is not just for disasters and emergencies, but
should be used to help a community adapt to changing demographic needs.
``Livable communities for all ages'' refers to places where citizens
can grow up and grow old with maximum independence, safety and well-
being. Although there is much that individuals can and should do to
maximize their independence as they age, public policy makers must make
critical decisions relating to housing opportunities, transportation
systems, and land use regulations, for example, that affect the ability
of an older adult to live at home and in their community.
One Approach: Mecklenburg County's Status of Seniors Initiative
I am proud to report that Mecklenburg County (which includes the
City of Charlotte) has refused to just wait and see how the aging of
the baby boomers will impact the community. The policymakers and
leaders in the County know that they cannot afford to wait. Currently
there are almost 90,000 people over the age of 60 in Mechlenburg County
and there will be approximately one-quarter of a million people over 60
in the County by the year 2030. That's almost a tripling of the
County's elderly population in fewer than 25 years.
In order to begin evaluating what this change will mean and to plan
accordingly, the Mechlenburg County Commissioners convened a broad
based group to examine this critical issue and launched ``The Status of
Seniors Initiative'' (SOSI) to develop strategies to assist the
community respond. Representatives from the hospitals, home care
agencies, social service organizations, housing authority,
transportation services, health department, the United Way and others
were included in the group. The collaboration also included the
Charlotte Chamber of Commerce, local attorneys, and representatives
from colleges and universities, the real estate industry and others. As
the director of the area agency on aging, I serve as a member of the
project's executive steering committee.
After four years of data gathering, research, analysis and
strategic planning, SOSI has completed three reports looking at the
impact of the aging of the baby boomers on our community and has
identified seven recommendations to begin making changes to respond to
this major demographic trend. Our motto is ``A Senior Friendly
Mecklenburg'' and our vision is a ``senior-friendly community that
values dignity and independence for all older adults.'' (These reports
and recommendations can be found online at http://
statusofseniors.charmeck.org.)
To provide you with a sense of how we approached the demographic
challenges, here are the categories we explored first:
1) Need for Information. How does our community ensure that older
adults, baby boomers, caregivers and others can get the information
they need about aging issues and services and, that they will know
where to go for assistance?
2) Caregivers. One-third of current older adults believe they will
be a caregiver in the next five years. Estimates of lost worker hours
and income and the resulting reduced pension benefits related to
caregiving are as high as $11.6 billion dollars. How will our community
provide the support caregivers need in order to continue to function?
3) Physical Environments. Does our community's physical environment
and infrastructure provide opportunities that older adults and baby
boomers need in order to remain independent? For example: Do we have
adequate, appropriate and affordable housing options for people as they
age? Is senior housing (public and private) accessible to community and
commercial services? Are crosswalks designed to allow enough time for
an older adult to cross the street before the light changes? Are street
signs actually large enough for older adults to read? Are sidewalks
wide enough for wheelchairs or level enough for walkers?
4) Transportation. Are there programs in places to help older
drivers access their driving and make adjustments to respond to
physical limitations? Will we have enough adequate, appropriate and
affordable transportation options available in our community to support
older adults when they need to restrict or stop driving?
5) A Focal Point Organization for Aging. As a result of funding
from various silos, our community has a fragmented service delivery
system which sometimes makes it very difficult to get information and
services on aging in just one place. We think the boomers will expect
more and thus demand changes. Can our community develop a uniform and
seamless system to enable all people to access needed aging information
quickly and easily, regardless of income status?
6) Safety & Security. We found that older adults perceive safety as
an important issue, regardless of the actual incidence of crime against
older adults in their community. So how can our community communicate a
safer, more secure environment for seniors? What can we do to help both
reduce actual crime against older adults and to reduce citizens' fears?
7) Public Policy. One of the guiding principles of SOSI is that our
community have a structure in place to allow those that wish to ``age
in place'' to have the supports they need to do so successfully. We
need to rebalance our systems to provide more options for older adults
to get the care they need at home and in the community rather than in
institutional settings.
