absolutely necessary and pursuant to the terms of the war powers act. >> the gentleman yield back. mr. sherman is recognized for two minutes. >> thank you. the state department is working hard to bring the blessings of democracy and the rule of law to every country except ours. rome was built with legislative decision-making. rome declined under an imperial executive. caregiving organizati.

wisconsin senator herb cull chairs the committee. live coverage on c-span3.

good afternoon. we'd like to thank all of you for being with us today. in 1965, the same year medicare was created, president johnson signed another landmark bill for america's seniors, the older americans act. today the program's authorized by the oaa serve more than 10 million older americans nationwide and over 386,000 in my state of wisconsin. they help seniors live independently in their communities through home care, home delivered and group meals, family caregiver support, transportation as well as other services. while the need for such vital oaa services has increased

during these difficult economic times, federal funding for oaa programs has not. this year, oaa programs were cut by 17% from last year. every five years congress takes a fresh look at oaa programs to assess whether they are meeting the needs of the people they serve. last september i held a field hearing in milwaukee to gather ideas for strengthening and improving oaa programs. since then, we've incorporated many of the recommendations we received into priorities, and we will work with our colleagues to include these priorities in the new bill. one of our priorities will address helping the nearly 44 million family members providing care to an older relative by simply asking them, quote, what do you need, by permitting states to assess whether family caregivers need services such as respite care and counseling. we can delay more costly institutional placements of

frail and disabled seniors. we also believe we must strengthen the long-term care ombudsman program, which helps resolve complaints of abuse and neglect in long-term care settings. we will work to expand the capacity of the national ombudsman resource center and increase the access to the records so they can be more efficient as well as more effective. once again, we'd like to it thank you all for being here. we look forward to your remarks, particularly those who are testifying on how we can improve the older americans act. we turn now to senator bob corker. >> thank you, mr. chairman. as always, thanks for calling the hearing. on the older americans act. we thank the witnesses who are here today to share your expertise and experience. i want to especially thank roz alisten carter, our former first

lady for sharing her experience and others. on the good work they're doing for seniors of east tennessee. i look forward to learning more about older americans act programs today. when the older americans act was passed in 1965 it was designed to be the human services support for seniors and complement the health support offered by the brand new medicare/medicaid programs. this non-medical support envisioned by the older americans act was proven to be what seniors need to stay in their own homes and independent as long as possible. these services, like home-delivered meals, rides to appointments and activities, housekeeping and personal care, case management, caregiver support, and senior centers a s the sort of home and community-based services that seniors and their families across the country rely upon.

in tennessee, older americans act home and community-based program serve about 159,000 people, almost 2,000 people are working and learning new skills for future sustainable employment because of the senior community service program. the service providers in tennessee work hard to help seniors maintain dignity and independence with the latest innovation and programs. for example, tennessee has started to get in place aging and disability resource centers. these centers are to serve as a single point of entry for all seefrs services a senior may be eligible for. i look forward to review thing the upcoming administration of these centers and to see if any necessary improvements in this information and referral innovation. in 2020 -- and this is something that i think all of us are

focused on as we look at future budgets -- there will be more than 75 million people over the age of 60, and thereby eligible for the older americans act programs. with our population growing older, these programs become more and more important, but, at the same time, with we are experiencing a fiscal crisis, a need to seriously review spending on all government programs. this means that older americans act programs will have to continue to innovate and increase efficiencies to meet increasing demand. i look forward to working with my colleagues and with our panelists to continue to modernize the older americans act so it can be flexible and appropriate to serve the needs of our nation's seniors. thank you, mr. chairman. >> thanks very much, senator corker. senator nelson of florida. >> thank you, mr. chairman. i want to take this opportunity to thank you for your long and

distinguished career. it this is the first opportunity publicly that i can say that to you, as we have already discussed privately, because last week you announced that you are agoing to retire from publi service and your 24-year career in the united states senate is most distinguished and most appreciated by a lot of folks who never get a chance to tell you. and like most citizens of the united states that have a connection one way or another with florida, so you do as well. the senator's brother is one of our distinguished citizens palm beach. and i want to say to ms. carter, thank you for you just keeping

on keeping on. it was a long time ago when you and your husband were campaigning in the florida primary in 1976, and you have been his partner every step of the word in the best sense of that word and you continue today rendering service to our country and to our people. so thank you very much. and, mr. chairman, i just wanted to mention that, on this subject that we are discussing today, a good example is a bill that i've had to file -- i say had to file because, for example, in all the good stuff that programs like community development block grants do, cdbgs, but it has, for example, a limitation of 15%

of the funds that can go to feeding programs for seniors. in one particular case, the city of miami wants to desperately to use those -- the remaining cdbg funds for assistance to seniors in the feeding programs, but they're limited to 15%. so i filed a bill to raise that a modest alt amount to 25% that would give the recipients of the cbgd's that amount to tailor their particular needs of the community, in this particular case the need of senior citizens. i just wanted to get that out on the record for the committee. >> very if. thank you. senator mark udall. >> thank you, mr. chairman. good afternoon to everybody iflt, too, want to associate myself with senator nelson's

remarks about your leadership. i haven't forgiven you yet, senator kohl. i want that on the record. >> i have your note. >> i want to welcome our panelists. i unfortunately have to step ouflt i serve on the intelligence committee and we're having an important debate on the patriot act and its reauthorizati reauthorization. i did want to recognize the former first lady. wonderful to see you here today. ms. greenly, you were hit in pueblo last summer. you were a real crowd pleaser. i can't say the same about myself, but thank you for holding hearing with us in pueblo. i know the chairman and many members of the committee have been holding great hearingings across the kroi on the oaa. we have a great opportunity in my opinion to modernize the act for you a new and unique generation of seniors. i'm a member of the baby boom cohort. these americans, my remarks today, my people are fast

approaching medicare eligibility. and i think we have different expectations, different experiences about how we can make our golden years really meaningful. so this is an important hearing, mr. chairman. look forward to working with you to modernize the act in ways that take advantage of the potential and contributions that every american can make regardless of their age. thank you again. >> thanks, senator udall. >> thank you. i'll be brief and i'll add a statement to the record, but we want to commend you not only for today's hearing but of course for your great service to the united states senate. you've been a great leader of this committee and we'll miss you. we know you're going to be here for a while yet. we're not saying good-bye yet but want to commend you. to rosalyn carter, former first lady, we're grateful you're here and appreciate your important witness on these issues over the years and your leadership and testimony today. assistant secretary greenley, we're grateful to have your testimony today as well.

on the second panel, i'm honored to say as a pennsylvanian we have a former mayor of york, pennsylvania, elizabeth marshall, who is here. we will say hello to her in a more personal way a little later, i'm grateful she's here. just a couple of words about why we're here. this legislation, of course, the older americans act, has often been described as the glue that holds a whole series of programs that benefit older citizens together. i think what brings us into this room today is not just legislation and policy but a shared commitment that we have more work to do as it relates to older citizens, those who have fought our wars, worked in our factories, taught our children, built our economy and gave us life and love, that we've got an obligation and enduring, abiding obligation to do all we can. one of the ways to fulfill that obligation is to make sure we make the right choices on legislation and policy.

