>> stackley has talked about organizing acquisition by capabilities instead of programs. specifically, he mentioned the naval [unintelligible] i wonder whether marine corps acquisition programs will get rolled up in this >> yeah. i don't know personally if there was an effort underway that kind of changed the acquisition program to kind of lump things under capabilities. i'm unaware of that. i'm not saying it is a bad idea. i haven't put any thought to it. how do we take what we have and make it better. i wasn't necessarily lumping it under capabilities. i can't answer that and i heard u class back there and i think

you're talking about the navy's carrier -- i think that is a tremendous effort. you know, we go back to the u.a.s. question we had earlier. there is an example of taking technology and a requirement and actually bringing it aboard something like a nimitz class carrier. that is pretty significant. you get to be seeing how it is going to turn out. we're optimistic. i don't know of any effort now of trying to pool all of that together under a different sense of capabilities under acquisition. >> one last question. are you waiting, sir? last question. wrap up. >> hello. i'm james fredrickson from the university of edenburg. you mentioned an emphasis on strategy first.

the context of risk assessment. my question is how that risk assessment is actually going to take place. for instance, is there more emphasis on capability in afghanistan now or trying shape the marine corps afghanistan after? >> that is a very good question. my sense is when we start talking about budget items and you start thinking about, you know, the fiscal pressures, we're probably talking close to afghanistan. i don't think there is anybody and let me just speak for myself. if you were to look at the written guidance i put out the day after i became the commandant. i had -- there is a bunch in there but i had four priorities. my number one priority is to -- everything that is required, to guarantee success in afghanistan for our deployed forces. that is my number one priority. and for the families back home

and the marines training, i will spend whatever money is required, i will take whatever personal capital is required, in other words, people, i'll make whatever expenditures are required with regards to training, quipping our forces, i'll do all of that, even at the expense of the rest of the marine corps to guarantee success in afghanistan. you heard me talk earlier it is not winning or losing. afghanistan is my number one priority and i know, as i sit on the joint chiefs, it is absolutely a top priority for our nation and certainly our service chiefs so i don't think -- i don't see that changing until such time as the withdrawal plan is executed and america comes out of afghanistan and our allies. our u.k. brothers and sisters and everybody else.

i don't think that is going to change. i think what we're talking about is the risk is in the future. in other words, we're out there in 13, 14, 15, 16, 17, probably the next decade and you can make the case that if you're going to look out over the next decade, you probably ought to look out over the next two decades. when you start buying equipment and procuring stuff, it takes a long time to buy it and all the things we talked about over the last hour. my sense that the risk will be addressed in what the department of defense is going to do for our nation in a post-afghanistan environment. i think if you try to take a look at the bulk of the effort, it will be towards strategy for the world beyond afghanistan. and then what can we do. what is required? what is it we can't do? how do we mitigate it?

>> please join me in thanking the commandant. [applause] >> memorial day on c-span, president obama names army chief of staff as his new chairman of the joint chiefs of staff. if confirmed, he will replace admiral mike mullen whose second term ends this fall. the announcement will be at 10:00 eastern. after that, he will head to the national cemetery to lay a wreath at the tomb of the unknowns. you can see the president's comments live monday morning at

10:50. also tomorrow, more commencement addresses. we begin with aboutor denzel washington at 3:00 p.m. eastern and then john ratsenberger speaks and following that, supreme court justice sonya sot mayor. commencement addresses, memorial day starting at 3:00 p.m. eastern on c-span. the senate judiciary committee met last wednesday to consider legislation broadening the government's ability to prosecute military contractors and employees for crimes committed overseas. witnesses include lanny breuer, the assistant attorney general for the justice department's criminal division. vermont senator patrick leahy chairs this hearing. it is 90 minutes. >> i will start what i want to

do in this hearing was to consider the need to ensure accountability for crimes committed by government contractors and employees who are abroad. president obama has been working hard to improve america's credibility in the world, our reputation for justice and commitment to the rufle. -- rule of law.

and contractors working abroad. in september twetch, a black water security contractor shot more than 20 unarmed civilians in the streets of baghdad killing at least 14 of them. they caused the obvious rift in our relationships with iraqi government. an effort to prosecute those for the shootings. our ability to hold the wrongdoers accountable is in doubt. jurisdiction for these offenses has been -- if agents has been on the scene immediately could have prevented the problem.

this blackwater case was not actually -- private security contractors have been involved in violent incidents in iraq and afghanistan including other incidents in which civilians have been severely injured or killed. the senate judiciary committee heard testimony from jamie lee jones who took a job at halliburton in iraq when she was 20 years old. in her first week on the job, she was drugged and gang raped by co-workers. 20 years old. sh reported this and her employers moved her to a locked trailer where she was kept by armed garsd and freed only when the state department intervened. miss jones testified about the arbitration clause in her contract which prevented her

from suing blackwater. criminal jurisdiction over these kinds of crimes abroad remains complicated. supervision inconsistent, sometimes impossible. the only person who got locked up was the woman who got raped. i worked with senator sessions in 2000 to pass the territorytorial jurisdiction act. to extend it to members of the u.s. military. and to contracts who work with the military. commit crimes or working abroad, whether with the military or not could be charged and tried in the united states.

