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S. HRG. 115–196 

AGING WITH COMMUNITY: BUILDING 

CONNECTIONS THAT LAST A LIFETIME 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

WASHINGTON, DC 

MAY 17, 2017 

Serial No. 115–5 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.fdsys.gov 

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(II) 

SPECIAL COMMITTEE ON AGING 

SUSAN M. COLLINS, Maine, Chairman 

ORRIN G. HATCH, Utah 

JEFF FLAKE, Arizona 

TIM SCOTT, South Carolina 

THOM TILLIS, North Carolina 

BOB CORKER, Tennessee 

RICHARD BURR, North Carolina 

MARCO RUBIO, Florida 

DEB FISCHER, Nebraska 

ROBERT P. CASEY, JR., Pennsylvania 

BILL NELSON, Florida 

SHELDON WHITEHOUSE, Rhode Island 

KIRSTEN E. GILLIBRAND, New York 

RICHARD BLUMENTHAL, Connecticut 

JOE DONNELLY, Indiana 

ELIZABETH WARREN, Massachusetts 

CATHERINE CORTEZ MASTO, Nevada 

KEVIN KELLEY, Majority Staff Director 

KATE MEVIS, Minority Staff Director 

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CONTENTS 

Page 

Opening Statement of Chairman Susan M. Collins .............................................. 1 

Statement of Ranking Member Robert P. Casey, Jr. ............................................ 3 

PANEL OF WITNESSES 

Lindsay Goldman, LMSW, Director, Healthy Aging, The New York Academy 

of Medicine ............................................................................................................ 5 

Meg Callaway, Project Director, Piscataquis Thriving in Place Collaborative ... 7 

Cathy A. Bollinger, Managing Director, Embracing Aging, York County Community Foundation .............................................................................................. 8 

Anamarie Garces, Founding Member, Miami-Dade Age-Friendly Initiative, 

Co-Founder and CEO, Urban Health Partnerships, Miami, Florida ............... 9 

APPENDIX 

PREPARED WITNESS STATEMENTS

Lindsay Goldman, LMSW, Director, Healthy Aging, The New York Academy 

of Medicine ............................................................................................................ 30 

Meg Callaway, Project Director, Piscataquis Thriving in Place Collaborative ... 47 

Cathy A. Bollinger, Managing Director, Embracing Aging, York County Community Foundation .............................................................................................. 48 

Anamarie Garces, Founding Member, Miami-Dade Age-Friendly Initiative, 

Co-Founder and CEO, Urban Health Partnerships, Miami, Florida ............... 63 

ADDITIONAL STATEMENTS FOR THE RECORD

Statement of Amy Schectman, President, Jewish Community Housing for 

the Elderly, Boston Massachusetts ..................................................................... 66 

Statement of the Altarum Center for Elder Care and Advanced Illness ............ 69 

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AGING WITH COMMUNITY: BUILDING 

CONNECTIONS THAT LAST A LIFETIME 

WEDNESDAY, MAY 17, 2017 

U.S. SENATE, SPECIAL COMMITTEE ON AGING, Washington, DC. 

The Committee met, pursuant to notice, at 9:30 a.m., in Room 

SD–562, Hon. Susan M. Collins, Chairman of the Committee, presiding. 

Present: Senators Collins, Rubio, Fischer, Casey, Blumenthal, 

Donnelly, Warren, and Cortez Masto. 

OPENING STATEMENT OF SENATOR SUSAN M. COLLINS, 

CHAIRMAN 

The CHAIRMAN. The hearing will come to order. Good morning. 

Thank you all for being here. 

As many of you are aware, originally this hearing had been 

scheduled for last week. Due to circumstances beyond our control, 

the hearing had to be postponed, and I very much appreciate our 

witnesses coming again or sending a representative when they 

could not do so to help us explore what is a very important issue. 

Isolation and loneliness can have serious, even deadly consequences, for the health and well-being of our nation’s seniors. We 

examined this growing epidemic in a hearing that this Committee 

held last month, and we learned that isolation is associated with 

a greater incidence of depression, diabetes, and heart disease. In 

fact, the health risks of prolonged isolation are comparable to 

smoking 15 cigarettes a day. I must say that fact astonished me. 

Today, we are looking for solutions that will help to build a 

stronger sense of community, therefore leading to happier, 

healthier lives for older Americans. 

When the Senate Aging Committee was first established in 1961, 

9 percent of Americans were over age 65. Today, those older than 

65 represent 15 percent of our population. By the year 2060, nearly 

one out of four Americans will surpass their 65th birthday. 

The fastest-growing age group is what is called the ‘‘oldest old,’’ 

those 85 years old and older. Today, we will explore ideas to connect seniors with communities to make home not only a better 

place to grow up, but also a better place to grow old. 

Most seniors want to live at home as long as possible. This, however, can pose challenges. Maintaining a home is an arduous task 

at any age and can be especially so for older adults. Snow may 

need to be shoveled. Repairs may need to be made. Windows may 

need to be replaced. The list is endless. 

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As seniors age and in some cases develop chronic diseases that 

present mobility and other impairments, homes may need more significant modifications such as wider hallways to accommodate a 

wheelchair, grab bars in the bathroom, chairlifts for the stairs. 

Transportation is another key factor of an age-friendly community. Seniors need a way to get to the grocery store and doctors’ appointments and to visit with friends or enjoy community events, especially once driving is no longer a safe option. Age-friendly communities often provide bus routes for seniors, volunteer driver programs, and other initiatives to help seniors go where they need and 

want to go. 

One key feature of age-friendly communities cannot be captured 

by infrastructure or policy but is part of our culture. In a 2007 report, the World Health Organization declared the development of 

age-friendly communities a global priority. 

One domain that stood out to me is the need for respect and inclusion for our seniors. In age-friendly communities, seniors are respected for their past and present accomplishments. They are included in community planning. They engage with younger adults 

and children. They are valuable and contributing members of society with a lifetime of experience to offer. Whether they are homebound or not, the community ensures that seniors are not left feeling isolated or left out. 

Respect and inclusion are an essential part of the spirit of the 

American democracy. Towns from the most rural to the most urban 

are responding to the needs of seniors, as we will learn today. Initiatives to create age-friendly communities have grown organically 

across the country. The national organization that provides support 

and tools is the AARP network of age-friendly communities. 

In Maine, our state motto is Dirigo, which means ‘‘I lead,’’ and 

I am very proud that Maine is leading the way. 

Of the 163 communities in the nation that have joined this network, 35 are in the State of Maine. We have communities such as 

Bethel and Biddeford, Eastport and Milo that are committed to becoming more welcoming to seniors. These 35 communities have 

each developed an action plan reflecting local needs. When the oldest and most rural state leads the way, it represents success for the 

entire nation. 

Our hearing today is especially fitting during Senior Corps Week. 

In Maine, 1,675 volunteers make significant contributions to communities through the state’s nine Senior Corps programs. Senior 

companions, RSVP volunteers, and RSVP Vet to Vet connect seniors with communities. Senior service presents a promising solution 

to help combat isolation and promote a sense of community and a 

sense of service and mattering. 

Today, we will hear from four program directors who will describe initiatives under way in their communities to address the 

needs of their aging populations. You will notice that no two models are alike, and that is the beauty of this approach. Each is built 

from the ground up. Each is tailored and customized for seniors living in their communities. The factor that ties these programs together is a strong sense of community that includes and values all 

of our seniors. 

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It is now my pleasure to turn to our Ranking Member, Senator 

Casey, for his opening statement. 

Thank you. 

OPENING STATEMENT OF SENATOR ROBERT P. CASEY, JR., 

RANKING MEMBER 

Senator CASEY. Chairman Collins, thank you for holding this important hearing and also for working to reschedule it after it was 

postponed from last week, and I want to thank the witnesses for 

being here today. 

As many of you know, May is Older Americans Month, and this 

year, the slogan for Older Americans Month is ‘‘Age Out Loud,’’ a 

good slogan. So our hearing topic today, living—livable, I should 

say, communities fits nicely into the theme. 

Older Americans want to be out and about, aging out loud in 

their cities and their towns. They want to go to little league games 

or see a movie or work or volunteer, shop or interact with their 

neighbors. For this reason, I am pleased that experts from communities large and small, rural and urban are here to discuss how to 

design livable communities. 

I am particularly delighted to have a leader here today from my 

home State of Pennsylvania and in particular York, Pennsylvania. 

I will introduce Cathy later, but we are grateful for the work that 

she has done and the people of York County and the City of York. 

And I can confirm what a great community York is. I was just 

there not long ago, and we are grateful that she is with us. 

We should aim for every county across the country to be like 

York County. And I know that Chairman Collins talked about communities in Maine and how many of them are livable communities, 

so we should have a competition, I guess, to get as many signed 

up. 

What does it mean in practice? I guess that is one question some 

might be asking. What it means is that local officials are reorienting their thinking as to their plans for and their investment in 

a number of things: number one, home repair programs so that 

aging adults can maintain their households without great expense; 

second, accessory dwelling units so relatives can live with their 

families and retain their privacy; third, more and varied transportation options for those who are no longer able to drive; fourth, 

wide, slip-free, even-surface sidewalks and more time to cross the 

street at traffic signals—I think people at any age would want 

that—and simple solutions like a bench to sit on and wait for a 

bus. 

These strategies can make a big difference to a senior who wants 

to be active and engaged in their community, and these strategies 

can help make progress on the public health challenge of senior isolation. These strategies also make it possible to have towns and cities that are inclusive, as the Chairman said, that are crossgenerational and are age- and income-friendly. 

I expect our witnesses today will also address the importance of 

neighborhoods that have a mix of older and younger residents and 

families from multiple socioeconomic levels. 

We know that inclusive neighborhoods are often the healthiest 

neighborhoods, and we also know that making our communities 

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age-friendly will not be fully realized without partners at the Federal level. 

It is, in part, for this reason that I have joined my colleagues in 

urging President Trump to work with us on an infrastructure package, legislation to invest in our infrastructure. 

I am committed to ensuring states and localities have the resources necessary to invest in our cities and towns of the future, 

creating millions of jobs along the way. 

I look forward to hearing from our witnesses about how that investment would also significantly benefit older Americans and individuals with disabilities. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you very much, Senator Casey. 

We will now turn to our panel of witnesses. First, we will hear 

from Lindsay Goldman. Ms. Goldman is the director of Healthy 

Aging and the Center for Health Policy and Programs at The New 

York Academy of Medicine. She oversees age-friendly New York 

City and works to improve all aspects of city life for seniors. 