i'm happy to be part of this hearing today. thank you, mr. chairman. >> thank you very much, senator casey. we're honored to have with us today former first lady rosalynn carter. we're all familiar with ms. carter's tireless advocacy alongside her husband president carter on behalf of human rights and conflict resolution around the world. she is also a dedicated advocate for caregivers and mental health issues here at home. ms. carter is president of the rosaly rosalynn institute for care gifg at georgia southwestern state university where she leads the institute's efforts to promote the well-being of family caregivers throughout our country. she is an inspiration for many and a ledgend in her own right. next we'll be hearing from kathy greenley, the assistant secretary for aging at the u.s. department for health and human services. ms. greenley has a wealth of experiences advancing the health

and independence of seniors and families. previously she served as secretary for aging for the state of kansas as well as the kansas stacannes state long-ter ombudsman. we thank you very much for being here and we'll take your comments and testimony, mrs. carter. >> i'm very pleased to be here this afternoon to speak about care giving, an issue that is very important to me. it's been part of my life since i was 12 years old and my father was diagnosed with leukemia at age 44. we lived in a very small town, and all the neighbors rallied around. but i still vividly remember going to my secret hiding place, the outdoor privy, if you can believe that, to cry. that's where i could be alone. i was the oldest child, and i felt the burden of needing to help care for my father and my three younger siblings, yet i was afraid and didn't always feel like strong.

but my mother depended on me. less than a year after my father died, my mother's mother died, and my grandfather came to live with us. he was 70 and lived to be 95. my mother cared for him at home until he died. i helped as much as i could, but i was married and living away much of the time. during the last few years of his life, he was bedridden and totally dependent on her, our family members, neighbors and friends, for all his needs. my story is not unique, but today the informal support networks that were so much a part of my life in a small town, neighbors, extended family, the church, are not there for millions of americans. families are fractured and dispersed. women, the traditional caregivers are now an integral part of the work force, advances in medical science means we're living much longer. yet resources that enable us to live independently are sorely lacking. we face a national crisis in caregiving, especially for our elderly citizens.

most frail elderly and disabled people live at home today. about 90% of the care they need is provided by unpaid, informal caregivers. most often family members, providing tasks that only skilled nurses performed just a decade ago and with minimal training. many of these caregivers are frail themselves and find the burdens overwhelming. consider are these facts -- older people caring for their spouses have a 63% higher mor l mortality rate than those of similar age without cares giving responsibilities. the stress of care giving someone with dementia negatively impacts the caregiver p up to three years after caregiving ends making them more susceptible to illnesses. caregivers report cancer, heart disease and diabetes at twice the rates of noncaregivers. and up to 50% report struggling

with depression. it's even higher when caring for a loved one with dementia. while experts estimate the value of care provided by unpaid informal caregivers to be more than $375 billion annually, medicare givers have to reduce their working hours or even quit their jobs, losing health and retirement benefits worth hundreds of thousands of dollars. economic consequences are devastating. our nation's family caregivers are enduring both physical and mental problems and even dying sooner because of the responsibilities in caring for a loved one. mr. chairman, there are only four kinds of people in the world. those who have been caregivers, those who currently are caregivers, those who will be caregivers and those who will need caregiving. that's all of us. caregiving knows no geographic or political boundaries. the rosalynn institute for

caregifg at georgia southwestern state university near my hometown is doing groundbreaking work helping with challenging care giving responsibilities. in one of our programs we undertook a national assessment of the state of caregiving in our country. we discovered innovative programs proven to be effective, but they were not and are not reaching people in need. one of them focuses on the spouses of people with alzheimer's disease. it provides concrete advice on how to deal with difficult behaviors like wandering, repeatedly asking questions and agitation. it also focuses on taking care of oneself and onsimple sec nee to reduce stress. a woman who went through the program said it changed her life. she said she was overwhimmed by difficulties and stresses on resuming care for her mother after her father died unxpiktedly. she now is proud to be able to

allow her mother to stay in her home. just think what a difference this kind of program would make in lives of caregivers across the dri. the rci, the rosalynn carter institute, has been working in georgia and in demonstration sites around the country to introduce these interventions at the community level. but of more needs to be done. there must be a fundamental shift in how this nation values and supports caregivers and caregiving. last october the rosalynn carter institute released a very important report averting the caregiving crisis, why we must act now. this report is a result of three years of intensive study, which involved hundreds of experts. i urge each of you to read it carefully for it contains a blueprint for a national initiative to support family caregivers. its recommendations include better assess thes of caregiver

health and greater flexibility in both public and private insurance programs to provide training and support for family caregivers and more. its most important recommendation, however, is a call for leadership. we propose a national quality caregiving task force in the president's office with shared leadership between the secretary of health and human services and the secretary of veterans affairs. we have the knowledge base to solve the caregiver crisis and we're already spending billions of dollars which can be used much more effectively. these are challenging times for our country with extreme pressure on federal, state and local resources. families and communities are struggling to cope, yet if we fail to act now, the consequences for those in need of care will be increased rates of institutionalization, higher risk of abuse and neglect,

unnecessary isolation, and perhaps even premature death for family caregivers it will mean much greater burden, increased risk of physical or mental health problems, and more financial hardships. for our already overtaxed health care system, it would be impossible to find the workforce to deliver high-quality institutionalized care. the overall impact would be an unpress acedented burden. in human terms, it would lead to unparalleled suffering for americans and their caregivers. we cannot let this happen. thank you for the opportunity to speak with you about this most significant national issue. mr. kohl, thank you. >> thank you very much, mrs. mrsmrs. mrs. carter. now we'll hear from ms ms. greenley. senator kohl, good to see you again, senator corker, members of committee on aging. thank you for the opportunity

today to taunl about the reauthorization of the older americans act. in preparation for this process at the administration on aging, we went through the most extensive outreach effort in the history of the agency to seek input all across the country from family caregivers, seniors and other individuals who are are providing support. we have a lot of information that we've gathered about the value of these programs and look forward to continuing to work with this committee as we take p up the challenge of reauthorization. senator kohl, i would like to join your colleagues in commending you in your service on behalf of older americans. i think i've mentioned to you before i first heard of you from our mutual friend george pa tross xi, the long-term care oemz buds man in kansas. not only have you helped seniors, but you've paid particular attention to seniors in nursing homes in this country. many of us, i think i can speak on behalf of the aging network, will miss your leadership and have valued your contribution.