as the military withdraws from iraq and afghanistan, -- there has to be accountability. they ought to be bound by the same laws that you and i and everybody else are bound by. this explicit jurisdiction will protect americans. we have to ensure criminal accountability to improve our national security. and then our allies have to work with us. and more over, the talented men and women we need to advance our national security efforts, step forward and serve if we stamp

out the lawless atmosphere in iraq and afghanistan. that's why the civilian territorial juries action is supported by ignacio. in the past legislation, it has been bipartisan. i hope it will be again. i hope we can move forward with it. i'm joined now by senator grassley. i will yield to him. >> thank you, plch. this is a very important hearing. glad you're having it. without a doubt, extending criminal law to government contractors and employees serving overseas is something that we ought to keep on top of. it is an important topic given the use or increased use of government contractors by federal agencies, particularly it has been highlighted

afghanistan and iraq wouldn't although it wouldn't be limited to those two countries. realso worked together to aend in act to ensure that funds that were under the trust and administration of our government

were protected from fraud and abuse. that fix was necessary to address a loophole created by the courts in the decision where iraqi funds administered by the u.s. government were subject to fraud. this was a damaging loophole because it essentially said that contractors were free to defraud the government as long as the money was from a foreign country that entrusted the u.s. government to administer it. ultimately we closed that loop hole in the recovery act which was inside into law by president obama. today is no less important because criminal act committed by u.s. citizens and contractors abroad could threaten our foreign relations. we must bring these criminals within reach of our law. it was introduced in the last two congresses. both times that legislation failed to clear both chambers

and was never inside into law. chief among the concerns at that time, was the lack of clear exception for contractors that were employed by the intelligence community. in twetch president bush issued a statement of administration policy citing surgeon concerns with legislation with jurisdiction over contractors and security and operations. i think there is a lot of mer it to extending our criminal law to civilian contractors and employees abroad. however we must make sure this is done in a manner taylored to specific problems. those concerns should be addressed in the proper form and not necessarily aired in public.

however in the limited scope that we can address that topic in this public forum, i intend to ask some questions about what -- the intelligence community would look like. i also want to know about how many new resources the department of justice will require to implement investigations for prosecutions. given the current fiscal situation, the federal government, i'm concerned reallocating resources from one side of justice to another could limit investigations and prosecutions. i look forward to the hearing today and most importantly i look forward to continuing my working relationship on this important topic. yppingt to inform the chairman that at 11:10 i have an opportunity to speak on the floor and will probably miss the rest of this committee hearing. >> thank you. there is a lot of that going on today as you know. i appreciate it. i share concern about resources

but i also share concerns about how we decline -- i would hate to think that -- the people, the gang rape i referred to -- part of our duty ji to guide some part of the intelligence service in a crime like that. we can -- our first swns tara lee, co-chair of global -- cross-border disputes. she has worked as a government contractor. former military lawyer, todd battlefield. member of the international stability association. served on several committees of the a.v.a.. addressing the expansion of the -- jurisdiction to cover

contracts on the battlefield. a degree from the u.s. naval academy. a law degree from the san diego school of law. go ahead. we'll put your full statement on the record. please go ahead. >> thank you, plch. mr. chairman, senator grassley, i want to thank everyone for the opportunity to appear before you today. i know you share the deep respect for the men and women in the defense contract community. as someone who has served, i want to thank you all not just for the opportunity to speak today but for the work you do for each of those communities. the issue today, extra territorytorial jurisdiction is not and should not be part of an issue. i think we all share a commitment and have a desire for clarity in the accountability mechanisms that reach our

citizens. when it is focused on those individual who is serve in harms way in our behalf, the obligation to provide them with claire city strong. i'm a former military lawyer. i studied and taught battlefield accountability. in my current legal practice, i advise companies on mitigating risks and represent companies when they face government investigations in civil or criminal litigations. i also devoted several thousand hours to legal work. victims who because they had no jurisdiction has no capacity or will to take criminal action rg, each of these experiences contributed to my broad perspective on the importance of claire any criminal mechanisms.

i can tell you in my experience, the military extra territorial jurisdiction act has not provided that clarity. as it applies on its base only to the contractors employed or accompanying the armed forces outside the united states. clarity and certainty are important to as important to the contracting community as they are to the government. companies have an obligation to advise them of their legal rights, risk or accountability when they are serving overseas. a continued absence of clarity does not serve the interest to have contracting community or its employees. for example, a company with both

e.o.d. and state contracts might accurately advise employees working on the defense contract that they are subject to meet the jurisdiction while advising employees on a state department contract they might be subject to jurisdiction. the civilian extra territorytorial act has to provide more certainty. not only might it provide more jurisdictional certainty, it can -- investigation of potential criminal incidents. contractors often operate unstable environments. those companies are much better served in my opinion if adequate u.s. government resources are adequate to assist with or provide the function. it also provides the personnel

and resources to serve that need. i believe you received written statements of support from several companies directly. the c.e.o. of triple canopy and the former command sergeant major of delta force has argued that the absencor effective accountability for contractors puts our country's ability to achieve our goals at risk. additionally legislation has support from the international association, a trade organization representing contractors as well as organizations from the human rights community. they also called for clarification over civilian agency contractors. this recognition of the need reflects the universal recognition that accountability for criminal wrongdoers is a

come opponent. thank you again for the opportunity to discuss this topic with you today and i do look forward to answering any questions that you might have. >> thank you very much, miss lee. we'll have each one testify and then we'll go to the questions. the next person to test satisfy geoffrey corn. retired lieutenant colorado they will. served with the u.s. army. prior to his retirement, he served as special steent the u.s. army judge on war matters. a senior law war expert. he also served as the chief for international law for the u.s. army europe. chief prosecutor for 101st airborne division. the professor of international

security law. law of armed conflict and professor corn received his law degree from george washington school of law. professor, it is good to have you here. thank you for coming. we'll put your post statement on the record but please go ahead, sir. >> thank you for the opportunity of allowing me to share my perspective. as a soldier and a military staff officer i was told to express my bottom line upfront and that is that congress should enact ceja because it is in the best interest of our armed forces. prior to 1970 trial by court mart ya'll was the primary way