We will go from New York City to rural Maine with our next witness, who is one of my constituents, Meg Callaway. Ms. Callaway 

is the program director of the Thriving in Place Collaborative in 

Piscataquis County, where some of Maine’s most rural communities 

are located. Meg works to provide critical services, such as food, 

housing, and caregiver support to older adults living in Piscataquis 

County by coordinating a network of existing local resources. She 

has nearly 25 years of experience in the Maine social service system and has worked extensively with Maine families, and I am delighted that she was able to return to participate today. 

I would now turn to our Ranking Member Casey to introduce our 

next witness. 

Senator CASEY. Thanks very much. 

I am pleased to introduce Cathy Bollinger from Spring Grove, 

Pennsylvania, which is in York County, as I mentioned. She is the 

managing director of the York County Community Foundation Embracing Aging Initiative. With a collaboration made up of businesses, charitable groups, and government agencies, Cathy works 

to create livable communities for aging Pennsylvanians. This work 

includes improving housing, transportation, lifelong learning, arts 

and culture, and health and well-being for seniors in York County, 

Pennsylvania. Because of this innovative work, York is one of only 

six communities highlighted for its livable communities work by 

the National Association of Area Agencies on Aging. She has done 

this work for years, and we are grateful that she is here. 

Welcome to the Committee, Cathy. Welcome back. You were here 

last week as well. We look forward to your testimony. 

The CHAIRMAN. I am now pleased to turn to Senator Rubio, who 

will introduce our witness from the great State of Florida. 

Senator RUBIO. Thank you. Thank you, Madam Chair, for holding this important hearing. 

I also want to take a quick moment to introduce Anamarie 

Garces from my home State of Florida and from my home City of 

Miami. She is a founding member of the Miami-Dade Age-Friendly 

Initiative, which works to improve the community life for older 

adults. Her organization works closely with a community that I 

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know well, Little Havana in Miami, Florida, to improve the quality 

of life for seniors, and I am pleased that she is with us here today. 

I thank her for her good work. I look forward to her testimony. 

The CHAIRMAN. Thank you very much, Senator. 

Ms. Goldman, we will start with you. 

STATEMENT OF LINDSAY GOLDMAN, LMSW, DIRECTOR, 

HEALTHY AGING, THE NEW YORK ACADEMY OF MEDICINE 

Ms. GOLDMAN. Good morning, and thank you, Chairwoman Collins, Ranking Member Casey, and members of the Aging Committee for the opportunity to testify today. My name is Lindsay 

Goldman, and I am the director of Healthy Aging at The New York 

Academy of Medicine. 

Established in 1847, the academy advances solutions that promote the health and well-being of people in cities worldwide. One 

of our current priority areas is healthy aging. The academy serves 

as the secretariat for Age-Friendly New York City, a public-private 

partnership with the city council and the mayor’s office, working to 

maximize the social, physical, and economic participation of older 

people. 

Beginning in 2007, using the World Health Organization’s eight 

domains of an age-friendly city, we conducted a comprehensive assessment of the city’s age friendliness to identify barriers to engagement faced by older people throughout the course of daily life. 

The assessment included guided conversations with thousands of 

residents, roundtable discussions with hundreds of professionals, a 

literature review, and extensive mapping. 

In response to our findings in 2009, the mayor’s office announced 

59 initiatives across 13 city agencies to improve the quality of life 

for older adults and appointed a commission for an age-friendly 

New York City to encourage private organizations to become more 

inclusive. Nearly 10 years later, we remain deeply invested in this 

effort. 

We applaud the Committee’s recognition of social isolation as a 

threat to public health. Through low- or no-cost solutions, AgeFriendly New York City works to optimize existing age-neutral assets that facilitate connections between the generations. 

Today, I will describe our strategies to increase walkability and 

access to public transit, to leverage public space and programming, 

and to maximize economic participation to prevent social isolation. 

There is considerable evidence that walking is associated with 

better physical and mental health, and the majority of older New 

Yorkers prefer to walk to destinations. However, older people reported challenges, like inadequate street-crossing times, poorly 

maintained sidewalks, and lack of seating. 

The Department of Transportation, DOT, established the Safe 

Streets for Seniors Program to evaluate conditions in areas with 

high rates of senior pedestrian fatalities or injuries and implement 

mitigation measures such as extending street-crossing times, constructing pedestrian safety islands, widening curbs and medians, 

narrowing roadways, and installing new stop signals. Through this 

process, over 600 dangerous intersections have been redesigned, 

and senior pedestrian fatalities have decreased 16 percent citywide. 

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DOT also installed over 1,500 new benches around the city, particularly near senior centers and housing, hospitals and health centers, commercial districts, and municipal facilities. In response to 

feedback that bus shelters often lack seating and felt unsafe, nearly 4,000 shelters have been redesigned with seating and transparent walls. Older people report increased mobility and new social 

connections as a result of these initiatives. 

While research suggests that participation in public space improves health and well-being through opportunities for physical 

and social activity, older people tend to spend more time engaged 

in solitary and sedentary pursuits, such as watching TV and reading. 

Older people in the neighborhood of East Harlem revealed that 

they did not use public pools because they were afraid of getting 

hurt during crowded general swim hours. In response, the Parks 

Department piloted senior-only swim hours at one pool in the 

morning when the pool was underutilized. The program was so 

popular, the Parks Department expanded it to 16 pools citywide 

and added water aerobics instruction. 

A preliminary evaluation indicated that older people who participated in water aerobics demonstrated greater lower body strength 

and flexibility than those who did not. 

Older people often have a limited catchment area for activity, so 

local businesses enable them to meet basic needs and to socialize. 

Local businesses also depend on older people, who account for nearly 50 percent of consumer spending, as loyal customers, yet older 

people often reported barriers, including accessibility, affordability, 

and lack of appropriate products and services. 

With input from the business community, the academy created 

the Age-Friendly Business Resource Guide to help businesses better attract and cater to an aging consumer base. We have educated 

30,000 storefront businesses, catalyzing improvements such as the 

addition of seating in stores, more legible signage, and new senior 

discounts. A small study found that businesses that made agefriendly changes had higher average cash receipts than similar 

businesses that did not. 

As illustrated by these examples, planning processes to inform 

improvements to the built, social, and economic environment 

should engage older people as experts on their own lives. By 

leveraging evidence-based, age-friendly strategies such as universal 

design and active transit, Federal investment in infrastructure can 

facilitate independence, promote engagement, and build a sense of 

community. 

Additionally, Federal leadership and funding can help to reduce 

social isolation and maintain the health and well-being of older 

people through the provision of safe and affordable housing as well 

as better access to health care, transportation, healthy food, technology, and arts and culture. 

Thank you. 

The CHAIRMAN. Thank you very much for your very interesting 

testimony. Both Senator Casey and I were struck by that reduction 

in pedestrian fatalities, which is really extraordinary. 

Ms. Callaway. 

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STATEMENT OF MEG CALLAWAY, PROJECT DIRECTOR, 

PISCATAQUIS THRIVING IN PLACE COLLABORATIVE 

Ms. CALLAWAY. Good morning, Chairman Collins, Ranking Member Casey, and members of the Senate Special Committee on 

Aging. Thank you so much for having us return to testify this 

morning. My name is Meg Callaway, and I direct the Thriving in 

Place Collaborative in Piscataquis County, Maine. 

Piscataquis has Maine’s second oldest population, and we are the 

state’s most rural region. We are actually one of only two frontier 

territories remaining east of the Mississippi River, with fewer than 

six people per square mile and a land mass slightly bigger than 

Connecticut. We are home to 17,000 people and 27,000 moose. 

[Laughter.] 

Ms. CALLAWAY. The Piscataquis County Thriving in Place Collaborative is one of nine aging-in-community projects that are funded through the Maine Health Access Foundation’s Thriving in 

Place or TiP initiative. These projects convene partners, including 

municipal leaders, social service providers, health professionals, 

businesses, and volunteers to assess the regional needs of older and 

medically vulnerable adults and to implement strategies that help 

them to stay at home and connected in their communities. 

TiP projects improve the coordination of existing services and 

supports in rural communities, and by doing so, we increase access 

to critical resources, such as housing, food, transportation, socialization, health care, and very importantly, caregiver support. We 

do this by building relationships and by facilitating communication 

between older people and community organizations. Older volunteers are integral to our efforts. Their experiences and priorities 

shape all that we do. 

While all projects focus on keeping older adults connected to 

their communities, our approaches vary. The situational needs of 

older people living on the rocky coast can be different than those 

of seniors living in the deep woods of Maine, and their available 

resources also can be quite different. 

The success of the Thriving in Place Collaborative—Initiative is 

largely due to the flexible funding that allows communities to build 

on their own strengths and to focus on the specific needs of their 

aging populations. 

For example, in Piscataquis County, a local farm provides fresh 

meals for seniors recovering from extended illness. Renovations are 

under way of an historic building that will house a senior center 

for independent adults and an adult day services program for older 

adults who need more support. 

We now have a central phone line that anyone can call for help 

with locating senior services, and when a caller has complex medical needs, we send a nurse to help put together a plan of care. 

With the help of AARP, we have stocked five local libraries with 

caregiver and aging resources, and volunteers provide social connection and fresh produce to homebound seniors through our local 

Senior Companion and Senior FarmShare program. We have a 

local volunteer hospice that provides respite for family caregivers. 

The Aroostook County TiP in northern Maine partners with their 

local nursing school and hospital to engage students in home-based 

assessments and discharge follow-up. Students review discharge inAGING-SDG-5 with DISTILLER

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structions, provide pre-made meals, and review medications to assist seniors after a hospital stay. And this collaboration is yielding 

significant reductions in hospital re-admissions. 

TiP Downeast on the Blue Hill Peninsula has established an inhome visitor program and is bringing evidence-based health programs deeper into rural, coastal areas, again, reducing hospital admissions and institutionalization. 

TiP programs are educating their communities about care transitions and the importance of completing advanced care directives. 

As TiP aligns these and so many other essential resources, new, 

more efficient ideas for engaging older adults and reducing isolation continue to emerge. These projects are actively demonstrating 

the power of community to keep seniors healthy, connected in their 

communities, and truly thriving in the places they call home. 

Thank you. 

The CHAIRMAN. Thank you very much for your testimony. 

Ms. Bollinger. 