thank you for your service. it's also wonderful to appear today with mrs. carter. a tremendous honor to be here. i met mrs. carter last fall when i traveled to the rosalynn carter institute to talk specifically about what we need to do to continue to advance the cause and the support for caregivers. she had released her report about that same time. mrs. carter is a leader in the field of caregiving. the work they're doing at the institute is innovative. the leadership she is asking for she herself is providing. i also want to acknowledge her work in the field of mental health. not something we'll spend as much time on in this hearing, but mrs. carter's work in mental health is really important for individuals dealing with mental health and their family members. i applaud your work, mrs. carter. it's an honor to be here. as you know and mentioned, i was the secretary of aging in the state of kansas. i have served now two years for the u.s. assistant secretary for aging. in both of those capacities, i

have listened to and spoken to literally thousands of individuals and families in a variety of settings, and i have seen firsthand how the older americans act reflects the values that we have in this country. supporting independence, helping people maintain their health and well-being so they're better able to live with dignity, protecting the most vulnerable among us, and providing basic respite care and other support for families so that they're better able to take care of loved ones in their holmes and their communities for as long as possible. this is what americans of all ages overwhelmingly tell us they prefer, to age at home in their communities. one of the real strengths of the older americans act is it doesn't matter if an individual lives in a rural area, frontier area or urban center. the programs and the community-based supports are flexible and flexible enough to meet the needs of individuals in all of these diverse communities and settings. over the past year alone, nearly

11 million older americans and their family caregivers have been supported through the older americans act comprehensive community-based system. these services, as you mentioned, senator kohl, complement medical and health care systems. they help to prevent hospital readmissions. they provide transportation to doctor's appointments and support of some of life's most basic functions, such as bathing or having a home-delivered meal. this assistance is especially critical for nearly 3 million seniors who receive intensive in-home services. 500,000 of whom would otherwise qualify for nursing home admission. for more than a year we've received reports from more than 60 reauthorization listing sessions around the country, have received online input from a variety of sectors, individuals and organizations and their caregivers. this input represents the interests of thousands of individuals with regard to the older americans act's services.

during this process, we heard an overriding issue that mrs. carter has already spoken to today, was also advanced through the vice president's middle class task force. and that's issue with regard to families. families are doing the best that they can, but they're struggling between balancing the demands of work, child care, and elder care. families tell us that they need some basic assistance in supporting their care for their loved ones. during our process of soliciting ip put, we heard that the older americans act is working and it needs to continue to be flexible. we also heard two particular themes that i want to suggest in terms of further conversation. one suggestion or recommendation that we have heard is that we continue to improve the program outcomes by embedding evidence-based interventions and disease prevention programs, encouraging comprehensive person-centered approaches, providing flexibility to respond to local nutrition needs, and

increasing efforts to fight fraud and abuse. second, we need to remove barriers and enhance access, extending caregiver supports to parents who care for their adult children with disabilities, providie ining ombudsman servic all residents of nursing seniors and using single access points to provide information regarding public and private resources for long-term supports and services. let me give you three brief examples we'd like to discuss as we continue our work. one, we should ensure that we utilize the best evidence-based interconventions for helping older individuals manage chronic disease. these have been effective at helping people adopt healthy lifestyles, improve health status and reduce their use of hospitals and emergency room visits. we want to improve the senior community services employment program by integrating it with other senior programs. as you know, the president has recommended in 2012 through this budget process that we transfer

the older workers program from the department of labor to the administration on aging. we would also like to continue to combat fraud and abuse of both medical you care and medicaid by permanently establishing the program as a basic component of the older americans act. so we can continue to use retired volunteers to help us detect and deter fraud in the area of medicare and medicaid. the older americans act has historically enjoyed widespread bipartisan support. based in part on this extensive public input, we believe that reauthorization can strengthen the older americans act and put it on solid footing to meet the challenges of a growing population of seniors, while continuing to carry out the critical mission of helping elderly individuals maintain their health and independence in their holmes and communities. thank you again, senator kohl, senator corker, for your leadership. i look forward to working with you and the rest of your committee. >> thank you very much,

ms. greenlee. we'll now commence questioning. we'll start with senator corker. >> thank you, mr. chairman. i'll be brief. again, thank you both for your testimony. ms. carter, i notice the chairman said you were a legend in your own right. certainly not in relation to anybody up on this panel, we serve with a lot of people here that are a legend in their own mind. so we thank you so much for having earned that and certainly bringing such focus on this issue. but thank you very much for your testimony. i have a few organizational issues to ask mrs. greenlee about. the president's budget this year transfers some additional responsibilities to your agency, title 5 senior community services, employment program, the state health insurance assistant program, the class act. you know you were talking about some of the flexibilities and other things that need to happen within your organization. is that going to, in your

opinion, distract at all from your ability to efficiently carry out the other responsibilities of the organization? >> no, senator corker. the agency has a 45-year history and experience in providing community supports to individuals. one of those kpoept components economic security of seniors. we have a variety of programs that have worked on pension koumsing, benefits outreach, bringing the program to oaa will help our mission. it's the only one of the programs that we do not administer. the senior health insurance assistance levels are delivered through our area can agencies at the local level. and the reason for the class act, the underlying need for the classes act, is to provide a different type of option for individuals to maintain their independence in the community. we feel like we have a wenl wealth of knowledge to support these other programs and can make them all work to help individuals, people with disabilities and seniors, remain

ind independent. i know secretary sebelius has mentioned that the class act is an unsustainable program unless numbers of changes are made. i know that y'all are probably closest to it, since as you mentioned you're going to be involved in implementing. are there things that y'all are already looking at to major structural changes to actually cause the class act to be sustainable? i know there's people on both sides of the aisle with a lot of concerns about that. >> senator, as you have referenced, i was designated officially in january of the administrator of the class program. the secretary and i have both had opportunity to testify, most specifically on the house side, and committed ourselves and our efforts to the financial solvency of this program. we both agree that there are reforms that need to be made to the program in order to sustain the program and make it financially sound for 75 years as required by the law. we will this fall issue prim p

marry regulations with regard to the program and at that time be able to provide more information about the kinds of things that we'll need to do through a regulatory process to strengthen the program. there are things that we were looking at, considered by the senate, prosecute the bibefore bill was passed that we'll return to first as we find ways to support the program. >> as you go about looking at implementing -- i know there has to be some investments made, if you will, through your organization to begin that implementation -- how are are we accounting for that? is that something that goes into the actual cost of the class act itself, or is that something -- how is that being accounted for? >> senator, as you know, health and human services was given money to implement the affordable care act. it is from those funds we've currently been paying our operational costs. we have made sure we can identify all the staff who are working on the class program full time, those of us who split our time between class and the administration on aging's

traditional work, so we can fairly account for the work we're doing. i believe we're adequately handling the accounting that needs to be done. >> i know there's a lot of -- there's going to be a tremendous amount of focus on medicare and its sustainability over the course of this summer. my hope is that, you know, we will in a bipartisan way figure out a way to make it solvent. we all know it's going to be insolvent as is. the trustees are stating by the year 2024. as you said with the class act, i think people believe it's already at that stage. i do hope you'll let us know of some of the major frailties that exist there and continue to keep us apprised of that. we thank you for your service. thank you, mr. chairman. >> thank you, senator. >> thank you, senator corker. senator casey. >> thank you, mr. chairman i want to thank you both for your

testimony and the personal witness you bring to these issues. i wanted to start with our former first lady. mrs. carter, on a question that relates to the specialized training that is often needed in these circumstances. i have been, over many years as a state public official for a decade and now in my fifth year in the senate, overwhelmed by the kind of care that's delivered by direct care workers, how strong they are, how dedicated they are, willing to do backs brebreaking and soms seemingly impossible work on behalf of those who need that care and on behalf of their families. but i wanted to does you about -- i noted in your testimony on the four recommendations that you made, as well as assistant secretary greenlee, about evidence-based programs, and i wanted to get your sense of that based upon

your experience as to evidence-based programs on this question of specialized training and preparing folks for doing that difficult work. what can you tell us about that in your experience? >> well, we've been working with evidence-based programs for a good while now at the rosalynn carter institute. one that we are working on -- we're doing six in all with johnson & johnson. and johnson and johnson's been great because they were the first ones to do clinical trials in nursing homes working with those who are suffering from mental disorders. so they've been very good to us. but we have six programs, and a couple on alzheimer's, and we actually are doing an alzheimer's one at home.