we held military accountable during operations abroad. however in the case of of united states versus red, that was restricted when the court held it only applied during periods of formerly declared wars. it was almost inconceivable that civilians would ever be subject by the trial by court-martial. the impunity created by this gap became apparent as the u.s. military focused increasingly on expeditionry operations on the decade following the end of the cold war. in response, congress enacted michigan eja that had a clear preference when civilians committed misconduct while operating abroad. however the perception of

contract immunity arose during occupation of iraq or afghanistan. the result of a jurisdictional gap that existed. demong 2006 amended the uniform code of military justice to reverse the opinion and resurrect military jurisdiction over civilians accompanying the armed forces in the field during any ting military operation. -- while the resident registration of civilians companying the force is likely constitutional, i believe that it does pose some serious constitutional questions. most significant of which is whether or not it is legitimate to try a u.s. civilian by court-martial when that is not a

requirement of absolute necessity. when an alternative is viable. i think court-martials are fundamentally fair, but the fact remains that a court-martial does not afford the full range of constitutional rights to a defendant as are afforded in article 3 criminal tribunal. it is because of this that i believe it was critically important to nabt meja. however it was based on an assumption that has become increasingly stale. civilians supporting the complex missions of today, although often operating in close proximity to the military are routinely connected to other government agencies. ceja is therefore necessary to complement meja. it will ensure they are all subject to federal civilian

criminal jurisdiction. i believe the ability to exercise such jurisdiction would be beneficial to the united states, because it would give us the opportunity to leverage the host nation to forego criminal prosecution of american citizens who commit serious misconduct and give us the opportunity to prosecute them in the united states, which i believe is often in the best interests to have nation and the criminal defendant. ultimately i can see no good reason not to enact ceja. i believe in enhancing the scope of jurisdiction over civilians abroad and limit military jurisdictions only to those of general win necessity. meja was the first step to

achieve this goal. ceja will be the next step. pressure to resorts to the broad grant of military jurisdiction in the 2006 amendment is almost inevitable. it is therefore in the interest of the nation, the military and potential civilian defendants to enact meja. thank you. >> i appreciate your perspective. our next witness is michael edney. he specializes in constitutional law. criminal and regulatory defense and complex civil litigation. from 2000-2009 provided legal advice to senior white house advisors. prior to that, he worked in the department of justice's office of legal council. bachelors from the university of

notre dame. law degree from the university of chicago law school. it is good to have you here. please go ahead. >> thank you, chairman leahy. i appreciate the opportunity to testify on this important subject. with troops deemployed in two -- deployed in two theaters of combarkts serious misconduct abroad is a recurring and complex matter. it leaves a gap for u.s. employees unassociated with the department of defense. this gap has raised serious foreign policy problems and problems with the uniform administration of justice. so the congress and the executive branch have struggled with whether and how to fill that gap through at least two administrations. that is because it is a difficult question and caution is very necessary in addressing it. expanding wide bands of federal

criminal law abroad to employees and contractors of all federal agencies including our intelligence community, could threaten vital security operations if not done with exceptional care. i want to make three points in my written testimony. first, the congress -- >> the testimony will be parts of the record full. >> thank you, plch. first the congress historically has been very careful in assigning relevant criminal laws extra territoryorialfect. it has studied off after lengthy classified briefings, restrictions to be placed on overseas intelligence operations. it ought not have unintended

side effects on authorized national security activities. the solution has been laid out by the assistant attorney general for the united states, lanny breuer. i agree with it. any legislation expanding general criminal law abroad should have a strong exception for intelligence or other national security operations. whatever additional restrictions should be placed on intelligence activities, we should wait for a set wrg the congress is exclusively focused on that smufment notably, finding an appropriate intelligence exception was the sticking point when this type of legislation came up in the 110th congress during the last administration. the current administration's position appears no different from the last. creating an appropriate intelligence exception would be an important step forward in moving this legislative project.

ambiguity should be avoided. using criminal offenses created for what is called the special maritime jurisdiction for the united states creates particular concerns in this regard. this is a common theme. this is a body of law that congress created for when the federal government is the only authority for military bases and embassies where there is no just state government. in a city here at home, these are the public order venns that we would expect but they were never meant for intelligence operations and we have no tradition that would assist us in applying them to this new field. the act avoided this problem by keeping the uniform code of military justice and its long history of governing violent armed conflicts as the primary regulator of the military itself.

there is no such easy solution for the intelligence community, which does not have this tradition. the result of intentional ambiguity is the chilling of operations and the delay to acquire clarity. intelligence officers should not have to rely on after the fact prosecutorial discorrection cession to carry out -- discretion to carry out operations. how these questions should be resolved is not clear and the process will take time while national security operations wait. third, if legislation imposes new restrictions on intelligence operation, any cases that follow likely will have classified information. it will place additional strain on the act that was enacted in 1980 to prevent espionage cases.