With these goals in mind, several projects are already underway.
1) In partnership with the Charlotte Police Department, we have
implemented a training program for new police officers called ``First
Responders.'' This training teaches law enforcement about the unique
needs of older adults and how to recognize signs of abuse, neglect or
exploitation.
2) In partnership with the Chamber of Commerce and a local Builders
Association, a meeting was held with over 200 real estate and building
professionals to talk about the SOSI report and its recommendations.
The Charlotte Planning Commission Director and a representative from
the Metropolitan Planning Organization are already engaged in
discussions regarding initiatives in response to the report.
3) The community college and the local Council on Aging are co-
hosting a conference entitled ``Can Businesses Boom as Boomers
Retire?''
4) While I was writing these remarks, our local government
television channel ran a 30-minute program about the SOSI report and
what we can expect from the aging of the boomers. There have been
newspaper articles, as well as presentations on the report to the
County Commissioners, the City of Charlotte, the Chamber, the United
Way, AARP chapters, and countless others. A very important part of the
work is educating the public about what the aging of the population
will mean for them and for our community.
It has been quite an adventure over the last four years as our
Mecklenburg community has pulled together to begin preparing for the
future. It is important to note that other than a ``will'' and
committed volunteers, we have very little in the ``way'' of funds.
Progress has been much slower than if we had had even one staff member
dedicated solely to this project. Yet it has been so exciting to see
the large number of people involved with SOSI, including many ``non-
traditional'' stakeholders who aren't normally identified as part of
the aging community.
Scaled to Fit: Rowan County's LIFE
Senator Dole's home county of Rowan is also one of the counties in
my AAA's PSA. In 2003, I began to work with a group called Rowan LIFE
(``Life Improvement for Everyone'') that included the local senior
center (Rufty Holmes Senior Center) and the county's senior services
department, all of which recognized that the community was in need of
more planning for the future. Although a much smaller and more rural
area, Rowan County shared several common denominators with Mecklenburg
County, including:
Recognition that the boomers would significantly increase
the number of older persons in the community;
Interest in Rowan County becoming a more senior-friendly
community;
A broad collaboration with many ``non-traditional''
stakeholders;
Very little funding to support the initiative; and
Committed volunteers.
Rowan LIFE has completed their first report and has identified five
initiatives on which they are currently working. As Rowan LIFE
completed their report, the local United Way was developing their
community needs assessment. United Way decided to include the Rowan
LIFE report for their section on aging. In addition, United Way's
collaboration with the project has also resulted in the community
getting a 211 county-wide information and assistance system
established.
It is so exciting to see that the planning Rowan and Mecklenburg
Counties have done has positioned them to leverage grants and other
funding to achieve their goals. For example, in Rowan County, a uniform
and seamless service delivery system is a major goal. Because of the
collaborative work we have done with Rowan LIFE, this community is
positioned to receive a State Rural Health grant of several hundred
thousand dollars to help make changes to their service delivery system.
Another part of the grant that Rowan County applied for is about
helping older adults with chronic illnesses manage their conditions for
improved quality of life. One part of that management will include
health promotion and disease prevention activities. Currently, Rowan
County uses Older Americans Act Title III D funds for a very exciting
evidence-based walking program our region calls ``Walk Around the
World.'' Participants in the program take a simple pre-test to
determine baseline capacity, then maintain a regular walking schedule
and record the actual number of steps taken. After six months, a post-
test determines the individual's increased capacity. Working together,
this community is making strides in helping people stay healthy.
With the burgeoning of the boomers into the elderly population, it
is absolutely critical that we increase funding for and emphasis on
health promotion programs. We will never have enough money to take care
of everyone, but teaching and supporting people to live healthier
lifestyles will improve quality of life and will be the only way our
service delivery systems will be able to continue to offer service
supports to the most frail and needy elders.