and we train people to go into the homes, they don't have to come in fl. when we were trying to get -- they didn't -- caregivers don't want to come in and they don't want to admit they're caregivers. so many of them, they don't want to admit they have help. it's just what they should do for a family member. but we send them into their houses. when they find out that this person can.c come to the house, they welcome them. and so we go i think six weeks a couple of type times a week, ad we have found that it increases the time people can stay at home without being institutionalized. the depression is lifted to a certain degree. and it just -- it's working. and we're also trying this in

other places around the country. but we're working with three now and we are comparing them to see which is best for alzheimer's. we've done one with cancer, but -- and we've had at the carter center everybody that we knew of, i think, in the united states who was working on evidence-based programs. i think we had one from ireland who came to that meeting. and we have had great reports and actually it just helped so much when the program works. and it is -- it's cost-effective because they don't have to try things and try things. they just know what works. and if think will follow the guidelines of the program, it can help. so we just need evidence-based programs in the whole country. it's going to be a long time before we get there, but we really are working and doing research right now on those

programs in many parts of the country. >> i thank you for that. i know that part of what we're trying to do is to not only improve care and provide the kind of highest level of care we can, but also to provide options for the workforce and sometimes i guess they're described as career ladders, ways for people to move up if they're in an entry-level position. i think that evidence-based research and the care that can come from that is going to be critically poimportant. i've got only about 20 seconds. assistant secretary greenlee, anything you wanted to add on this question of training or the evidence-based methods? >> just state the obvious. it's such a broad topic. it will take many different federal organizations working together. we have a community living initiative within hhs that looks at issues with regard to people with disabilities as well as

seniors. senator corker mentioned the classes act. this was identified even in the law of the classes act. you know, how will we support the public programs that we will have in the future of the class act, the medicare and medicaid programs, the programs we have under the older americans act, disability programs with a paid workforce and provide enough support that they have meaningful careered ladders but also they have a skill set to serve an increasingly aging population. it will take both a paid and unpaid workforce to provide the kaifr needed in this country. >> thank you very much. >> thank you, senator casey. senator manchin. >> thank you, mr. chairman. thank both of you for being here. we appreciate it very much. state west virginowest virginia you've done and assistance we get from the older americans act and what it's done to our state. we have the second most aged state in the nation per population. probably one of the most rural

states so it's quite costly to get the services that are needed. we've expanded those and i think the word you had mentioned earlier was flexibility. i can't explain enough how much flexibility that we need in some of these states so that the money is not siloed. transportation is one. meals on wheels is another. used for small states and rural states sufficient as myself. there's more populated states and i know funding mechanism is based on population, it should be base on td on the services t are given. if y'all could just consider that, we serve an awful lot of people in west virginia and our funding is much lower, but we're feeding many, many, many more than other states that might not have the need as we have. with that, i think you might be aware of some of the programs we've expanded and the fair programs and lighthouse programs. we did some things during the most difficult recession times we expanded programs because it was a priority of ours to allow

our seniors to live in dignity in their own homes with a little bit of assistance. a need base is a big thing in west virginia because we have a lot of seniors who want to be able to contribute and pay their way or pay part of their way if they can. so we try to develop flexible plans to where they felt like they were still contributing but they couldn't just find the service anywhere. a lot of times if you're on a certain cuff and you get -- if you're not within a certain guideline as far as income, the service is not even offered. i think that's something that should be considered, too, because it's not for a lack of need. they just can't find anyone else to provide those services and they're willing to pay. so we hope those flexibilities are are taken into consideration. in transportation, that's the one that we're having some concerns about. i don't know if -- i support the oaa lock, stock and barrel. tell me what you think you can do to help us help ourselves more. >> senator, we do have a

transportation support that we can provide in the older americans act. transportation is such a huge issue that i don't think there's a way to completely address the transportation needs with such a program of this size. we need to talk to other partners at the federal level and at the state and community level to figure out what the best way is to provide transportation services. i think one of the best things that we can do -- and for this answer i'm actually relying on my kansas experience -- is to make sure we remove any barriers so if we provided support for, say, a van at any level with government fundses we use it to the best of our ability to serve all populations we can. so i think we need to be innovative, work with our transportation partners, and figure out how we can make sure we're not in the way of what needs to happen in a community to get the job done. >> what recommendation do you y'all have? i know mrs. s carter, from your experience, which recommendation would either wn of you would have we could be more efficient with the dollars we have. as you know the budget

constraints are going to be tough on all of us. by setting priorities we can make sure the dollars we have are in place if they go further. we're all growing older and in need of the services i'm sure. but is there anything that we can do that would help you have more efish siz? have we tied your handzs in any way, mrs. charter? >> one of the greatest helps would be to have data so we could know how to allocate the resources. and one of the recommendations that our study has made is that we use the behavioral risk factor surveillance system that the centers for disease control has developed. they have developed a caregiving module, if we could use that in the states in the oaa, it wouldn't cost very much because the question is not on the survey, all surveys, and you have to ask for it. so we checked to see -- georgia

doesn't have it in their survey and so we checked to see how much it would cost. it would cost $21,000 a year just to get that data in georgia. and that would be so helpful in cutting costs. >> for about a decade now, the administration on abling has been focused on evidence-based practices. we do this a lot in the field of alzheimer's, support for individuals and family members, the evidence-based placket iss i mentioned in my testimony. those of us who work in the social services arena understand science is not just for people in the laboratory. that good evidence, good outcomes in science is a critical part of delivering quality and effective social service programs. that's why we're suggesting that we continue to work in this effort it with regard to the health programs to make sure we have good outcomes. i believe fr agree about the data. our ability to continue to research our programs make the

case with regard to the effectiveness, their ability to provide cost savings to other programs such as medicare and medicaid is also a critical component of this conversation as we figure out as we go forward how to balance the supports that are needed with the increasing pressures of more seniors and the struggling budgets at the federal and state level. >> i'll wait for my second round. thank you very much, both of you. >> thank you very far, senator manchin. we'd like to thank you both profusely for being here today. you've made tremendous contributions today as you have in the past. and again, we appreciate you being here. thank you so much. >> thank you, senators.