STATEMENT OF CATHY A. BOLLINGER, MANAGING DIRECTOR, 

EMBRACING AGING, YORK COUNTY COMMUNITY FOUNDATION 

Ms. BOLLINGER. Chairman Collins, Ranking Member Casey, and 

members of the Special Committee on Aging, thank you for the opportunity to testify today. I am Cathy Bollinger, managing director 

of York County Community Foundation’s Embracing Aging Initiative. 

Embracing Aging launched in the fall of 2013 with a release of 

a report we commissioned that identified how to make York County 

more age-friendly. The report led us to form committees to address 

the issues of attitudes around aging, community engagement, 

health and well-being, housing, and transportation and walkability. 

Our goal is to create a community that is a safe, welcoming, appropriate, and adaptable place to age. To accomplish this, we develop and implement strategies to improve attitudes around aging, 

so that we can care and understand about the needs and the perspectives of all ages. We also provide strategic leadership and advocacy to create more high-quality, forward-thinking options to help 

older people live as they choose in their community. 

Located in south central Pennsylvania, York County is home to 

over 440,000 people. It has 72 municipalities. Ten percent of people 

of all ages live in poverty. Seventeen percent of our county’s population is age 65 and older. 

Thirty-seven percent of our residents are age 50 and older. Over 

one-third of York countians age 65 and older struggle to meet their 

basic needs, forcing them to make difficult choices among things 

such as nutritious food, prescription medications, or adequate heating and cooling. 

Embracing Aging works collaboratively across sectors to effect social change. Most important is assuring that older people are 

around the table in the planning, implementing, and evaluation of 

programs and ideas. 

Building relationships with key stakeholders and sharing specific 

strategies to ensure public spaces, services, and policies are age-inclusive is important in creating a livable community. This is the 

reason we have awarded grants to support partnership planning, 

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improve walkability, provide age-friendly seating, improve signage, 

and offer a free park-and-go shuttle for seniors attending local 

events. 

Helping older adults be proactive in creating their plan for aging 

in community is also important to age-friendly work. We created a 

program that teaches older people new strategies to examine their 

needs in housing, transportation, health, finances, and social interactions, and introduced them to services and programs to help 

them live longer and stronger in the place that they call home. 

We awarded grant money to an organization to grow its capacity, 

to provide home repairs and maintenance services to older adult 

homeowners without financial means, so they can remain living 

safely in their home. 

Assuring older people have employment opportunity helps create 

a livable community. We partnered with our local Economic Alliance to host employer industry forums to assess employers’ interests in how best to recruit older workers and build an employment 

environment that works for employees of all ages. The results are 

the foundation for an age-friendly business designation program we 

are developing. 

As part of this work, we developed a program for employees entitled ‘‘Embracing Aging: Challenging the Perceptions of Aging’’ to 

increase understanding of older adults, and people across different 

generations, to help build a workforce that is more creative and 

productive, and more open and supportive of older customers. 

We are an aging society, and data demonstrates that each future 

generation will continue to live longer. The impact of this change 

has not yet been fully reflected in government policies affecting a 

community’s infrastructure, Social Security, and Medicare. The 

heavy lifting to support the infrastructure necessary for this 

change must come from government. 

Specifically, we think funding for the following is key to improved livability: one, better transportation options, including improving walkability; two, incentives to address blighted properties 

and incentives to preserve and build more low-income and affordable housing with supported services proximate to transportation; 

and three, enhanced in-home community-based services and a 

health care plan that does not penalize older adults. 

Chairman Collins, Ranking Member Casey, and members of the 

Special Committee on Aging, thank you for the honor in sharing 

the work of York County Community Foundation’s Embracing 

Aging Initiative, and thank you for your commitment to making 

America a great place to age. 

The CHAIRMAN. Thank you very much for your testimony. 

Ms. Garces. 

STATEMENT OF ANAMARIE GARCES, FOUNDING MEMBER, 

MIAMI-DADE AGE-FRIENDLY INITIATIVE, CO-FOUNDER AND 

CEO, URBAN HEALTH PARTNERSHIPS, MIAMI, FLORIDA 

Ms. GARCES. Chairman Collins, Ranking Member Casey, and 

members of the Aging Committee, thank you for the opportunity to 

testify before you today and for the work you are doing. My name 

is Anamarie Garces. I am a founding member of the Miami-Dade 

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Age-Friendly Initiative. I am co-founder and CEO of Urban Health 

Partnerships, one of the lead partners in the initiative. 

The Miami-Dade Age-Friendly Initiative is a collective impact effort focused on policy, systems, and environmental changes toward 

creating a community for all ages and ability, where older adults 

can stay active, engaged, and healthy with dignity and enjoyment. 

And it is led by a diverse group of partners, including AARP Florida, the Alliance for Aging, Health Foundation of South Florida, 

Miami-Dade County, Miami-Dade Transportation Planning Organization, United Way of Miami-Dade, and Urban Health Partnerships, along with an advisory committee and 50 key stakeholders 

and community members. 

Miami-Dade is the most populous county in Florida, with 2.6 million people, more than 500,000 older adults above the age of 60, 

and we expect that to increase to 800,000 by 2040. 

Miami-Dade has a diverse population. Sixty-seven percent of the 

county identifies as Hispanic, and most who are bilingual speak 

Spanish. 

Miami-Dade has identified age-friendly as an important approach 

to reducing social isolation and addressing how we can build a community that supports the wants and needs of older adults. It recently joined the AARP Network of Age-Friendly Communities, 

making it the fifth largest community in the country to join the 

network. 

The World Health Organization’s domains of livability can be 

broken up into two categories: the built environment or the environment we can see and touch, such as housing, streets, parks, and 

infrastructure; and the social environment, such as the opportunities, support, and services that are available. Both are important 

and interdependent. 

Miami-Dade has focused on the built environment, first recognizing that if services or opportunities for social engagement are 

available, but residents do not have access or do not feel safe accessing them, it will isolate them from the resources and services 

that they need. 

Some of the age-friendly strategies that have been implemented 

in Miami-Dade include ensuring that all transportation policies 

have an older adult focus. The Comprehensive Development Master 

Plan, land use, and community health and design elements were 

considered with an older-adult lens. The long-range transportation 

plan has performance measures specifically to assess how well we 

are meeting the older adults needs. 

Miami-Dade parks have incorporated standards, programs, and 

facilities to engage older adults. The Housing Work Group supports 

the development of the Affordable Housing Trust Fund for MiamiDade. 

Summits, workshops, events, town halls, and surveys have taken 

place, and the input received has translated into a robust action 

plan to guide our work. 

In 2012, our Safe Routes to Age in Place Project launched to empower older adults in Little Havana to recognize the needs and to 

identify changes to improve the safety within their neighborhood. 

Little Havana, or La Pequena Habana, was recently named a national treasure. It is a diverse neighborhood in Miami-Dade known 

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for its Cuban-American heritage and is home to immigrants from 

across Central America and the Caribbean. 

The older adults engaged in the workshops, they led a CDC 

Healthy Aging Network walking audit, and they discussed themselves with elected officials and transportation agencies what they 

would like to see in their communities, and they advocated for the 

changes that would make them more able to access their daily 

needs. 

We also developed an advisory committee to provide input to the 

Florida Department of Transportation on the Little Havana Pedestrian Safety Study. The low-cost, high-impact built environment 

projects have exponential benefits for older adults. 

One tactic is shade. Utilizing a digital laser infrared thermometer temperature gun, it was determined that shaded bus stops 

were 10 to 20 degrees less hot or had lower surface temperature 

that non-shaded bus stops in Miami-Dade County. The average 

temperature in Miami on any given day is 82 degrees. Due to concrete and heat island effect that is created at bus stops without 

shade, older adults can experience temperatures of much more 

than 100 degrees while waiting at their stops. Research supports 

that shaded stops provide the sensation that individuals waited 10 

minutes less than those at non-shaded stops. 

The Safe Routes to Age in Place Advisory Committee recommended an age-friendly business district, so we developed one. 

Older adults told us that once they had safer streets, a financial 

incentive, and places to go, they would be motivated to walk more. 

Initially, 25 businesses within only a quarter mile of their target 

location of where they lived provided purchasing incentives for 

older adults to walk every Tuesday to their stores. An age-friendly 

community is called ‘‘age-friendly’’ and not ‘‘senior-friendly’’ because the strategies are not only good for older adults but for everyone, from the very young to the very old. The same curb cut or 

ramp that may be added to ensure a wheelchair can get onto a 

sidewalk is the same one that can help a parent push a child in 

a stroller. Each time added to a crossing signal, that can help ensure that an older adult or anyone will not lose their footing if they 

try to rush across the street too quickly. 

We need your continued leadership to ensure age-friendly livable 

communities are a priority in our cities, to help build the infrastructure that works for all ages and connects us to our resources 

and to our citizens, and to ensure aging continues to be the conversation in all aspects of decision making, and we build policies 

and plans for the future of our country. 

Thank you for the opportunity to testify today and to share some 

of the strategies Miami-Dade is using to connect the community 

and to plan for our aging population. 

I welcome your questions. 

The CHAIRMAN. Thank you very much for excellent testimony 

with so many good ideas, and I love that we have such a variety 

of communities represented here because it shows that these strategies can be effective, whether it is in a very large city, a bilingual 

area, the most rural community, a suburban community, no matter 

where people are living. And I really congratulate each of you for 

the work that you are doing. 

AGING-SDG-5 with DISTILLER

12 

By the way, I could really relate to the issue of the time to cross 

the street. Having broken my ankle back in December, I quickly 

learned that unless I got there at the very beginning of the light 

changing, I did not have time to safely make it across the street 

in the early days of my injury, and it was a real eye-opener to me 

about what it is like not only for an older person who may be moving more slowly, but as our last witness just pointed out, a parent 

with a stroller. And so a lot of the practical things you are doing 

do help people of all ages but particularly our seniors. 

Ms. Goldman, I am curious as a result of your work if you found 

that attitudes are changing about aging. 

Ms. GOLDMAN. I think that they are. I think that we still have 

a long way to go. If you have ever tried to purchase a birthday card 

for anyone over 50, you are aware of the bias that we contend with 

on a daily basis, some subtle, some not so subtle. 