Small Steps: Early Responses to Boomers
I would like to mention a couple of other programs that have been
initiated in my PSA in preparation for the boomers. One of my smallest
counties, Lincoln County, was the only county in North Carolina that
did not have a congregate meal program where older adults could gather
in a public place for meals and socialization. Since the late 1980s, I
had been encouraging Lincoln County to begin a meal program. About two
years ago, while meeting with the local service providers, I again
asked the question about the congregate program. The service provider
responded: ``You know, I don't think baby boomers are going to be
interested in a congregate program; I wouldn't. So why would I go to
the effort of starting a program that is going to die?'' I responded:
``Ok, we're boomers sitting around this table, so what kind of meal
program would we be interested in?''
Out of this conversation about the preferences of baby boomers, the
``Restaurant Voucher Program'' was born. The program provides a variety
of opportunities for participants to attend programs on healthy living,
where they receive meal vouchers to use in participating local
restaurants. Boomers like to have choices so the program includes
several restaurants. Boomers may not want to come to a congregate meal
at a certain pre-determined time, but they will go to the participating
restaurant for lunch or dinner during the restaurant's more open hours.
The program also allows multi-generational families to go out together
and the participant can still use their voucher (vs. congregate meal
programs that are limited to eligible older adults). This program has
very good partnerships with the local restaurants, most of which see it
as a community service.
One of our other small counties, Cabarrus, has a pilot program for
consumer-directed care. Again, for boomers, choice is a very important
word. The Cabarrus County consumer-directed care program allows
eligible participants to directly contract with providers and thus
customize any services to their individual needs. While not workable
for every consumer, this approach to offering services and supports is
becoming popular and may be one of many ways to prepare the long-term
care infrastructure for the future. For example, a boomer is caring for
an older parent in her home, which does not contain a washer or dryer.
The parent's medical condition is increasing the need for frequent
laundering, so the caregiver asks a AAA for respite care so she can go
to the Laundromat, or the services of an in-home aide to do the
laundry. But consumer-directed care could allow for the purchase of a
washer and dryer for the home, eliminating the need for respite or
chore services, which over the long run are more expensive than the two
appliances.
What We Still Need to Do and Why
As the Centralina Area Agency on Aging director, I have invested a
lot of time in supporting Mecklenburg and Rowan counties' community
planning efforts. I believe that AAAs can offer tremendous technical
assistance to local community planning entities to help them define
their mission, determine their process and gather critical information.
Unfortunately, I have only had the staff resources and time to support
two of the nine counties in our PSA. Some of the other counties have
expressed interest in starting similar planning processes, but with my
agency's regular responsibilities under the Older Americans Act and the
recent demands that Medicare Part D enrollment counseling and
assistance has placed on my agency, I simply cannot do so at this time.
I would urge Congress to consider adding resources to the Older
Americans Act to encourage and support AAAs to take on this community
planning role. In the long run, this is the most cost-effective and
rational way to brace ourselves for the boomers and their effect on our
nation.
Widespread public support for such a measure exists: The need to
improve state and local integrated delivery systems to meet the 21st
century needs of seniors became the 10th highest-ranked resolution at
the 2005 White House Conference on Aging. Delegates suggested a new
Older Americans Act title on community planning as one of several
implementation strategies for this resolution. North Carolina's state
unit on aging has also identified community planning as a high priority
and, with limited resources, we are trying to identify strategies for
our aging network to adopt.
In conclusion, Mr. Chairman, the boomers will change the way we do
business. In North Carolina and in my region, we have also recognized
that as an aging network, we must collaborate and work with many ``non-
traditional'' players. Aging impacts all parts of life--our
environment, our workforce, our caregivers, our health, our service
delivery system and our leisure--just to name a few. It is critical
that we educate our communities about what this change will mean and
aggressively plan to meet the challenges it will bring with it. The
Older Americans Act has been the framework for the aging network since
1965. Today in 2006, it must be modernized to help communities prepare
for the boomers. Too much is at stake to ignore the age wave and too
much will be lost if we delay.
Thank you for the opportunity to testify before you today. I would
be pleased to answer any questions you have today or in the future.