we'll turn now to the second panel, if you'd step up to the table, please. first we'll be hearing from elo elizabeth marshall, a recipient of home-delivered meals. ms. marshall was elected as a first female mayor of york, pennsylvania, in 1977. she also served as a member of the york city council. next we'll be hearing from max richmond, who serves as chairman of the leadership council of aging organizations, a coalition of 66 national aging organizations. mr. richmond is a former staff director at this committee and is currently the acting ceo of

the national committee to preserve social security and medicare. welcome. next we'll be hearing from heather bremer, who is executive director and state ombudsman for the wisconsin board on aging an ombudsm ombudsman. she serves on the coalition of wisconsin aging groups advisory council. senator corcoran has a witness from tennessee. >> i would like to introduce timothy howell, who is seated. he's the chief executive officer of the home assistance services a nonprophet that provides in-home care giving in tennessee. he aims to improve the lives of seniors and persons with disabilities while maintaining their independence and disability. he's been the ceo since 2008. as ceo mr. howell oversaw the completion of renaissance towers, an assisted living

community. he's president of the tennessee association of homemaker services providers, member of the national council on aging and the downtown rotary. thank you for traveling from east tennessee to be here. >> thank you. we'll hear now from mrs. marshall. >> thank you very much. in the early 1960s, i increasingly became involved in the york community, which was undergoing a turbulent time with tensions high over racial issues. i'm sorry. i was not on the first page. i'm sorry. this is addressed to you, chairman kohl, and to senator casey, and other members of the

committee. thank you for inviting me to testify before you today. i'm pleased to be able to share with you my thoughts on the older americans act. throughout my life, i have always strived to be an independent woman. born in 1918, i'm a child of the great depression, and if continued to live by the values of the economy, thrift and self-reliance that i learned during my formative years. my husband, howard, and i married after he returned from serving overseas. we moved to york, pennsylvania in 1948 and we bought our first and only home there in 1954. this is the same house i live in today. our two sons still live near me, and my daughter resides in new hampshire. an old song by joseph burke

called "a little bit independent" is my theme song, if you will. a little bit independent in your walk, a little bit independent in your style. i have worked throughout my life to be an independent woman. to find my strengths and use them. whether in service to my family, community or country. in the early 1960s, i increasingly became involved in the york community, which was undergoing a turbulent time. and i eventually, in 1971, i was elected the first member of city council, and later served -- i'm sorry. it led to my election to york city council in 1971, and then i was elected as the first female

mayor of york in 1977. i later served as deputy controller for the city of york. so i know something about government and the challenging choices faced by decision makers as to the best use of taxpayer dollars. after my public service career, i worked as a real estate agent for 18 years and retired just 11 years ago at 81 years of age. i have been on my own now for ten years since my husband passed away in 2001. many of us in our neighborhood are long time residents. our tight knit community is essentially aging in place, together, and helping each other remain in our homes for as long as possible. i am proud to still be an independent woman. i want to be able to stay in my home near my family at davis.

i'm grateful that the york county area agency on aging is there for me and for thousands of other seniors in my community. i have a care manager at the area on aging. she was able to connect me to the home delivered meals program and if i need additional supports, services or even just information, she will be ready to assist me and my family. three times a week, a volunteer from the local senior center delivers both hot and cold meals to me in my home. i appreciate the meal service and it's also nice to have a friendly visitor check in to make sure i'm safe and doing well. i understand the home delivered meal service is funded in part through the older americans act.

the act allowed the coordination and provision of many other in home and community programs. there's even a part of the act focused on family caregivers to help them help us. we can't forget our senior centers, which are more important than ever to help older adults stay connected to their community. many recipients of services are like me. they just need one or two little bits of help. others may need more services, but the act allows seniors to receive just what they need to stay healthy. even if you need a high level of support, receiving is care in your home, it's still more affordable for you and the taxpayers than care at a nursing home. as our leaders struggle to balance the budget and reduce the deficit, the cost savings that older americans act

programs generate are even more critical. my story is not necessarily a unique one. my peers and i have served our families, community and country for many years. with the right balance of help, we can continue to remain contributing members of our society and maintain our health, independence and dignity for as long as possible. i'm glad to be able to continue living in my home of 57 years where i can still be "a little bit independent" in my walk. the older americans act allows you to retain your dignity, health and independence with just a little bit of support. i urge this committee and your colleagues in the senate and house to understand how vital

these little bits of support are to millions of older americans determined to age in place. we need to reauthorize the older americans act in a timely and bipartisan fashion. and prepare our country for the wave of baby boomers standing behind my generation. thank you, senator kohl and members of the aging committee for inviting me to share my thoughts about the older americans act with you here today. >> thank you, mrs. marshall. that was a beautiful statement. >> i'm sorry. i didn't hear that. >> that was a beautiful statement. thank you so much. >> thank you. >> mr. richtman? >> mr. chairman, members of the committee, first of all, let me say to mrs. marshall, you're a tough act to follow, but i'll do my best. on behalf of the leadership

council of abling organizations, i'm honored to testify before the special committee on aging about the lcao older americans act reauthorization consensus document. lcao is a 66 member coalition of diverse, national, nonprofit organizations dedicated to preserving and strengthening the well-being of america's older population. historically, lcao has played a significant leadership role in past reauthorizations of the older americans act. in preparation for this year's reauthorization, we worked for over six months to develop the consensus document that we have submitted to the committee. under the leadership of lcao community services committee, individual organizations presented their ideas and suggestions for improving the older americans act. these ideas were incorporated into the consensus document

which was enthusiastically endorsed by the full lcao at our april 6 meeting. the lcao, older americans act reauthorization document contains 98 recommendations. they do a number of things. they reinforce key existing priorities in the current statute and seek to address challenges and opportunities brought about by the exponential growth of our older population. we agreed that the older americans act continues to work very well for older adults across the country. the act's core mission, infrastructure and programs remain relevant, effective and very much relied upon by older adults and caregivers. the problem we face, of course, is insufficient funding, which makes it difficult for the aging network to carry out older american act priority as established by congress in past

reauthorizations. there simply is not enough money for all the needs that exist. on that note, i would like to thank you on behalf of our organization, mr. chairman, for your request to the general accounting office to examine the true magnitude of this unmet need. we also acknowledge that the older americans act, like other statutes is a dynamic document that can and must change to address emerging needs and embrace new innovations. it's notable that the older americans act is up for reauthorization the same year that the first of the baby boomers turns 65. not only are the numbers of older adults increasing at a historic rate, but this population is becoming much more diverse. additionally as older americans live longer, they face growing health and economic challenges, all of these issues are converging to place tremendous strain on the aging network.