But I think that what we have done is really tried to keep older 

people active and engaged in their communities for as long as possible, and by virtue of doing that, really promoting intergenerational contact. And it is only through that kind of contact that we 

challenge these stereotypes of aging and begin to really consider 

the aging of the population as a tremendous opportunity. So I think 

that having older people in parks, in restaurants, in theaters, in 

museums, and interacting with people of all ages, because generally they tell us they prefer to be in multigenerational environments, helps to connect people and helps people to realize exactly 

what an asset the older population is. They have very high rates 

of civic engagement and voting, high rates of volunteerism. They 

represent 70 percent of charitable donations. They serve as caregivers to children and older adults, enabling other people to continue working, and they are long-term, engaged residents of neighborhoods. 

The more we can ensure that our community assets are welcoming and accessible to people of all ages, the further we will go 

in challenging ageist stereotypes which contribute to lower levels 

of engagement and activity and higher levels of social isolation. 

The CHAIRMAN. Thank you. 

Ms. Callaway, you mentioned in your testimony that health care 

providers in your communities in Piscataquis County are critical in 

engaging with the older adults. Could you offer us any examples 

of how rural hospitals and other providers have repurposed their 

space or changed their activities to better engage and meet the 

needs of older residents? 

Ms. CALLAWAY. Sure. Actually, our local hospital, Mayo Regional 

Hospital, has some grant funding from the Maine Health Access 

Foundation, which also funds the TiP, to reach out to people who 

are older and find out what some of their barriers are to health 

care. One recent forum revealed that a lot of people are having difficulty accessing dental care. 

Just by being at the table at these networks across the state, 

hospitals are helping to get the word out to their patients about the 

resources that are available in community, and I think that with 

more patient-centered models, more hospitals are aware of asking 

older people about their transportation, about their formal and informal supports, about whether they are struggling with 

AGING-SDG-5 with DISTILLER

13 

caregiving. And they are also hosting events where they learn 

about transportation options. 

We have a local transportation provider that has been providing 

transportation for many years but has only recently started to 

focus on older people, and so they have gone with us to senior 

housing facilities and shared what it is they can provide. And they 

have signed people up so that people do not have to worry about 

whether they are in one program or another, and then they take 

them in a van on a ride to a local ice cream shop or to the local 

fossil museum to have the experience together. They get some social interaction with each other, and they learn that riding on this 

level of transportation is accessible and easy for them. And as a result of doing that, in one year they have increased ridership by 10 

percent and actually added routes, which in our very small, very 

rural area, where it is hard to get from one place to another, is 

very significant. 

The CHAIRMAN. Thank you. 

Senator Casey. 

Senator CASEY. Thank you, Madam Chair. 

I wanted to start with Cathy. Because you have been here two 

weeks in a row, I think I can call you by your first name. You made 

two trips. We are grateful for that, as well as our other witnesses. 

I guess I wanted to start with the issue of transportation, which 

has been mentioned obviously in a lot of the testimony. That is 

such a big component of the life of any community, and I guess in 

terms of just itemizing, if you had a wish list of improvements that 

could be made—and I would argue that the Federal Government 

should be a full partner in that. That is one of the highlights of 

my opening comments, which was that we hope—we hope that we 

can have a bipartisan infrastructure bill. A huge part of that, of 

course, would be transportation. 

So I guess in terms of the work that you have done in York 

County and in particular the Community Foundation, what would 

you identify if you had to list the priorities for transportation investments or improvements? 

Ms. BOLLINGER. Thank you Senator Casey for your question. As 

we know, people are living longer, and we also know that transportation is a key social determinant to health. And it is really hard 

for us to keep pace without federally funded dollars to support the 

infrastructure and to assist in identifying multi-modal innovative 

solutions. So smart planning, seed money is really important so 

that we can do demonstration projects that will help us be poised 

to support replicable and innovative projects and prepare for the 

rapid change happening in our communities. 

To share an example of this, the Central Pennsylvania Transportation Authority, which does business in York County as Rabbit 

Transit, received seed money from the Transit Planning4All Initiative, and this seed money was used to address barriers to accessibility for older adults and people with disabilities. And through this 

funding, Embracing Aging has partnered with Rabbit Transit in a 

program called ‘‘3P Ride: More People, More Places, More Possibilities.’’ 

We did a lot of focus groups to really understand the barriers facing older adults and people with disabilities and have been working 

AGING-SDG-5 with DISTILLER

14 

on solutions with this funding. So, for instance, we were able to 

add capital improvements to the transit enhancement plan to systematically address high frequently used transit stops that have 

been deemed a safety risk. 

We have expanded the hours and services for older adults so they 

can attend faith-based services over the weekend or go to neighboring counties. We have been able to provide additional runs to 

address major fixed-route crowding, and partner with volunteer 

transit providers such as Uber to help get individuals at risk of 

being late for appointments to and from where they need to. 

Smart planning and seed money for demonstration projects are 

priorities for changes in transportation infrastructure. 

Senator CASEY. Cathy, I was also noticing in your testimony on 

page 7 under the topic or under the heading of transportation and 

walkability, which was a couple of fundamental changes that could 

be made, large and well-placed directional signs, lighted roadways, 

clearer road markings, brighter stop lights, and dedicated left-turn 

signals, I think we all like those. 

Ms. BOLLINGER. Yes. Yes, definitely. 

Senator CASEY. Very practical. 

I guess the other thing is this dynamic where because older 

Americans in some communities might feel that they lack a safe 

and reliable way to get around, that is forcing some of them to 

move, can you speak to that issue? 

Ms. BOLLINGER. We do not know the full impact that lack of 

transportation has in York County. We do know that 23 percent of 

York countians are living alone. We know some of them have transportation challenges, such as 8 percent of households of people age 

65 and older do not have vehicles. 

What we have done to start to address this issue is we partnered 

with the York County Planning Commission to have maps created 

of our county by municipality to show concentration areas of older 

adults living in the community, but we have different layers to it, 

so we can see older adults living in poverty, older adults living 

alone, older adults without transportation. And then layered on 

that are things like the fixed-bus routes, libraries, grocery stores, 

doctors’ offices, senior centers, medical facilities, arts and culture 

venues, so that we can really begin to identify where the pockets 

of isolation are York County and begin working with municipalities 

to develop strategies to address them. 

Senator CASEY. Thanks very much. 

I know I am out of time. I just want to highlight one piece of the 

research that the foundation did. You said on page 2, quote, ‘‘If we 

removed age 55-plus employees from York County’s workforce, 

13,420 jobs would be vacant, and almost $1 billion would be removed from the economy.’’ That is a remarkable impact, and I 

thought that was significant to highlight. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you. 

Senator Cortez Masto, we are delighted to have you with us 

today. 

Senator CORTEZ MASTO. Thank you. Thank you, Madam Chair 

and Ranking Member. 

AGING-SDG-5 with DISTILLER

15 

And I appreciate you coming back to talk with us. I am from Nevada, and so my first question is—really, I am going to follow up 

on the transportation, but, Ms. Callaway, I want to ask you this 

question. In Nevada, there are 17 counties. Fifteen of the counties 

are rural, and that is our challenge, is how do we get services, how 

do we get transportation, how do we address this issue in our rural 

communities to really bring the services that are necessary for 

some of our aging population. 

I am curious if you can address a little bit more what you have 

done in your rural communities and to spur that and help us identify areas where we can focus on more of these services. 

Ms. CALLAWAY. One of the things we are very hopeful about is 

that as we are transitioning from funding from the Maine Health 

Access Foundation, we are working with AARP more and working 

more at the individual community level, so we have recruited town 

managers to support the work. And I think a lot of the increasing 

access comes down to the fact that everything in Maine is very personal, and the person from whom you learn about a resource is absolutely critical to whether or not you follow up on it. 

And the work we have done so far is quite regional. So we have 

focused on service providers being more aware at a granular level 

about the kinds of transportation that are available and opportunities to volunteer to be a driver, but now getting to more the local 

community level is absolutely critical. 

One of the problems that we have in deep rural Maine is that 

alternatives to actually getting people physically to their destinations are not even available to us enough. We do not have enough 

broadband access. 

Senator CORTEZ MASTO. Right. 

Ms. CALLAWAY. There are great cutting-edge technologies that 

would allow for telehealth. We have a wonderful resource in a local 

geriatrician who does house calls. That is quite remarkable, but 

there is absolutely no succession plan for her. And she frequently 

talks about the fact that if you are in a busy medical practice, you 

do not think about the person who does not come to you, and attach to each of those who cannot get to a doctor’s appointment are 

caregivers who themselves are very stranded and isolated and are 

providing 30 billion hours of uncompensated care. 

So if we were to be able to get the funding, not just to continue 

to coordinate what we have, but to really extend it through telehealth, I think that would be a critical resource. 

Senator CORTEZ MASTO. And thank you because I think that my 

colleagues and I—and this is part of our infrastructure package. I 

think we have all identified the need for broadband throughout all 

of our communities because of the services it will bring and reach 

people that normally would not have access to those services. 

So thank you. I appreciate those comments. 

Ms. CALLAWAY. Thank you. 

Senator CORTEZ MASTO. Ms. Garces, I was curious, your conversation and your statements, because southern Nevada, Clark 

County, where Las Vegas is, that is probably about 70 percent of 

the population, 2 million, and we have a very large Spanish-speaking immigrant population, so I appreciate your comments. 

AGING-SDG-5 with DISTILLER

16 

I am curious. Did that create any special challenges for you, and 

what lessons can we in Las Vegas learn from how you approached 

and brought and talked about how we address services for the 

aging population in those Spanish-speaking communities? 

Ms. GARCES. Thank you for your question. 

One of the lessons learned is that the Spanish population, documented or undocumented—or citizens or undocumented have very 

common threads through all of their cultures. Their language 

might be Spanish, but they maybe represent more than a dozen different countries within a small area, but family or the nuclear intergenerational households, those common threads, and understanding the context of that community, understanding the fabric 

of that community can help us in identifying what are the solutions 

needed to prevent isolation and to provide them the services that 

they need. 

So it would not have been—it was not necessarily a challenge in 

Little Havana. It was just something that was understood. It was 

a foundation that allowed us to then have the success that we were 

able to have. 

Another part or a lesson learned that I would like to share is ensuring that they are part of the process from day one, not only that 

we are listening to them to understand, but that they are the ones 

that will be able to help make the solutions and identify not only 

those needs for services and identify where they would like to go, 

but understanding what the root causes are of why they cannot get 

to those services or why they need those services and then working 

with them to co-design the solutions needed. 

Senator CORTEZ MASTO. Thank you. I appreciate it, again, and 

thank you for having this hearing. I have to run to another meeting, but I so appreciate the conversation. Thank you. 

Ms. GARCES. Thank you. 