the expansion of federal criminal law that ceja compensates and cepa reform have to go hand in hand. i look forward to the committee's questions. >> thank you very much. >> the question to miss lee and then to professor corn. talking about the fact that the government contractors working overseas more than ever before. we though the legal framework is unclear. r when the military missions in iraq winds down and afghanistan for that matter, the american presence there will no longer be primarily military or d.o.d. we will have thousands of civilian contractors and employees and it is our criminal

jurisdiction will no longer extend to these contractors and employees. does that create urgency in the past? >> thank you, plch. that is a very michigan. -- plch how is this going to work in the absence of the department of defense. in what ways should we adjust the advice we give our employees. in what ways will this change the legal universe in which we operate? i think the department of defense limits authority to environment and does make it particularly important not just for the contractors to understand what jurisdiction will apply to them in the absence to have department of

defense but also for the host country perceptions. >> >> called upon to advise some of these companies with a passage of a very clear ceja, would that make your job easier? saying you can do this but you can't do -- and i realize it is kind of a leading question but also make it easier to tell the host country. >> there is two parts of it and i smiled when you asked the question. it does work counter to my interest. as a lawyer, i'm in business all day long. that's what we do. if there is lack of clarity in a statute, i stay busy all day, but on behalf of the companies i represent, i think you have the tounts clearly articulate your intent here and that is always a good thing. i also think as the good thing from the host country perspective. i think what we have seen, if there is just the perception of

the culture of impunity, that is a dangerous thing for military members and contractors that have to operate in that environment. >> mr. corn, how do you feel about that? >> senator, my concern is that although we draw down in these missions, the military will still have some presence in these locations and if there is no viable civilian criminal jurisdiction for act s of serious misconduct, the military may be pushed into the role of becoming the primary prosecutorial response of misconduct. i think that would be unfortunate. i'm not willing to say that the exercise is per se unconstitutional but i think it is in the interest of the military and civilian defendants to have a jurisdictional scheme that ensures such juries zix exerciseed only as a measure of

true last resort. this dove tails with what miss lee mentioned is that if we don't enact meja, there will be an inconsistent dealing with the method of military misconduct and civilian misconduct unless the military is the primary prosecutorial authority. by that i mean if there is an act of serious misconduct bye-bye a contract, the military member who commits the same misconduct will be tried in an american court. a military court but an american court. that civilian may have no option other than to be turned over to the host nation authorities for prosecution and that could create a perception of unfair treatment. i saw this once when i was in hideleberg, germany for u.s. army europe with an allegation of a rape by a contractor in bosnia or it was kosovo, i

think, prior to the implement of meja. the military commander had a very difficult dilemma. because if we didn't allow the local authorities to assert jurisdiction, there was no jurisdiction to assert. ultimately the case was done away with because the allegation fell apart. i don't want this person to have impunity for it. so having ceja would create a viable credible alternative which would be flile federal district court. >> do you agree or disagree? >> i don't disagree with that. i think that the -- i think, senator, as you point out, the more civilian contractors and employees we have overseas in these operations and these difficult areas, the more.yeptly

the gap in -- more poignantly the gap will be -- the question is how do we go about filling it? >> we also -- blanket immunity. i talked about a serious case with halliburton at the beginning of my statement. i hate to see something like that just be ignored. my life was easy the eight years i spent as a prosecutor in the united states. when a crime is committed, you go and prosecute the people you think committed the crime. here you a real difficulty. how do you approach it? as professor corn just mentioned, you also have the -- and miss lee has too, sometimes where the situation is going to be prosecution, the defendant

would much prefer being before an american court with our usual experience. we have seen some highly public lissized cases abroad where you wonder how in heaven's name those are done even with close allies of ours? i think one has dragged on for a couple of years in italy on a case where a young woman is accuseded of murder and when her parents point out the facts, ethical misconduct that even the courts said, then the prosecutor wanted to prosecute them for defamation. i think i would much rather be having the trial here in the united states. that's my view. senator grassley? >> you described how -- intelligence was important. what are the potential pitfalls that we face if pe pass

legislation extending law without carving out intelligence and national security? >> thank you, senator grassley. one of the problems is that it is difficult here and i think it is difficult period, to really account for all the many ways that the criminal laws that we draw up for the united states might apply to otherwise authorized national security operations. so that has to be very carefully studied. that's why the previous administration and i believe this one supports leaving those questions for another day. and finding an intelligence -- that protects those activities. if you had an intelligence carve out that focused on authorized intelligence activity or authorized national security operations, you would avoid the

situation that chairman leahy pointed out in his initial statement where a securities contractor that claims he was protecting somebody in the intelligence community but went off the reservation on a frolic and clearly serious misconduct, would not be covered by that. that's the key. the key is that it has to be sufficiently simple that the intelligence community continues only to worry about the authorities that are currently working under and any further authorities or restrictions that this congress decides or warned in the specific context of the intelligence community. >> do you have any idea what steps should be taken? >> yes. i think -- i mean, i think the first issue is that it needs to be very simple. if it were to become too specific, it would provide

points to oured a versares about what is authorize -- adversaries about what is authorized. also it needs to have a -- an allowance for the reasonable belief of intelligence officials that they are engaging in authorized conduct and finally, the important key is that it be drafted in a way that that keeps these potential criminal laws off the table because their applications of these activities again is extraordinaryly complicated. >> you discussed maritime and territorial jurisdiction as a basis for applying criminal law abroad, that statute was designed to cover general crimes

when no state and local government existed. this approach is similar to the military extraterritorial jurisdiction act utilizing special territorial jurisdiction. this is different for civilian contractors opposed to military members prosecuted under meja. what is that distinction and why is it important? >> yes, i think this is an important point that the committee should keep in mind as it turns again to crafting legislation in this area. because it is attempting to follow the military extra territorial jurisdiction act model. as a man from nebraska, this would be the type of law that i would expect to govern my activities while living in omaha that would be supplied by the late legislature to keep me

safe. but the applications of intelligence activities and military activities for that matter are very complicated. the way that the meja act dealt with this problem was to maintain privacy of the uniform code of military justice. that happens in 3261-d in title 18. it says that if you're subject to the ucmj, the ucmj alone will govern you. after a long history, while they are abroad cuttinging combat operations, we have a lot of case law that in a sophisticated manner deals with violent combat operations. there is no substitute that you can resort to. so the impulse to look to the special maritime territorial jurisdiction sets of criminal offenses would be a difficulty