a network that is already overburdened but eager to expand capacity and enhance planning to meet the demands and opportunities presented by our aging population, particularly in times of fiscal restraint, times such as now, we acknowledge that the improvements can be made in the efficiency and effectiveness of the older americans act in its delivery of core services and how it interacts and coordinates with other federal programs that serve older adults. there are recommendations throughout the document we presented that call for improved coordination of services and identification and dissemination of best practices that already occur in local communities in order to strengthen the aging network nationwide. lcao also believes it is crucial to strengthen evaluation, research and demonstration of aging services. this will not only empower the

aging network to continue implementing best practices but will also state with authority the degree to which the older americans act provides a cost effective way for older adults to remain in their own homes with health and economic security. the older americans act programs such as in home assistance, home delivered and conning 53 gait meals and respite for caregivers benefit individuals and their families. they also save federal and state government resources from being spent on otherwise unnecessary care on hospitals and nursing homes. on behalf of lcao, i applaud this committee for its leadership and calling attention on the upcoming reauthorization. we urge congress to continue the long tradition of bipartisan and timely reauthorization of this important statute while providing the funding needed for

older americans act programs to keep older americans independent and productive. thank you again for the opportunity to testify today on behalf of the 66 members of the lcao, and i welcome your questions and comments. thank you. >> thank you, mr. richtman. heather bruemmer. >> chairman, kohl, ranking member corker and members of the committee, thank you so much for this opportunity to testify today. the state long term om budsman of wisconsin. it is a privilege and honor to be here on behalf of the ombudsman act. the significance of this effort to reauthorize the older american act cannot be overestimated. it is a primary duty of this nation to protect our most vulnerable individuals and to preserve their pride and dignity.

everyone has a history, a story. we all create memories, so it's our responsibility to ensure that all members of our rapidly aging population has the proper access to services to respect the right to be who they are and who they've been. the older american acts provides critically needed services that allow older adults to remain for as long as possible in the community with needed support. since 1978, the ombudsman program has been the only program that serves consumers provided by residential care facilities. i think we all appreciate and value the importance of living in our own home. we heard from elizabeth today. as a result, there's been remarkable growth in the community based services for seniors in wisconsin. in november of 2008, we had a significant trend happen. we have more assisted living beds in the state of wisconsin than we do nursing home beds. wisconsin was one of the original pilot states when the

long term care ombudsman was first created by congress and our state has relied and improved the resources available. the board on aging formed in 1981. we had five ombudsman. today we have 15 outstanding ombudsman and over 100 volunteers serving 95,000 clients in nursing homes and assisted living facilities. nationally, ombudsman visited 79% of all nursing homes on a quarterly basis last year. 46% of assisted living facilities and similar homes. throughout the country, it's difficult for ombudsman to participate in visits. the inability of congress to provide sufficient funding is certainly not the result of trying by the champions such as yourself, chairman kohl and the members of this committee. each year the program resolves hundreds and thousands of kplanltsdss and interestingly, 77% of these complaints are

resolved to the satisfaction to the client' needs. we spend time in nursing homes. we are able it address the needs of assisted living with the same intensity as the nursing program, it would be unbelievable. we have falls, medical mismanagement, medication errors, pressure ulcers and abuse situations. unfortunately they are on the rise. we spend a tremendous amount of time investigating these incidents and provide education and guidance to facility staff to help prevent recurrences of these problems. we are faced with inadequate resources but we keep moving forward. resident family counsels are vehicles by which open communications are really important in order to deliver excellent quality of life and care. when considering this reauthorization, it is important with this requirement to maintain resident and family

involvement with the assistance of the ombudsman program. access to confidential information for ombudsman is important. we are recommending that this reauthorization ensure the private and unimpeded access by individuals to ombudsman services in a confidential setting. the sections of this act relating to the process of limitations and disclosure of client information needs clarification and emphasis. it is important that the text of the older american act clarifies the privacy provisions of the health insurance portability and countdownability act do not impede the record by the ombudsman and representatives of the program. the administration of aging declared that the ombudsman are providing a health care function. tloit the country, more and more country that can speak for themselves. we have no legally authorized representative to speak on their behalf. it's our duty and we recommend

that we add language to intensify their efforts to expand their education. the board on aging also support the recommendation to amend title two to provide base appropriation beginning at $1 million. it is proven to be a valuable site for ombudsman, for technical assistance. it would be extremely helpful to expand the facility and ability to work with state workers. the older americans act gives us a strong foundation. reauthorization gives us a window of opportunity to build a robust demonstration of the nation's concern for the well-being of our elders. it is important that congress and the aging network come together to strengthen our long term care ombudsman programs to provide a safe and home like environment. on behalf of wisconsin's long

care ombudsman program, i thank you senator kohl, ranking member corker and the members of the committee for allowing me to share our thoughts of the reauthorization. >> thank you, mrs. bruemmer. mr. howell? >> thank you, senators, on the special committee of aging to address you today. as the ceo of senior citizens home assistance service that provides homemaker and personal care to 20 counties in east tennessee, i see elders and people with disabilities every day that come to me with different situations. although their stories are different, their goal is the same, to maintain their dignity. their health may be fading and all their mental status diminishing, but they are still human beings and their dignity should not be diminished over time. senior citizens home assistance service was formed in 1970 as a study to see if people could use

homemaker services to stay in their homes. since then, we have been on the battle of the forefront of maintaining dignity for our elders. the majority of the work we do is through our homemaker and personal care services. we screen, hire and train caregivers to travel to the home and provide light housekeeping, laundry, shopping, companionship and personal care, bathing, feeding toileting and grooming. this year, we will help over 2,500 people with over 300,000 hours of one on one care to stay in their home. the good news is that the story, is that the agency receives funding from many different sources. we have a full fee private pay system so those that can afords to pay for the services can. then we also receive money from federal, state, veterans administration programs but i

think one of the best things that we have and something we could have helped senator manchin with with his question, is we have a sliding scale fee for people that do not qualify for the government programs but also may not have the ability to pay the full fee. we have a sliding scale fee because we are able to have fundraisers and we get united way funding. if somebody comes to us that does not have the -- that has a gross income that keeps them from the government programs, we are still able to help them, even though they may have expenses such as a home mortgage or medicines or things like that, we are able to help them with a sliding scale fee. they can pay us $7 an hour, $9 an hour. they still can get the help they need to stay in their homes. partnerships are key, we have found, in the battle to provide dignity. we get cleaning supplies donated to us from a local office company so that for those that cannot afford to purchase them, and we also receive

nonperishable foods from second harvest, which is another five 0 one c 3 in our county. that allows us to give food to those that may not have the money to pay for their bills at the end of the month. if you're looking for employment opportunities and i understand, mr. kohl that you might be here recently since you're retiring, we can train you to be a caregiver. our oldest caregiver was born in 1911. she is 90s years old. she brings an aspect to care giving that a person my age cannot do. she is unique with her companionship. we works about 20 hours a week. she talks to people and relates to people while she's cleaning their homes. even on your worst days, she can give you a smile that can brighten your life. over 50% of our 310 employees are older than 50. we have a great caregiver

training program that we teach people to be a caregiver. even with all our programs to keep people in their homes, we realize the cost does become expensive at times as their need increases. this is why we built renaissance terrace that charges $2,200 a month. we are able to keep the monthly fee low because we receive federal, state and local government funding from knox county and from the city of knoxville as well as private donors and foundations to construct the building. with the construction cost funded we have to charge enough to pay for the operating cost such as payroll and supplies. the people that live in our facility are able to pay for the help or the va may help or in some cases family members may help for the fee. the important fact is, is that i'm not here asking you for more money for my assisted living.