The CHAIRMAN. Thank you very much for your testimony, and I 

want to second what you said about the importance of rural 

broadband. That is a huge issue in my state as well and should be 

part, as you indicated, of our infrastructure package, so thank you 

for bringing that up. 

Ms. Callaway, in your testimony, you mentioned that renovations 

are currently under way in an historic building in Dover-Foxcroft 

that will eventually serve as a senior center and perhaps offer 

adult day care services, respite care for caregivers. And we have 

discussed at our previous hearings that it is not just the older person who may be ill or disabled who can become isolated. It is the 

caregiver as well, and they can become overwhelmed with the responsibilities and absolutely exhausted from an endless series of 

24/7 days. Can you discuss what services you envision could be offered in Dover-Foxcroft at this building if it is turned into an adult 

center? 

Ms. CALLAWAY. Absolutely. The one most critical resource for 

caregivers is respite. A few hours to take care of one’s own needs, 

with all the burden of care that families are carrying, is absolutely 

critical, and this is uncompensated care. In very rural Maine, people are torn between the demands of low-wage employment and the 

needs of their relatives, which can be quite intense. 

AGING-SDG-5 with DISTILLER

17 

People are leaving marginally independent adults with dementia 

home alone, and if you can imagine what it must be like to go off 

to work and worry that your mother or your spouse might wander 

away or leave a burner on, that is quite a distraction, and that 

adds a tremendous amount of stress to daily living. 

So what we are hoping to provide at the senior—at the adult day 

services center is full medical care. So there will be nursing care. 

People will be able to have a few warm meals. They will be able 

to have—they will offer bathing and companionship for people, and 

that will free the caregivers up to participate in some of the programming through the senior center for independent adults. So 

whether that means taking a health class, Tai Chi, Qi Gong, or attending a support group, those are really critical resources. 

We also—anytime we have a forum where people can learn more 

about dementia care, people turn out for that in numbers that they 

just do not turn out for anything else. 

And we have been very successful in spreading the Savvy Caregiver Training Program, and we would hope to base that out of the 

senior center too, which is all about not only taking care of a loved 

one with dementia, but what it means to take good care of yourself. 

The CHAIRMAN. Thank you. That sounds just wonderful. What a 

great gift to the community that would be on so many fronts, and 

I have seen senior centers in communities in Maine who have 

made such a difference in getting people out of their homes and to 

socialize and enjoy one another’s company. But your concept of 

combining the two, I think is really innovative and needed. 

Ms. Garces, I am intrigued by your effort to develop an agefriendly business district, where you convinced 35 different businesses to offer incentives to seniors if they would walk to the business on Tuesdays, I think it was. And this is a great idea, in my 

view. 

I am curious how the program was started, whether businesses 

were eager to participate, or did you have to really sell them on 

this? And have the participating businesses reported benefits from 

participating? 

Ms. GARCES. Thank you for the question. 

The 25 businesses that joined—how it began was because when 

the older adults expressed to the elected officials what they would 

like to see in their communities based on the walking audit that 

they had conducted, we asked them, ‘‘Well, what else—what else— 

why would you want to walk?’’ And they said, ‘‘Well, if it was a 

purchasing incentive, a place to go, and the streets were safer, we 

would get there,’’ and so the agencies and elected officials committed to making the streets safer. There were places to go within 

a quarter mile. A quarter mile is the distance that we felt older 

adults would feel comfortable. Usually, it is about a half mile, but 

for these older adults, they did not feel more than a quarter mile, 

they could really get there in walking distance and feel comfortable. And so that is how we decided to reach out to the businesses. 

And we originally looked at the New York model of modifying 

businesses for older adults to accommodate older adults, but in 

Miami, that in Little Havana, that did not seem possible with the 

urban core that we were working with. But what did seem possible 

AGING-SDG-5 with DISTILLER

18 

was providing this purchasing incentive or this purchasing power 

to the older adults. 

In the pilot phase, it was very successful, more successful in 

some stores than others. Over 70 percent reported very successful, 

and almost 90 percent reported that it was successful in obtaining 

more customers. The ones that reported the most, that were the 

most successful, were those stores that—or those businesses that 

the older adults like to frequent the most for luxury. So beauty parlors were very popular if they wanted to access something. So those 

that were technology-based—and we are seeing a big gap in MiamiDade for older adults with technology and trying to increase their 

use of technology, but those that were technology-based were not 

as frequently—or not as frequented by older adults on Tuesday 

mornings as those other stores. But the majority of stores did see 

that the business-friendly district was very successful. 

The CHAIRMAN. Thank you. 

Senator Warren. 

Senator WARREN. Thank you, Madam Chair, and thank you 

again for having this hearing, very important subject. 

According to the latest research by the Joint Center for Housing 

Studies at Harvard University, because of low incomes and limited 

assets, about 4 million senior households are eligible for rental assistance, but only about a third of those who need this help can actually get it. The problem is that the housing simply does not exist, 

and because of this affordable housing shortage, a large majority 

of low-income senior households face paying more than half their 

incomes for rent or living in severely inadequate conditions or both 

of those. 

Now, there are a number of reasons for this shortage, but one of 

them is that in 2011, Congress cut off funding for the new construction in Housing and Urban Development’s 202 program, which 

provides housing to low-income seniors. 

So, Ms. Garces, you are the co-leader of the Miami-Dade County 

Age-Friendly Initiative. I know that you are an expert on public 

policy issues affecting seniors, including housing assistance. Can 

you explain a little bit about how the 202 program works? 

Ms. GARCES. Sure. Thank you for your question. 

The 202 program, or the HUD program that was established in 

1959, provides funding to private nonprofits in order to develop and 

operate housing and supportive services, and that is for very lowor extremely low-income seniors. What we are seeing now, more 

than 430,000 seniors are engaged or nationwide are living in those 

homes or in the program. 

In Miami-Dade, we have more than 7,000 units. The issue is the 

long waiting list. Many seniors are on these waiting lists, thousands and thousands, and many of them never are able to be removed from the waiting list. 

Another issue we are having, because construction, as you mentioned, Senator Warren, has not been granted or funded, has not 

been granted for new construction, when renewal to the contract 

for these properties comes up and there is—the market rate is 

soaring, such as in Miami, many of those properties, we face them 

going into market-rate value, and so we lose the affordable housing 

that we currently have for older adults to market-rate values. 

AGING-SDG-5 with DISTILLER

19 

And in Miami-Dade, in particular, more than 50 percent of older 

adults are spending more than 30 percent of their income on housing. 

Senator WARREN. So despite the fact that our population is getting older, as the Chair pointed out, the changing demographics in 

the country, and that we already have severe housing affordability 

crisis for seniors, Congress has not seriously funded new dedicated 

housing for seniors in more than 5 years. Is that a fair statement? 

Ms. GARCES. That is correct. Yes. 

Senator WARREN. Now, the shortage of affordable housing is not 

only a problem individually for seniors. It is also a problem for our 

economy overall. When seniors spend more than they can afford on 

housing, then they are forced to cut back on other necessities, so 

they spend less money on transportation or food or health care. Reduced spending in these areas can cause depression, can trigger 

other health problems, which in turn can increase cost for taxpayers when seniors are forced to use more Medicaid or more Medicare services. 

So, Ms. Garces, cutting off funding to the 202 program may have 

saved Congress some money in the short run. 

Ms. GARCES. Right. 

Senator WARREN. But how do you see the costs when seniors cannot afford housing? 

Ms. GARCES. Senator Warren, as you mentioned, when seniors 

cannot afford housing, they are forced to make very difficult decisions. They need to spend their limited or fixed income on transportation, on health care, on their time. They need to make decisions on how they will spend their time. There are costs on—that 

strain individually and on the society, on the community. 

We also are—the lack of affordable housing can lead to poverty 

and homelessness. What we are seeing now is that 100,000 seniors 

are expected to be homeless by 2050 nationwide, and that is more 

than double the number that we had in 2010. And that is just part 

of the cost that we will face—— 

Senator WARREN. Yeah. 

Ms. GARCES. [continuing]. With the shortage of affordable housing. 

Senator WARREN. Thank you. I think that is a very serious warning. 

You know, the 202 program has been a lifeline for seniors in 

Massachusetts, where more than 13,200 seniors live in housing 

supported by this funding. The typical income of Massachusetts 

seniors living in 202 housing is between $12,000 and $15,000 a 

year. Nonprofits such as the Jewish Community Housing for the 

Elderly in Massachusetts and LeadingAge are leading the charge 

to try to convince Congress to revive funding for projects under the 

202 program. 

And as we start looking at the 2018 budget, I hope that members 

of the Senate Aging Committee will take a very close look at this 

and we might be able to work together to make sure that there is 

adequate funding, so that there is more housing available for our 

seniors. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you. 

AGING-SDG-5 with DISTILLER

20 

Senator Casey. 

Senator CASEY. Thank you, Madam Chair. 

I guess one of the questions we try to focus on at the end of a 

hearing, because you traveled a great distance to be here twice, is 

what you hope we would do. You can express it any way you want. 

You can express it, ‘‘We hope you do the following.’’ You can be a 

little more assertive and say, ‘‘You should do the following.’’ You 

could say, ‘‘We will come back a third time if you do not do the following.’’ 

[Laughter.] 

Senator CASEY. But I guess I want to give everyone an opportunity, starting with you, Ms. Goldman, to outline priorities. 

Obviously, two big topics are, as Senator Warren said, housing 

and obviously transportation, but what would you hope we would 

do just, say, in the next year? We have budget and appropriations 

debates coming up, and we might need some direction around here. 

So this is your opportunity if you can outline those for us, maybe 

just two. We would give you a third one if you need it. 

[Laughter.] 

Ms. GOLDMAN. Thank you. 

So I think, first, consulting older people as to what they need 

from their communities is really key. They are experts on their 

own lives, and so we should ask them. 

Second, I would say ensuring that we create communities 

through investments in infrastructure that are welcoming and accessible to people of all ages and abilities, and I think housing is 

really key here. 

I just wanted to add to the conversation about the 202 buildings. 

In New York, it is not just a question of affordability. It is also a 

question of accessibility, and so we have 45 percent of rental housing in New York City is walk-up buildings. Right? But in those 202 

buildings, 80 percent have elevators, and so what we see is when 

people are younger and they are able to navigate those walk-up 

buildings, it is fine. When they become older, when they become injured or suffer some mobility impairment, they can no longer navigate those stairs. 