if you're expandsing the criminal law beyond the department of defense to all federal government agencies including the intelligence community. >> rights. if congress failed to include an intelligence exemption in the legislation and relied on prosecutorial discretion of the justice department, would that have an impact on the intelligence community, for example, would they have ask the justice department to from vide legal opinions and if the intelligence community became reliant on the justice department to preapprove intelligence prayings would it have a chilling effect on that community? >> i think that you seized on a very important point, senator grassley. as i mentioned the application of these criminal offenses, the military operations, the intelligence operations would be very complicated. there are a lot of common law doctrines in the department of

defenses such as justification and public authority that the justice department would have to sort through. as i mentioned in my initial statement, we can expect than the intelligence community will turn to the justice department first to sort that out. that will take time and it will require a pretty significant exercise of discretion. i think what you'll see is that it would transfer a lot of responsibility about what intelligence operations occur from the senior executive branch officials that this senate confirmed to oversee those operations to the attorney general because he will have a very wide legal interpretive task in advance before he approves those operations. i think we can also expect that the justice department won't -- won't provide general guidance in this area as they shouldn't. these legal inquireys, if many

of these federal laws are applied, require very fact-specific issues and it would be a kind of defacto reorganization of the way that we conduct the international security prayings if -- if the federal -- operations if the federal criminal laws were not selected with great care. >> thank you. >> thank you, plch. -- mr. chairman. it seems very obvious to me that we're going to be depending on private contractors who work overseas more and more as we pull out of iraq, there will be more -- there will be -- they will be tied to the state department and then we have to make sure that they are accountable to u.s. laws. unfortunately, the actions of a small number of bad actors have

tarnished the entire reputation of the contracting community which you represent. you said in your testimony the companies that you represent would reasonable care greater certainty and clarity on the application of u.s. criminal laws to their employees. i would like to explain this a bit more. you talked about the culture and impunity. now i -- the chairman talked about jamie lee jones and k.b.r. and halliburton. now jamie lee jones was gang raped by k.b.r. employees. what i understood was that this had happened many times before and k.b.r. insisted that she was required to go under arbitration.

k.b.r. is no minor player in contracting. well, also, she formed her own foundation while in the four years that she was trying to fight to get into court. part of r her foundation was finding and inviting women who had -- this had happened to but who had submitted to the mandatory operation and she found 40. 40 women who had been raped. by contractors. now you heard all kinds of stories of prostitutes being brought into these contractors, including prostitutes in local -- in the host country. was it a culture of impunity?

is there a culture of impunity? i just want to know, as i said, k.b.r. is not a small actor. it is probably the biggest contractor there is. i'm not terribly convinced that this community wants this but i hope they do. >> i can tell you i believe that they do, senator. i want to clarify i never represented k.b.r. when i'm speaking about certain things i'm speaking of my own personal opinion and on behalf of individual clients anyway. i can tell you from my personal experience as a military prosecutor that even a perception of a culture of impunity is i think a dangerous thing and i think that is what i referred to when i spoke before. that is the potentially host

country perception of impunity. that is why the clients that i work with are all in support of the measure that would move forward for better, more effective accountability across the board. i think it is because it is fair to say that they recognize much like you have and many other senators and many members of the american public have recognized that it is contrary to goals of our mission oversees the allow even a perception of impunity to persist. >> k.b.r. was contract with d.o.d. as we withdraw from iraq more and more will be contractors for the state department. we did a bill, an amendment in the appropriations, d.o.d. appropriations that contractors couldn't exercise their

mandatory arbitration. clause in their employment contractors if they are getting paid through d.o.d. do you think it would be wise in terms of trying to get rid of this culture of impunity if we did the same thing for state? >> you mean, senator, specifically for civil liability and civil -- those kinds of things? i think that is something that is within congress' power to do. i apologize i'm not as familiar with that bill. >> well, basically, k.b.r. took the position that in her contract with them, they had a hand tori arbitration clause on any complaint about employment and they took the position that if she was raped, that was employment. dispute.

they had taken that position with evidently 40 other women and she fought them. now my question is do you think it creates a culture of impunity and would continue to create a culture of impunity if people like blackwater or other who are under the employee of the state department are able to assert these arbitration agreements on their employees who -- under same or similar circumstances. i'm asking your opinion. >> i can tell you as a lawyer who practices civil litigation, what i often advise my clients when they ask me should we have arbitration clauses in these agreements? sometimes these will be

arbitration clauses, not just in the defense contracting community but in other industries of the united states. i'll tell you my hons experience. i tell a lot of the clients i work for or most of them, it is not a guarantee it will be cheaper or faster or easier if done by arbitration. it can be just as expensive as litigation. victims who were making rape allegations in military justice proceedings, their families would often ask me the same thing. what should we do about this? should we sue about this? the way that they are super ip posed over civil lit gation is a complicated area and i think it is not -- i don't mean to not answer you directly. it is not secure enough to say it will improve the perception

of impunity. i'm not sure that it will. >> you don't understand my question then. because this is mandatory arbitration. it is not that no one is allowed to arbitrate. you can arbitrate if you like. i would appreciate an answer to my question, which is do you think that the state department should honor mandatory arbitration. i'm not talking about a woman has a right to arbitrate. of course a woman would have the right to arbitrate. that's not the issue. >> i think i do understand. what they are is arbitration in lue of litigation. -- lieu of litigation. that may be an area where you and i disagree as to whether that necessarily means that a person going forward in arbitration has given up anything that will be of benefit

to them or right to them. in my experience they are not always and so, you know -- >> my time is up, but i'm not satisfied with the answer because not always is not a satisfactory answer. >> well, i can tell you and i mean this very sincerely. the u.s. litigation process in terms of achieving redress for claims like miss jones is not likely to be very satisfactory either. so i think that is all i meant to express. i can't do an eert/or for you and tell you one will -- either/or for you. >> i think the woman should have a choice. thank you. >> now to senator whitehouse and

senator blumenthal. i should note the issue of arbitration -- i think what we're saying. we have arbitration if it is agreeable to both parties. i also agree with what miss lee said. on both civil and criminal litigations, the results are not always satisfactory.