through combining your one time investment with other partners, we developed a program that can sustain itself through the residents paying for their care. i want to thank you for taking this challenge of providing care to the elders and persons with disabilities while keeping their dignity intact. i encourage you to look for solutions that can maintain and support themselves with an investment from you but i realize that this will not always be the situation. again i thank you for allowing me to be here today. i'll answer any questions you may have. >> thank you, mr. howell. i would like to ask you, mrs. marshall, your home delivered meal, how important is that in your day and in your week? what would you do if you didn't have the home delivered meal system? >> well, it's hard to know,

because i have been able, through my whole life, to be independent. and my son is worried about the fact that i'm alone a lot of the time. and he thought that there should be somebody looking in on me every day. so i order the meals on wheels. i get it monday, wednesday and friday and there's always someone there in case, you know, i should have fallen, some accident of that sort. so that takes care of three days a week and it also helps me as far as shopping and cooking for myse myself. the various foods that i get, well balanced and healthy. they sometimes need seasoning,

fixing up a little bit before you put them in the microwave, but it's a very well balanced, healthy diet really. i'm very grateful for it. on tuesday and thursday, i'm on my own and saturday and sunday, but i've been very grateful for the fact that i have wonderful sons handy to me and a daughter in new hampshire who has been a boon to me. i'm very grateful for the help of my children. it may be a burden on them. i'm sure in many ways it is, but i don't hear about it. >> how often do you talk to your daughter in new hampshire? >> well, i really grew up in two communities. i had a grandmother in new hampshire who had a stroke in her 60s and she lived.

she could not speak very well, but she lived at home and my mother went up to new hampshire in june every year after school was done, and took care of her or helped take care of her because she was in a wheelchair and completely unable to do anything for herself. in fact, i never really got to know her, because she wouldn't talk very much. she would sas very beloved by h family. i have many pictures of her in her wheelchair surrounded by her family. there wasn't such a thing as meals on wheels at that time. generally there were people, and in new hampshire, many country people, because this was in the white mountains, the village in the white mountains, so i really had two residences growing up. it was a wonderful, wonderful

experience. >> to the other members of the panel, what is your principal recommendation to us as we go about reauthorizing oaa? mr. richtman, would you like to give us your opinion? >> mrs. marshall? >> i'm sorry. my hearing is not all it should be. >> thank you. i was addressing this to the other three members of the panel, your principal recommendation for reauthorization? >> i think, as i mentioned in the testimony, it's, we feel, very important that the committee take into account ways to improve coordination of services, to identify the best practices, things that work in local communities and make sure that all of the agencies involved have the resources to replicate these best practices around the country.

and if i could, mr. chairman, to follow up on the question you asked about home delivered meals, maybe i hope this isn't presumptuous, but i could give this as a recommendation. you mentioned that i have i was staff director of this committee in the '80s and i was involved in previous reauthorizations. there was a member of this committee who was, shall we say, cynical about the older americans act activities and one of the nutrition service providers from that senator's state arranged to take that member of the senate to deliver meals on a truck, deliver meals and the reaction that the senator had when he met people that had no other way to get a hot meal or have any interaction with anybody turned him around. he became a strong advocate for

the program. i guess i would recommend some firsthand experience by members of the committee with some of these programs. >> that's very good. mrs. bruemmer? >> thank you. i think it's really important that our vulnerable residents in long term care facilities have access to our ombudsman services which i addressed in my testimony. we have so many people living in long term care facility that is don't have family. it's important that the ombudsman who is their advocate be able to express their best interest. secondly, i think we all know and you recently had a wonderful hearing on elder abuse. it is occurring in our world unfortunately. it's our duty to protect our most vulnerable people we serve. it would be wonderful if we could get additional supports of funding to provide training and prevention. we talk about prevention frequently. it does make a considerable difference if we can educate

people on how to prevent. we provide prevention services in nursing home and assisted living to staff, and it has a positive impact to the people they serve and supporting the national ombudsman resource center, which really benefits our wonderful residents that we serve. thank you. >> mr. howell? what's your principal recommendation? >> i would suggest looking for partnerships and funding opportunities that can be a one time investment for the government and then maybe those programs could sustain themselves over time through private pay, and then also, i would like to say that through the single point of entry system, we need more case management from the providers at the time that the help is being asked for. people go through many questions to get into the enrollment process, at least i know in the state of tennessee they do. they get asked those questions several different times.

i think we need a system to where once you are asked those questions once, it is shared amongst the service providers and the case managers and the mcos so you don't have to going back and keep asking that elderly person again and again, what is your income and what is the help you need. i know we're going to do an intake and we ask does that person have a pet, and i don't need to second that person who has cat allergies. if they smoke, i can't send someone whoasthma. we have to help that person stay in their home if we don't get the information we need. shared information among everyone and look for partnerships so that program that is can sustain themselves over time. >> thank you very much, mr. howell. senator corcoran?

>> thank you, mr. chairman and ms. marshall, thank you for being here. you said you hope you weren't a burden for your children or grand children. i know that's not the case. i'm sure you're a blessing. there's probably a whole line of people in your community who would be willing to adopt you if they felt that was the case. we thank you for being here and putting a face on the issue that all of us care about. thank you very much. mr. richtman, i know as director of the committee and the national committee to preserve social security and medicare, you've been very critical of legislation i've offered to get spending back to historic norms over the next decade. i understand that's the world we live in today. also, it seems you've been very resistant to changes to medicare that might make it sustainable. there are a lot of people in this town that know medicare is going to be insolvent or bankrupt in the year 2024,

there's no getting around that. cbo even says about 2020. i'm one dering if y'all have put forth your own innovations or changes to cause medicare to be solvent and to cause it to be there for seniors down the road? >> well, of course, this isn't the subject of this hearing, but i will respond. i think the legislation you're talking about is the one you authored with senator mckas kel, is that correct? >> that's correct. >> the concern we have on that is we feel that some of the process that that legislation deals with will lead to dramatic cuts in the programs that we advocate. it will do it in a way that a more indirect way that may be politically is easier but nevertheless the impact would be

the same. on medicare, you're right, we were in opposition to the bill that was defeated yesterday in the senate. passed the house. we feel that chairman ryan's proposal to deal with medicare in effect eliminates the program. turns it into something entirely different. >> that really wasn't what i ask. i understand that. i've read some of the things you've said about that. my question is have you offered your own solution since i mean putting our head in the sand would mean that future wonderful people like mrs. marshall would not be able to benefit from the program. >> i was going to get around to that. we supported the affordable care act which has some very significant improvements in medicare. and -- >> even with the affordable care