In the 202 buildings, they have elevators, but unfortunately, 

there are 200,000 people on the waiting list for 202 housing in New 

York City. That is from a recent study by LiveOn New York, a senior advocacy group. 

So I think that what you see is unnecessary or premature institutionalization and severe social isolation when people who just 

cannot get out of their homes because they are inaccessible. So I 

would highlight the importance of investment in the 202 program 

as well as I would agree with everything that has been said to this 

point about investment in public transportation, in active transit 

strategies that promote walking and safe use of roadways by bikers 

and pedestrians. 

And I think that just generally ensuring that we consider the 

needs of people as they age is going to be essential moving forward. 

Thank you. 

Senator CASEY. Thank you. 

Ms. Callaway. 

AGING-SDG-5 with DISTILLER

21 

Ms. CALLAWAY. Well, I thank you for putting together a panel 

that really reflects the geographic diversity of the aging experience, 

and more than anything, I would ask you to remember that the experience of aging depends so much on your ZIP Code. 

And I think it is also very important to continue to listen to older 

people themselves when they speak up about what they most need 

and want and to remember that funding the infrastructure for all 

of the services under the Older Americans Act is absolutely critical. 

There are people for whom their Meals on Wheels contact is 

about the only contact they will have. Those are particularly important in rural areas. I would encourage funding for telehealth, increasing broadband access, so that in lieu of driving people to 

events, they can see their medical provider through telehealth. 

And I want to applaud Senator Collins for her efforts to support 

caregivers. With the rate of dementia that we see, no matter where 

you live, it is a very high rate of people who are struggling with 

cognitive decline, and the people who are caring for them desperately need support in order to avoid being isolated and becoming unwell. 

Thank you. 

Senator CASEY. Thank you. 

Cathy? 

Ms. BOLLINGER. In addition to the things I outlined in my oral 

and written testimony, as well as the other items and strategies 

the panelists have been sharing, I would like to just end with sharing our definitions for when I said we want to create a community 

that is safe, welcoming, appropriate, and adaptable. 

A safe community is one that is deliberately accessible and inclusive to people of all abilities and mobility. 

A welcoming community is free of misconceptions about aging 

and has increased appreciation of the wisdom, experience, social influence, and economic impact of older adults. 

An appropriate community is one that refrains from one-size-fitsall solutions; instead it has options that are based on function rather than a person’s age. 

And adaptable means creativity and flexibility are applied to the 

products, goods, services, events, and opportunities to best meet 

the want and needs of older adults. 

I think keeping these definitions in mind is important for Creating livable communities. 

Thank you. 

Senator CASEY. Thank you. 

Ms. Garces. 

Ms. GARCES. Thank you for this opportunity. You do not often get 

asked that question, if we had a wish list, so I am going to take 

you up on that offer. 

Senator CASEY. Sure. 

Ms. GARCES. Okay. So every budget item that comes before you, 

every policy that comes before you, you all have a tremendous 

power to choose to look at it with a health lens, to choose to look 

at it with an older adult lens, to choose to look at it and is it okay 

for those that are young, is it okay for those that are older. May 

every policy, every budget item think how will this impact older 

adults. 

AGING-SDG-5 with DISTILLER

22 

How will this impact me, yourself, in 20 years? Will you be able 

to live where you live today? Will your children be able to grow in 

the homes that they are working so hard to invest? We can barely 

afford to go to college and not have tremendous debts. How will we 

be able to live in an environment and be able to foster and grow 

with dignity and enjoyment? 

Please, the request is to ensure that older adults are considered 

and everyone, but intentionally considered in each one of those decisions. 

And the second request, since you allowed two, would be, as you 

were speaking about the infrastructure bill and for transportation 

and what the request will be for transportation, the request of 

what we were trying to do in Miami-Dade, because we are often 

asked these questions, is really ensuring that that silo of transportation—we are not looking at only how does transportation impact 

older adults, but how do public spaces, parks, housing, and transportation impact itself? 

When you make those decisions on infrastructure or make recommendations for budget items, will the Housing for 202 program 

be close to transit? Will public spaces—will there be an X amount 

of green space for that older adult to engage with their neighbors 

to truly prevent isolation? Ensuring that there are not silos while 

you are creating that policy, that it is not just the infrastructure 

or the structure that you are creating or the sidewalk or the bike 

lane, but let it go to someplace. Let the older adult access all that 

investment. Leverage that investment to be able to have the greatest quality of life that they can possibly have. 

Senator CASEY. That is great. Thank you very much. 

The CHAIRMAN. Thank you, Senator Casey. Those were great answers that you solicited from your final question. 

I chair the Appropriations Subcommittee on Transportation and 

Housing, so many of the recommendations I have heard today are 

particularly helpful to me. 

I do feel compelled to correct the record on the Section 202 program, and I told Senator Warren, who had to leave, that I was 

going to do so. And I showed her some of the actual figures, because this is a program that is near and dear to my heart. 

It is true that there are unacceptable waiting lists, not only for 

the Section 202 program, but Section 8. Virtually, every federally 

assisted housing program that we have—and, indeed, 84 percent of 

HUD’s budget goes just for renewing the existing programs that we 

have out there, not accepting new people, but just making sure 

that we are keeping people who already have the vouchers to live 

in these programs. 

So the fact is that in the omnibus bill for fiscal year 2017 that 

we just passed, as I do a quick glance of all the key housing programs at HUD, we take the biggest increase to the Section 202 program for our seniors, and that was a 16.1 percent increase. So I 

could not let the record be mistaken that we somehow slashed the 

Section 202 program. In fact, it got the biggest increase of any of 

the housing programs. 

It does not mean that there are not problems. It does not mean 

that there are not seniors on waiting lists. I would point out that 

seniors also qualified for Section 8 program. It is not only the SecAGING-SDG-5 with DISTILLER

23 

tion 202 program. And I would like to see us do better in figuring 

out how can we house the vulnerable families, seniors, and others 

in our society. I think we have a lot of work to do in that area. 

But it is not true that Congress—and I knew it was not true because I chair that Subcommittee. It is not accurate to say that Congress slashed that program. In fact, it got the biggest increase of 

any of the housing programs that are the major housing programs 

in HUD. 

And our Subcommittee, I am proud to say, also has greatly increased funding to help deal with individuals who are homeless, 

and that is something that the idea of people not having a safe 

place to go at night is very troubling to me. 

So it is a 16 percent increase for the Section 202. We do need 

to do more. It is hard within the budget constraints, and when 84 

percent of HUD’s budget is just for renewing the existing programs, that does not give you a lot of flexibility. But we were able 

to find some new funding, and I did want to point that out. 

Ms. Bollinger, I just had one—since I did not get to ask you a 

question, I do have one question that I wanted to ask you before 

we wrap up the hearing, and that is about age-friendly workplaces. 

I am becoming increasingly concerned about individuals who lose 

their jobs between age 50 and 65 or even 62, where they might be 

able to take early retirement, not that that is necessarily a good 

decision. But they have a really hard time finding new employment, despite the wisdom, experience, and skills that they bring. 

And in addition, being able to work during that time period improves your economic status, and it helps solve the social isolation 

problem. So could you talk to us about the work that you have done 

in helping to educate employers, helping to update skills of employees, if necessary? I am really interested in that. 

Ms. BOLLINGER. Thank you for your question, Senator Collins. 

As I mentioned earlier, we did partner with the Economic Alliance to assess the receptivity of employers in York County across 

many different industry forums to see if they were interested in 

providing strategies to best recruit older adults and to really assure 

that they have meaningful employment. And that as they do want 

to transition or change maybe from a traditional 40-hour-a-week, 

there are is opportunities for them. 

I can share that the results of the assessment early on focused 

on the communication gap between the generations versus what 

employers could be doing to proactively assure they have meaningful recruitment and employment of older workers. This was very 

telling for us, especially because when we started the assessment, 

we asked them to think of their oldest worker and then to provide 

an adjective that describes that older worker. Every single person’s 

adjective was one of the most, positive adjectives that there could 

be, and yet they were not doing anything to really be thinking 

about recruiting and maintaining older workers. 

So we are working on this, and will hopefully be reaching out to 

employers as the year goes by and into next year with pilot programs. We are trying to find partners to help implement some of 

the strategies, because we feel that if we can do that, then we can 

create some wins, and maybe other employers will come on board. 

So we are early on in our work with that, but thank you. 

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24 

The CHAIRMAN. That is terrific, and I hope you will keep us informed of your efforts. As the Senator representing a state where 

we have seen a lot of mill closures and people who have worked 

hard their whole life all of a sudden find themselves unemployed 

when they are 52 years old, it is really tough, and particularly in 

rural Maine where there may not be a lot of other opportunities for 

employment. So I am very, very interested in that. 

Senator Casey, did you have any closing words you would like to 

make? 

Senator CASEY. Just I wanted to add one comment, that we are 

going to have a lot of debates about appropriation matters, and one 

that I am—one of many that I am concerned about is the LIHEAP 

program. I think the proposal by the Administration was to eliminate the Low-Income Home Energy Assistance Program—not cut, 

eliminate. We should probably have an award in Washington for 

the bad idea of the year. There would be a long list of things, I am 

sure, but that is one of the worst ideas I have heard in a long time. 

So I am hoping that the budget director slipped it in at the last 

minute and no one at the White House saw it and it is just a big 

mistake, but that is a particularly negative approach to a lot of 

these topics we talked about. So we are going to be paying very 

close attention to that. 

But I wanted to thank Chairman Collins for arranging this hearing and working to make sure that we got it rescheduled and thank 

our witnesses for your great work and bringing this to our attention, especially across the diversity that is represented by the witnesses and by the regions you come from and giving great testimony about a topic that not enough of us are focused on, which is 

how can we make better our communities by making them more 

livable, especially for those who fought our wars and worked in our 

factories and taught our kids and built the great American middle 

class and have done so much for us. We have got to make sure that 

we are giving them opportunities to have the chance to live in livable communities across the country, so we are grateful. 

The CHAIRMAN. Thank you very much, Senator Casey, for your 

participation in shaping this hearing and for working so closely 

with me. 

I want to thank all of our witnesses for testifying, and again, I 

want to apologize that due to circumstances beyond our control 

that you had to come back a second time. But it was terrific to hear 

your testimony. 

Like Senator Casey, the lesson for me today is it does not matter 

what the community is like, or where it is, or how big or how small 

it may be. There are strategies that can be employed to help us 

make sure that we are connecting our seniors with community, preventing isolation and loneliness, and taking advantage of the 

many—the volunteering and the many other services that our seniors can provide. 