good afternoon. we'd like to thank all of you for being with us today. in 1965, the same yar 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 oldermericans 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, tranortation as well as other services. while the need for such vital oaa services has increased ring 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 lookat 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' 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, at 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 bein 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 eecially thank roz alisten carter, our former first lady for sharing her experience and others. on the good work they're doing r seniors of east tennessee. i look forward to larning 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 servic 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 toet 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 olr, tse 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 prrams 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 thi 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 scussed 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 totell 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 fus 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 wer hit in pueblo last summer. you were a real crowd pleaser. i can't say the same abt 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 apprching 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 wel 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 hee. 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 jt 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 happtoe 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 ound 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 caregirs throuout 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 helpeds 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 mort 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 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, medicareivers 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 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 fo 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 eachf 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 iortant recommendation, however, is a call for leadership. we propose a national quality caregiving task force in the president's office with shared leadship 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 isation, 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 stem, 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 cagivers. 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,rs. 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 ve mentioned to you before i first heard of you from our mutual friend george pa tross xi, the long-term care oemzuds 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, wi 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 ecifically 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 wor 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 oken 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 ts country. supporting independence, helping people maintain the 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 r families so that they're better able to take care of loved ones in their holmesand their cmunities 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 caregirs 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, suc 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 thousas 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 pgrams, encouraging comprehensive person-centered approaches, providing flexibility toespond 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 thr 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 spitals and emergency room visits. we want to improve the senior

community services employment program by integrating it with other senior programs. as you kn, the president has recommended in 2012 through this budget processhat we transfer tholder 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 voluntee 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 americanact 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 yo 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 individus. one of those kpoept compones i economic security of seniors. we have a variety of programs that have worked on pension koumsing, benefits utreach, 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 al 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 refenced, 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 neeto 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 we 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 clas act itself, or is that something -- how is that being counted for? >> senator, as you know, health and human services was given moy 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 andhe 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 kno 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. asou 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 tness 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 directare 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. onehat we are working on -- we're doing six in all with johnson & johnson. and johnson and johnson's been great because theywere the first ones to do clinical trials in nursing homes working with those who are suffering from mental disorders. so they've bee 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 o 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 o 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 thworkforce 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, anhing 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 mu. 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 tse and i think the word you had mentioned eaier was flexibility. i can't explaienough 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 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 anday 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 contributingut 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, becauseit's not for a lack of need. they just can't find anyone else to provide those services and ey're willing to pay so we hope those flexibilities arare taken into consideration. in transportation, that's th one that we're having sme 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 doave a ansportation 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 vy 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 theirsurvey 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 itwith regard to the

health programs to make sure we have goooutcomes. 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 elecd 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 tenssee 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 vals 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 t 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 kit 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 vitor 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 o 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 me 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 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 coalitn of diverse, natnal, 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 toarry 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 by 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 t improvements can be made in the efficiency and effectiveness of the older americans act in its delivery of core services and how it interac 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 o 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 uge 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 th 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 t testify today. the state long term om budsman of wiscsin. 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 primaryuty 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 communy 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 recurnces 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 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 fo allowing me to share our thoughts of the reauthorization. >> thank you, mrs. bruemmer. mr. well? >> thank you, senators, on the special committee of aging to address you today. as the ceo of senior citizens home assistance service tat 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 serves 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 ings 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 b also may not have the ability to pay the full fee. we have a slidin 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 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 t provide

gnity. 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 allow 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 fundingrom 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 facilityre able to pay for the help or the va may help or in some cases familyembers may

helpor 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 thr 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 yo for alowing 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, buit'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 wayst 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 live at home and my mother went up to new hampshire in june every year after school was done, and tookare of her or helped take care of her because she was in a wheelchair and completely unable to do anything for hersf. 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 weo 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? >> ihink, 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 thiss 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 wld 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 aonderful 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 frequent. it does make a considerable difference if we can educate people on how to event. 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 cent, which really benefits our wonderful residts tt 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 manament 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 doeshat pers 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 fo

partnerships so that program that is can sustain themselves over time. >> thank you very much, mr. howell. senator corcoran? >> thank you, mr. chairn and ms. marshall, thank you for being re. you said you hope you weren't a burden for your children or grand children. i know that's nothe case. i'm sure you're a blessing. there's probably a whole line of people in your community who would be wilng 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 gislation i've offered to get ending 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 e 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' 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 ha 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 i 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 progm 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, e 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 wos, 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 reasn, you're talking out, 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 progrs 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 th. 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

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 youery much, setor 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 maxichtman 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 joand 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, reall 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 people need. metimes 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 ju what they need to stay healthy." we can often talk and talk in this town in describing gislation 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 seice. 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.

[captions copyright national cable satellite corp. 2010] [captioning performed by national captioning institute]

>> this morning on "washington journal" an update on iraq and the call of iraq troops and the progress made by the security forces in iraq. then a discussion about the u.s. appears to train and the military. after that, current u.s. terrorism strategy in afghanistan. and after that, the national highway trust fund and the role of federal and state gas taxes play in funding. plus your emails, phone calls, and tweets. that is live at 7:00 a.m. eastern. earlier today, president obama visited a joplin, missouri after a tornado killed over 100

residents. he inspected the damage and met with local residents and emergency workers. we will have a brief remarks by the president into missouri governor. this is close to 10 minutes. >> hi how are you? >> i am fine. >> god bless you for your work. who is this? >> tanner. >> nice to meet you. your uncle lives right down there?

i am glad he is ok. >> his house is over there. >> how are you, sir? >> farnam to win well. thank you so much. -- i am doing well. thank you so much. >> this is so helpful. god bless you. this is such a wonderful thing to do. [unintelligible] god bless you. we appreciate you. tell your uncle we are praying for him.