act, it's insolvent in the year 2024. i'm trying to ask -- >> well, the affordable -- were it not for the affordable care act, the medicare program would be insolvents much earlier than 2025 which is the date that the trustees have issued. it's true that the date of insolvency went back four or five years from previous -- >> closer to today. >> closer to today. a lot of that has to do with the recession, less revenue coming into the program. >> mr. richtman, are you going to answer my question? >> i'm trying to, senator. >> i wish you would just get to it. have you offered solutions to the program? i haven't heard -- instead of sand bagging people that are, have you offered solutions? >> our solution which i was trying to explain included the affordable care act. that is a very positive

improvement of medicare. added 12 years. i would say that's a pretty good solution. added 12 years to the solvency of the program. added benefits for seniors that they did not have before such as preventive care with any out of pocket costs. i offer that as a solution. i think it's becoming more and more popular. >> it's very disappointing, someone in your position would stone wall a situation so important as this. let me ask you this. chairman kohl and i have both been very fortunate in life. he far more than me. >> me too. >> would you agree that it would be an appropriate thing for folks like mr. kohl and myself to have minimal, if almost no benefit, in other words, medicare would be more based on ability to pay, where we would have to pay far more for the

benefits of medicare than someone like -- someone else who might not be as fortunate? would you agree that would be at least a portion of a solution even though that would not solve it? would that be something that your organization would support? >> no, we would not. the reason, you're talking about, i assume, means testing. >> that's exactly right. >> we are opposed to means testing for medicare and social security. i'll tell you why. these programs, all the polling shows that they are tremendously popular because they're insurance programs. people pay into them while they're working and they get the benefits. means testing these programs turns these programs into welfare. that's what welfare is. a means tested program. i've said this at many events that i participated in.

if you ask a group of seniors how many of you are on social security, how many of you are on medicare, and usually at my meetings, they all are. you say how many of you are ashamed to be on these programs? nobody is. if you ask them, would you be proud to be on welfare, they wouldn't. i think turning these programs into welfare programs which is what means testing does puts them in a different category and the support almost tremendous majority support for these programs would dissipate. we're opposed to that. >> well, portions of medicare already are means tested. what i hear you saying is you're more interested in generational theft. >> that's not fair, senator. most of the surveys we've done. we just did one with selinda

lake. our members who are almost all on the program, they are just as concerned that these programs be there for their children and their grand children. i feel that we reflect that. i take issue with the charge that we're interested in that kind of generational warfare. >> i'm very disappointed that you've offered no real solutions. but i look forward to talking with you in another venue on that. mr. howell, thank you for traveling up here. i notice on the other hand, your organization does have a sliding scale ability to pay. you found something that as being very useful. i wonder if you would describe that in a little more detail. >> i would be glad to. when our board set up the nonprofit in 1970, they wanted to be able to help everyone who came for assistance to the agency. so the sliding scale fee was one good way to do that.

we have found many benefits from that. one of them being if we are going to united way and asking them for funds and let's say they appropriate to us in knox county somewhere around $120,000 and we provide help to a person over here and they are able to pay $7 an hour. that help cost us somewhere around 18 or $19 an hour, we really only have to come up with another $11 per hour to get that funding. what that does is allows that money to be stretched out further and help more people. we don't usually have a waiting list for services. if someone calls me, i can usually get the help out to them as quickly as they need it. i think that telephone call is important because it's saying i've given up my ability to do something in my life, so now i need help. will you come do that? we don't have to put them on a waiting list to do so. we can be there and help them. i also think in a lot of ways it makes us more accountable because those people are paying for that service.

that sliding scale fee has increased over time. even if they're paying $7 an hour to a person in their 80s or 90s, that's a lot of money for maid service or getting them transportation or helping them go grocery shopping. that is a lot of money to them. i think some of our proudest moments is when we get a check issued from someone and it's for $28. that's for service but thank you. how many people write thank you on the bottom of their checks when they pay their bills. they do that because we're keeping them in their homes. i think the sliding scale system has been a great system for the people we serve. >> thank you. has there been any stigma attached to that, as mr. richtman just alluded to? >> in the services that we provide, no, sir. i don't know of any stigma attached to that. we do help people qualified for the government programs.

they are in those and the government is paying for those. we help those who have the ability to pay the full fee. our caregiver may go to the home of a very wealthy person one day and a very poor person the next day. we train them to treat them with the same dignity and provide the same service to them. >> thank you very much for being here. i look forward to the rest of your testimony. thank you. >> thank you very much, senator corker. senator casey? >> thank you, mr. chairman. what i'll do for the record is submit questions for mr. howell, ms. bruemmer and max richtman because i have a constituent on the left there, the former mayor of york and i wanted to speak directly to her for a few moments, you three don't mind, i hope. i'm grateful and i appreciate all of your testimony and the work that you do. i've known max richtman for a long time and i appreciate his

advocacy for many years on behalf of older citizens. i did want to direct my maybe just a comment or two, mayor. first of all, once a mayor, always a mayor. we appreciate your public service to the city of york. being a mayor, being a member of city council at any time is a difficult job and we appreciate what you did and what you continue to do for the community in york and for your testimony today. i was struck by a couple of lines in your testimony which, in some ways, really summarized or encapsulated what we're talking about today, the older americans act. i was looking at your testimony, the last page of your testimony when you say, and i'm quoting "many recipients of services are like me, they just need one or two little bits of help." a pretty good summary of what a lot of people need.

sometimes it varies. then you go on to say, and i'm quoting again, just a line or two beyond that, "the act is flexible that way and allows the senior to customize their care plan to just what they need to stay healthy." we can often talk and talk in this town in describing legislation paragraph after paragraph. rarely do we have a witness who's able to sum it up very directly. and with the personal experience that you've brought to this, you've been able to, through your testimony today and i know in other ways, bring to life and be, in a sense, bear witness to the benefits of these services. we're greatly appreciative of that, because you didn't have to do that. you could have just lived with the benefit of these services, but to travel here and to bring

your story and your witness to this is very, very important. we're truly grateful. i know that the whole audience fell in love with you today. i don't think anyone who knows you was surprised by that, but we especially appreciate your testimony and your public service. i guess the last thing i would say is, again quoting you. you say a paragraph later, "the beauty of the older americans act is that it allows you to retain your dignity, health and independence." you have defined independence. we're grateful that you're willing to share your story with us today. if i can think of an intelligent question, i'll write it down and send it to you, but i think you answered most of our questions through your testimony and through your personal witness. thank you very much.

>> thank you so much. >> thank you senator, casey. i have also one last question for you, mrs. marshall. might you consider making a comeback in politics and running for mayor? >> well, i have been active in a grass roots group and i helped to rejuvenate the democratic party because i'm a roosevelt democrat. i think i have always felt that when people needed help, they should have some programs that help them, and it just shouldn't be such a matter of who has wealth and who hasn't. human life is precious. >> thank you. well, we thank all of you for being here today. this has been very important to us as we continue with the

reauthorization of oaa. you've made an effort to be here today. it's important and you've made a big contribution. thank you so much. thank you all for being here. >> thank you. >> thank you. xa÷ú>qoñoñññññ