I also thank you for the very specific ways you are doing that in 

your communities. It really shows you need different strategies in 

different places. 

Now, coming in right before I was gaveling the hearing to a 

close, but making it, which he would not have if I had not asked 

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25 

one more question, is Senator Blumenthal from Connecticut. We 

welcome you, and please proceed. 

Senator BLUMENTHAL. Thank you, Madam Chair. I apologize for 

being late. As Senator Collins and Senator Casey know, the occupational hazard of being a U.S. Senator is you have to be in three 

places at one time or more, so I really appreciate your having this 

hearing and giving me this opportunity to ask just a couple of 

quick questions. 

Let me ask Ms. Callaway. I am a member of the Veterans Affairs 

Committee and also a father of two veterans, and I have urged the 

VA to expand Wi-Fi access in more of its health facilities, where 

I understand it has been lacking. 

In fact, in West Haven, at our facility there, it was lacking until 

I brought that absence to the attention of the Secretary, then Secretary McDonald, and Secretary Shulkin has been very helpful as 

well. 

So, as you know, Internet access can literally be a lifeline for 

people of all ages, most especially for our senior veterans. Any veteran undergoing treatment, they are isolated when they are in a 

VA hospital, often completely isolated from friends, family, support 

networks, and that kind of connection is very, very important. 

Can you tell us what kinds of increased Internet access and connections can be made available at the facilities where they are now 

lacking? 

Ms. CALLAWAY. Well, I wish I had a more specific answer to your 

question, but I can get you some information about what our local 

economic development council is doing to seek additional funding 

for broadband access. That is a high priority. Particularly in 

Piscataquis County, we have a very high percentage of veterans in 

our area. But I will provide that. 

Senator BLUMENTHAL. Any of the other witnesses want to comment on Internet access and how it can be helpful? 

Why don’t we go left to right. Go ahead. 

Ms. GOLDMAN. I think that Internet access is really critical for 

older people, both under ordinary circumstances and in disaster situations, where it is really useful to have access to a variety of modalities of communication. We saw this during and after Hurricane 

Sandy in New York, where older people did not have Internet access or the same kinds of devices that their younger counterparts 

had. They were more likely to rely on landlines, which failed, and 

as a result were unable to maintain situational awareness and access the resources that they needed following the storm. 

But just generally, I think that there is a digital divide that exists. It is not just in rural communities, but also in low-income 

urban areas, where we see that among people who are older, specifically over 75, Internet access drops off. People who are low income and have lower levels of education, as well as people of color, 

are also less likely to have Internet access, which puts them at a 

tremendous disadvantage increasingly digitized, whether it is government benefits or access to employment opportunities or the ability to stay socially connected with friends and family. 

So I would say that an investment in broadband and Internet accessibility is really critical for older people, though the focus is 

often on expanding access for children and families. 

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26 

Senator BLUMENTHAL. Ms. Garces? 

Ms. GARCES. I just wanted to add to that. I believe your question 

was how do we increase the ability to provide Internet or 

broadband to a larger group in—— 

Senator BLUMENTHAL. Exactly. My question was somewhat 

inartfully phrased, but based on the experience at the VA, my feeling is that broadband, Internet access should be made more widely 

available to all groups, including senior veterans who are often less 

likely to have that kind of access. 

Ms. GARCES. Yes. And it also leads to de-isolation. So it is one 

of the preventative strategies for isolation, is to provide Internet 

access, and so looking at hubs, government hubs, hospitals, essential services that we have within our communities, and allowing 

them to expand their broadband or have some type of a membership that would be of low cost or that would allow access to those 

specialized populations could be a way to increase the strategy. 

Senator BLUMENTHAL. Thank you. Thank you very much to all 

of you for being here today. Thank you. 

The CHAIRMAN. Senator Blumenthal, in all seriousness, thank 

you for making the effort to join the hearing. You have been a very 

diligent member of this Committee, and I appreciate your participation. 

Senator BLUMENTHAL. Thank you. 

The CHAIRMAN. Again, I want to thank all of our witnesses 

today. I also want to thank our staff, which has worked hard on 

this issue and to bring us such excellent witnesses. 

With that, we will have 1 week for additional questions to be 

submitted to the record. You may get some from individual Senators who were unable to be here today, and I very much appreciate your participation. 

This hearing is now adjourned. 

[Whereupon, at 11:00 a.m., the Committee was adjourned.] 

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APPENDIX 

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Prepared Witness Statements 

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HEAL THY CITIES. 

BETTER LIVES. 

Testimony of Lindsay Goldman, LMSW, Director, Healthy Aging 

The New York Academy of Medicine 

before the 

United States Senate Special Committee on Aging 

"Aging With Community: Building Connections That Last a Lifetime" 

May 17,2017 

Good afternoon, and thank you, Chairwoman Collins, Ranking Member Casey, 

and members of the Aging Committee, for the opportunity to testify today on 

solutions to prevent social isolation as we age. My name is Lindsay Goldman, 

and I am the director of healthy aging at The New York Academy of Medicine 

(the Academy). 

Established in 1847, the Academy addresses the health challenges facing New 

York City and the world's rapidly growing urban populations. One of our current 

priority areas is healthy aging. Over 1 million New York City residents, or 12 

percent of the total population, are 65 or older; they are projected to increase to 

over 15 percent of the population by 2040. 1 Often among the most long-term 

and civically engaged residents, older New Yorkers possess significant financial, 

social, and intellectual capital but often face barriers to fully contributing to city 

life. 
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The Academy employs a three-pronged approach to addressing complex issues 

of urban health, including the changing demographics of cities. We begin by 

reviewing existing evidence and data, we then consult the people affected by a 

given problem, and in collaboration with those people, convene all relevant 

sectors to develop creative solutions collectively. The social determinants of 

health provide an underlying framework for all of our work: 

"The social determinants of health are the circumstances in which 

people are born, grow up, live, work and age, and the systems put 

in place to deal with illness. These circumstances are in turn 

shaped by a wider set of forces: economics, social policies, and 

politics."2 

The Academy uses this approach in our role as the Secretariat for Agefriendly NYC, a partnership with the New York City Council and the Office 

of the Mayor, which works to maximize the social, physical, and economic 

participation of older people to improve their health and wellbeing and 

strengthen communities. 

Age-friendly Cities and Communities Model 

Age-friendly NYC adheres to the Active Aging Framework developed by the 

World Health Organization (WHO) in 2006.3 Grounded in evidence, the Active 

Aging Framework posits that a person's disability trajectory can be slowed or 

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reversed through increased engagement in their community, which is associated 

with better physical and mental health. The WHO Age-friendly Cities and 

Communities model was created to identify and address barriers to engagement 

faced by older people throughout the course of daily life within the following 

eight domains:4 

1. Outdoor spaces and buildings 

2. Transportation 

3. Housing 

4. Social participation 

5. Respect and social inclusion 

6. Civic participation and employment 

7. Communication and information 

8. Community support and health services 

Through qualitative and quantitative data collection methods, feedback from 

older people is gathered and used by policymakers, community leaders, and 

residents to make neighborhood resources, services, and amenities more 

inclusive. While the provision of health care and supportive services is certainly 

important, it is only one of eight domains within this framework, which suggests 

that aging must become a priority for all sectors and disciplines, including but 

not limited to architecture, urban and regional planning, arts and culture, and 

business. When viewed through the Active Aging Framework, an aging 

3 
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population is an opportunity to improve communities for people of all ages and 

to delay or reduce disability and dependence. For example, extending street 

crossing time also helps families with small children and younger people with 

disabilities stay safe. 

Age-friendly NYC 

Beginning in 2007, Mayor Michael Bloomberg, City Council Speaker Christine 

Quinn, and the New York Academy of Medicine launched Age-friendly New York 

City with its first undertaking being a comprehensive assessment of the city's 

age-friendliness across the WHO's Eight Domains of an Age-friendly City. The 

assessment included guided conversations with thousands of older people, 

roundtable discussions with hundreds of professionals, a literature review, and 

extensive mapping. In the fall of 2008, the Academy released the findings of the 

assessment process in Toward an Age-friendly City: A Findings Report. 

In response to the findings of the community assessment, the Office of the 

Mayor and the New York City Council asked all city agencies to consider how 

they could improve the way they integrate and serve older adults through their 

work. Out of this review, in 2009, the City announced 59 initiatives to improve 

the quality of life of older adults, which are outlined in Age-friendly NYC: 

Enhancing Our City's Livability for Older New Yorkers. The Mayor's office is 

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currently in the process of developing a new set of commitments to build upon 

the successes of the first phase of implementation and respond to emerging 

needs. Age-friendly NYC is an initiative of OneNYC, the City's strategic plan for 

growth, sustainability, resilience, and equity. 

Appointed by the Mayor and staffed by the Academy, the Commission for an 

Age-friendly NYC is composed of civic leaders from across sectors and 

disciplines, working to develop the overall strategy for Age-friendly NYC and to 

engage private organizations in changing the culture of New York City to 

become more inclusive of older people. The Age-friendly NYC Commission has 

helped New York City become a global leader in the age-friendly cities 

movement through an array of innovative pilot projects, many of which have 

been replicated or adapted in other parts of the world. Products created include 

the Cultural Arts Guide for Seniors, agefriendlycollege.org - a database of 

educational opportunities for older people, and age-friendly tools 

for neighborhoods, urban planners, local businesses, architects, building 

owners, libraries, and many others. 

Age-friendly NYC was one of the founding members of the WHO Age-friendly 

Cities and Communities Network which currently includes 400 localities across 

37 countries5; 163 are in the United States.6 The AARP Network of Age-friendly 

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Communities is the WHO's U.S. affiliate. Most age-friendly initiatives, also 

known as "livable communities," are developed at the city or community level; 

however, states like New York are now working to adapt the model at the statelevel, and Ireland has been designated an Age-friendly country. Based on our 

experience, the Academy has provided technical assistance to over 60 

communities working to become more age-friendly, and in 2013, Age-friendly 

NYC was awarded "Best Existing Age-friendly Initiative in the World" by the 

International Federation on Ageing. 