[unintelligible] obviously, the scene speaks for itself. when we were in tuscaloosa a few weeks ago, i talked about how i had not seen devastation like that in my lifetime. you come here to joplin, and it is just as hard braking, and in some ways even more devastating. -- heartbreaking, and in some ways even more devastating. i want to thank the mayor and other delegations along with the first lady in the red cross in helping people respond. it is going to take years to

build back. we mourn the loss of life. there will be a memorial service to help families let them know we are praying for them and thinking about them. we had a chance to meet with the people that lived in this community. we were hearing stories, miraculous stories. in 85-year-old gentleman who still has a service that got a chicken pot pie out, the storm came, he went into a closet, and came out without a scratch. there are good stories to tell him happy stories. but there has also been a lot of hardship as well. the main thing for the people here in joplin is that this is not just your tragedy.

it is a national tragedy. that means there will be a national response. the federal government has been on the ground since the day after this has happened. there is an outstanding team of state and local officials. we will do everything we can to continue what ever search and rescue efforts that remain. we are doing everything we can to make sure people get to the shelter they need, the support they need. we are working with the government to cut through any red tape necessary with respect to building here. i have been telling every family that i have met here is that we will be here long after the cameras leave. we are not going to stop until joplin is back on its feet. all of the volunteers helping out -- one thing that is incredible is how many people

out of state have driven as far away as texas and nearby illinois. people coming to volunteer. firefighters, ordinary citizens. it is an example of what the american spirit is all about. that gives us a lot of encouragement at a time when people are going through a lot of hardships. thank you, governor. >> i have been here every day, trying to work and back up local officials to coordinate the federal response and make sure we greenlight the necessary items. today is a day of remembrance. has removed to the memorial service, the loss of life, and the loss of property is significant. it will take a lot to keep the strength of this community's resolve to get this done.

we appreciate the president focusing your attention right here to help us in ways that will make a lasting difference to this community. god bless you. >> thanks. in the bill building process, there are a lot of families thankful that they are -- rebuilding process, there are a lot of families and all that they are ok. they have lost property and means of transportation. schools have been destroyed. for all americans, take time out and make a contribution to the american red cross or other charitable organizations in joplin. that will make an enormous difference. even if it is five dollars or $10 or whatever you can spare, it will help. this can happen to anybody. there is a difference between

you being in the path of a twister and a few blocks away, you are ok. that is a very slim margin. we all have to get together. we are here by the grace of god. thank you very much, everybody. >> after touring the tornado damage, president obama attended a memorial service for the victims. he talked about the world service of residence during the tragedy and pledged continued support for the joplin until it is rebuilt. this is about 35 minutes.

>> thank you. [unintelligible] [applause] thank you. >> we love you. >> i love joplin. thank you. thank you for being here with and for your people every step of the way. we are grateful to you, reverend, father -- i am so glad you got out of that of a. -- a tub. [laughter] [applause] to reverend brown for that incredibly powerful message. [applause] to the senator, who has been here along with the congressman

billy long. to the mayor, to crack, who does not get a lot of attention. he is head of fema, our emergency response to the federal level. he has banned in tuscaloosa, joplin, and everywhere -- he has been to tuscaloosa, joplin, and everywhere else in between. and to the president of the national red cross, who has contributed mightily either. most of all to the family in france of all of those who have been lost and all of those who have been affected. today we gather to celebrate the lives of those lost those lost to the storms in joplin and across the midwest. we are keeping our prayers for

those still missing. we are mourning families -- with the families who stand together during this time of pain and trial. the the as a red and brown and alluded to, the question that weighs on us is why? why our town, why our home? why my son, husband, wife, sister, friend? why? we do not have the capacity. we cannot know when a terrible storm will strike. or where. for the severity of the devastation that it may cause. we cannot know why we are tested. -- with the loss of a loved one.

with the loss of a home where we have lived a lifetime. these things are beyond our power to control. that does not mean we are not powerless in the face of a diversity. how we respond when a storm strikes is up to us. how we live in the aftermath of heartache in a tragedy is up to us. it is in these moments through our actions that we often see the collapse of what makes life worth living in the first place. in the last week, that is what joplin has not just talked

missouri, america, but the world. i was overseas in the aftermath of the storm and there were world leaders coming up to me saying, let the people of joplin know we are with them. we are thinking about them. we love them. [applause] the world saw how joplin responded. a university turns itself into a makeshift hospital. [applause] some of you used your pickup trucks as ambulances hearing the injured on doors that served as structures. your restaurant brought food to

people in need. businesses getting donations. you waited in line for hours to donate blood to people you know and to people you have never met. in all of this, we have lived in the words of scripture. we are troubled on every side yet not distressed. we are perplexed but not in despair. persecuted but not forsaken. cast down but not a destroyer. -- destroyed. you have shown the world what it means to love thy neighbor. you banded together and came to each other's aid. he demonstrated simple truth that it meant heartbreak,

tragedy, and -- amid hard brick, tragedy, no one loses -- heartbreak, tragedy, no one loses strength. we can all love one another. [applause] as you move forward in the days ahead, i know that rebuilding what you loss will not be easy. i just walked through some of the neighborhoods that have been affected. you look out at the landscape, and there have to be moments where you just say, where do i begin? how to start? there are going to be moments where after the shock has worn off, you feel alone. but there is no doubt in my mind what the the people of this

community can do. there is no doubt in my mind that joplin will rebuild. as president, i can promise you your country will be there with you every single step of the way. we will be with you every step of the way. [applause] we are not going anywhere. the cameras may leave, the spotlight may shift, but we will be with you every step of the way until joplin is restored and this community is back on its feet. [applause] we are not going anywhere. [applause]

that is not just my promise but america's promise. the promise i made here in joplin is the promise i made in tuscaloosa, or any of the communities that have been hit by these devastating storms over the last few weeks. there have been countless acts of kindness and selflessness in recent days. we have already heard a record of some of them. perhaps none as inspiring as what took place when the storm was bearing down on joplin, threatening an entire community with a search description. -- better destruction. the wins showed no regard for human life. it did not discriminate on race or background. some said i am willing to die right now so that someone else

might live. the has been that for himself over his wife when his house came apart around them. the mother who shielded her three young sons. a husband and a father who loved to sing, was sold in his church choir. dean was working a shift at the home depot when a fire rang out. he sprang into action, moving people to safety. over and over again, he went back for others, until a wall came down on top of him. most of the building was destroyed. not where he had directed his co-workers and customers. there was a young maine -- man named christopher lucas, who

was 26-years old, the father of two daughters with a third daughter on the way. he was doing his job as manager on duty at pizza hut. he heard the storm coming. this former sailor quickly ushered everyone into a walk-in freezer. the freezer door would not stay close from the inside. as the tornado bore down on the small storefront, christopher left the freezer to find a rope or cord or anything to hold the door shut. he made it back just in time tying a piece of bungee cord to the outside wrapping the other end to his arm holding the door closed with all of his might. he held it as long as he could.

that was until he was pulled away by the incredible force of the storm. he died saving more than a dozen people in the freezer. [applause] there are heroes all around us all of the time. they walk by s on the sidewalk. they sit next to us in class. they passed us in the aisle. they come to our table in a restaurant and asked us what we would like to order. just as we can not know why why tragedy strikes in the first place, we may never fully understand where these men and

women find the courage and strength to do what they did. what we do know is that in a split second moment, where there is little time for internal reflection or debate, the actions of these individuals were driven by love. love for a family member. love for a friend. or just love for a fellow human being. that is good to know. in a world that can be cruel and selfish, this knowledge that we are inclined to love one another, that we are inclined to do good, to be good, that causes us to take part.

we see with fresh eyes what is so fragile, so important to us. we put aside our petty grievances, minor disagreements. we see ourselves in the hardships of others. and in the stories of people like diener and christopher, we remember that each as the us -- each of us have a result of compassion and there are heroes all around us, all of the time. in the wake of this tragedy, let us live up to their example. , to liveach day count with a sense of ritual regard.

[applause] to live with that same compassion that they demonstrated in their final hours. we are called by them to do everything we can to be worthy of the chance that we have been given to carry on. i understand that at the memorial yesterday for the dean, his wife decided to play a recording of him whistling a song he loved, "amazing grace." the lyrics are a fitting tribute to what joplin has been through. through many dangers, toils and snares, i have already,. come. it is a phrase that has brought me save and thus far, and grace

will -- it is grace that has brought me safe thus far, and grace will lead me home. when this flesh and heart shall fail and mortal life chelsea's, i shall possess a life of joy and peace. may graze guide the people of joplin home. god -- grace guide the people of joplin home. god bless you, and yell and bless america. [applause]

[applause] >> thank you, mr. president. i had been told that you were walking our streets. i had been told of your genuine interest in your compassion. on behalf of one of the citizens and get on behalf of a very large crowd, thank you sir.

[applause] all of us have had a friend's who went to stand beside us this week. some could do so in person, and others mailed us their hearts and asked to borrow what ever we needed from those letters and notes. one friend wrote me the following. the storm did much damage. i cannot imagine. there are limits. a tornado cannot destroy the sovereignty of god, the church of god, the plan and promises, the justice, the love of god. it shall not destroy the grace of god. it shall not destroy the son of

god. and he is right. [applause] as i wrap up the remarks that have been made today, i want to go back to what was mentioned earlier. this time it is from paul. in the butt of a philippians, paul does not define peace as the absence of conflict or struggle. that is not peace. it is the discovery of the presence of a personal god, the same christ wheat at the tomb of his friend, which over the harsh experience we experience in this world. he made us to be his shadow. who tore off a part of himself to make us, and yet losing nothing in the whole, he is the greater light, and we are the

lesser. he is the god the who says he has described our names on the palms of his hands. he is that one, who has promised his faithfulness. my prayer, on behalf of my friends is that may you know him and may you know his piece as we rebuild not only our homes but also our lives. clinging to what will never be shaken, the faithfulness of got, would you stand in joining the kamla, great is thy faithfulness. is hymn, "great

is thy faithfulness." ♪ ♪ you will find the words printed in your program. ♪ ♪

♪ ♪

father of love and life, we thank you for this time of prayer, inspiration, and renewal. allow us to continue to be open to your healing powers in our efforts to reach out to all to meet their needs. bless this community and all those that have come to us to be our strength. as we move forward, and support to one another in response to the words of your son, love one another as i have loved you. we say yes, and we ask you to continue to bless us and help us dream new dreams as we call you at this time. amen. let us join peace and love

. ♪ ♪\ ♪ " god bless america" ♪ [unintelligible]

♪

♪ ♪

♪ [unintelligible] ♪ {how great thou art} ♪

[applause] [unintelligible] ♪ ♪