NYC Solutions to Prevent Social Isolation 

We applaud the Committee's recognition of social isolation as a threat to public 

health. Recent research suggests that social isolation may be as threatening to 

health as smoking, obesity, and lack of exercise. Social isolation predicts 

morbidity and mortality from cancer and cardiovascular disease,7 rehospitalization,8 and mental health issues such as depression.9 Social isolation 

is also a risk factor for elder abuse, 10 as well as negative health outcomes, 

including death, following emergency events. 11 ·

12 Older people in New York City 

may be at greater risk of isolation due to higher rates of living alone (50%), 

poverty (19%), mobility impairment (27%), and lack of English proficiency 

(34%).13 

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Social connection, on the other hand, is not only good for health, but is also a 

priority for older people. According to a 2013 national survey of 4,000 people 

aged 60 and over, 40 percent rated "staying connected with friends and family" 

as the most essential component of a high quality later life.14 Age-friendly NYC 

works not only to reduce social isolation but to prevent it by talking to older 

people and then working with local leaders and stakeholders to eliminate 

barriers to engagement with services and amenities, including local businesses, 

arts and cultural institutions, parks, libraries, and colleges and universities. 

Many of these solutions are low or no-cost and work to optimize existing, ageneutral assets and facilitate connections between the generations. Inadequate 

intergenerational contact has been shown to perpetuate stereotyping and 

exclusion that contributes to the social isolation of older people. 15 Three ways 

Age-friendly NYC works to prevent social isolation include increasing walkability 

and access to public transportation; leveraging public space and programming; 

and maximizing economic participation. 

Increase Walkability and Access to Public Transportation 

A 2006 survey found that 52 percent of New York City-dwelling respondents 

were likely to walk to a destination rather than use another form of 

transportation. 16 There is considerable evidence that walking is associated with 

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better physical and mental health. 17 However, during consultations, older people 

reported significant barriers to pedestrian safety including inadequate street 

crossing times, poorly maintained sidewalks, and lack of seating. 

The NYC Department of Transportation (DOT) established the Safe Streets for 

Seniors Program in 2008. DOT evaluates conditions in areas with high rates of 

senior pedestrian fatalities or injuries and then develops and implements 

mitigation measures, such as extending pedestrian crossing times at crosswalks 

to accommodate slower walking speeds, constructing pedestrian safety islands, 

widening curbs and medians, narrowing roadways, and installing new stop 

controls and signals. DOT solicits ideas and feedback through presentations and 

workshops at senior centers and community boards and also partners with the 

Department for the Aging to coordinate outreach and share resources. Through 

this process over 600 dangerous intersections have been redesigned, and 

senior pedestrian fatalities have decreased 16 percent citywide. These changes 

have made streets safer for all New Yorkers. 

The CityBench program is another initiative to increase walkability. Through a 

federal grant, DOT installed over 1 ,500 new benches around the city, particularly 

near senior centers and housing; hospitals and community health centers; 

commercial zones and shopping districts; and municipal facilities. Individuals 

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and communities can request a bench in a specific location, and older people 

report having made new social ties with people who frequent the same benches 

at the same times. 

Finally, in response to feedback from older people that bus shelters often lacked 

seating and felt unsafe, nearly 4,000 new bus shelters have been installed. The 

new shelters have seating, and the walls are transparent, addressing concerns 

about the old shelters which hid their interiors from view. These shelters were 

paid for by advertisements projected on their sides. DOT has worked to replace 

and install additional bus shelters at locations throughout the five boroughs 

identified by older people and community leaders. 

Use Public Space and Programming to Build Community and Improve 

Health 

According to the American Time Use Survey, older people spend more leisure 

time engaged in solitary and sedentary activities such as watching tv and 

reading, and less time engaged in socialization and recreation. 18 Research 

suggests that participation in public space improves health and wellbeing 

through opportunities for physical activity and social engagement. 19 

When discussing local recreational opportunities, older people in the 

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neighborhood of East Harlem revealed that they had not used public pools in 

decades because they felt uncomfortable and unsafe among all of the children 

and teenagers. In response, the Department of Parks and Recreation piloted 

senior-only swim hours at one public pool during morning hours when the pool 

was underutilized. Known as "Senior Splash," the program was so popular (often 

over 100 people in attendance) in East Harlem that the City expanded it to 16 

pools throughout the City and added water aerobics instruction. A preliminary 

evaluation of this program indicated that older people who participated in regular 

water aerobics demonstrated greater lower body strength and flexibility than 

those who did not. 20 In addition to Senior Splash, the Parks Department 

developed BeFitNYC, a search engine on their website to connect older people 

to free and low-cost fitness opportunities, discounts at fitness centers and 

recreational facilities, and free yoga, tennis, and walking tours. 

Maximize Economic Participation 

The importance of local businesses in the lives of older people repeatedly 

emerged as a theme of community consultations throughout the city. Local 

businesses enable older people, who often have a limited catchment area for 

activity, to meet their basic needs, to socialize, and to support the local 

economy. Local businesses also depend on older people, who account for 

nearly 50 percent of consumer spending in NYC ($70.1 billion annually), as loyal 

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customers who often prefer to pay in cash and rely on word of mouth rather than 

paid advertising to learn about new establishments. Yet older people often 

reported barriers to patronizing local businesses, including accessibility, 

affordability, and lack of appropriate products and services. 

With input from the business community, the Academy created the "Age-friendly 

Business Resource Guide" and supplementary training materials to help 

businesses understand the value of making age-friendly changes to their 

marketing, ambiance, design, and overall consumer experience. With these 

changes, businesses are in position to market their age-friendly features. 

Through a partnership with the New York City Business Improvement District 

Association, Age-friendly NYC has educated 30,000 storefront businesses about 

age-friendly business practices, catalyzing improvements such as the addition of 

seating in stores, more legible signage, and new senior discounts.21 A small 

study conducted by the Academy found that businesses that made 

improvements had higher average cash receipts than non-participating, similar 

businesses within the four-month study period. The Age-friendly Local Business 

Initiative was highlighted by the National Association of Area Agencies on 

Aging's 2015 report, Making Your Community Livable for All Ages: What's 

Working. 

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As illustrated by these examples, planning processes to inform improvements to 

the built, social, and economic environment should engage older people as 

experts on their own lives. By leveraging evidence-based, age-friendly strategies 

such as universal design22 and active transit, 23 federal investment in 

infrastructure can facilitate independence, promote engagement, and build a 

sense of community. Additionally, federal leadership and funding can help to 

reduce social isolation and maintain the health and wellbeing of older people 

through the provision of safe and affordable housing, 2425 access to health care, 26 

transportation, 27 healthy food, 28 technology, 29 and inclusive arts and cultural 

programs. 30 

In addition to involving older people in planning for inclusive communities and 

leveraging federal infrastructure investments to promote increased physical, 

social, and economic participation of older people, the federal government can 

fund and implement Section 203 (c) of the Older Americans Act. Section 203 (c) 

authorizes a Federal Interagency Coordinating Committee on Aging to convene 

federal agencies to work together to optimize the wellbeing of older people 

through existing programs and services. The Coordinating Committee also 

offers a mechanism through which the federal government can work more 

collaboratively with states on aging issues. Interagency coordination has been 

the bedrock of Age-friendly NYC, and New York State is currently engaged in a 

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process of assessing state policies and initiatives from an aging lens. Similar 

leadership at the federal level is important to encourage agencies to work 

together to develop action plans to harness the strengths and meet the needs of 

a growing population of older Americans. 

About the Academy 

The New York Academy of Medicine advances solutions that promote the health and 

well-being of people in cities worldwide. 

Established in 1847, The New York Academy of Medicine continues to address the 

health challenges facing the world's rapidly growing urban populations. We accomplish 

this through our Institute for Urban Health, home of interdisciplinary research, 

evaluation, policy and program initiatives; our world class historical medical library and 

its public programming in history, the humanities, and the arts; and our Fellows 

program, a network of more than 2,000 experts elected by their peers from across the 

professions affecting health. Our current priorities are healthy aging, disease 

prevention, and eliminating health disparities. 

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References 

1. New York City Department of Planning. New York City Population 

Projections by Age/Sex & Borough 2010-2040.; 2013. 

http://www.nyc.gov/html/dcp/pdf/census/projections_report_201 0_2040.pd 

f. Accessed January 18, 2015. 

2. World Health Organization. Closing the Gap in a Generation: Health 

Equity through Action on the Social Determinants of Health. Final Report 

of the Commission on Social Determinants of Health. Geneva; 2008. 

http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf?ua= 1. 

Accessed December 11, 2014. 

3. World Health Organization. Active Ageing: A Policy Framework. Geneva 

Switzerland: World Health Organization; 2002. 

4. World Health Organization. Global Age-Friendly Cities: A Guide. Geneva; 

2007. 

http://www. nyam. org/agefriend lynyc/docs/WHO _ Globa I_ Age _friendly_ Citi 

es_A_Guide.pdf. Accessed December 10, 2014. 

5. World Health Organization. Age-friendly World. 2017. 

https:l/extranet.who.int/agefriendlyworld/who-network/. Accessed May 5, 

2017. 

6. AARP. AARP Network of Age-friendly Communities. 2017. 

http://www.aarp.org/livable-communities/network-age-friendlycommunities/info-2014/member-list.html. Accessed May 5, 2017. 

7. Hawkley L. Loneliness in everyday life: cardiovascular activity, 

psychosocial context, and health behaviors. J Pers Soc Psycho/. 

2003;85(1 ). 

8. Mistry R. Social isolation predicts re-hospitalization in a group of older 

American veterans enrolled in the UPBEAT Program. tnt J Geriatr 

Psychiatry. 2001; 16(1 0):950-959. 

9. Cacioppo J. Loneliness as a specific risk factor for depressive symptoms: 

cross-sectional and longitudinal analyses. Psycho/ Aging. 2006;21(1). 

10. Mysyuk Y, Westendorp RGJ, Lindenberg J. Perspectives on the Etiology 

of Violence in Later Life. J lnterpers Violence. 2015. 

doi:10.1177/0886260515584338. 

11. Klinenberg E. Heat Wave : A Social Autopsy of Disaster in Chicago. 

Chicago: University of Chicago Press; 2002. 

http://www.worldcat.org/title/heat-wave-a-social-autopsy-of-disaster-inchicago/oclc/4 7971411 &referer=brief_results. Accessed December 5, 

2013. 

12. Goldman L, Finkelstein R, Schafer P, Pugh T. Resilient Communities: 

Empowering Older Adults in Disasters and Daily Life.; 2014. 

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http://www.nyam.org/news/docs/pdf/Resilient_Communities_Report_Final. 

pdf. Accessed December 14, 2014. 

13. U.S. Census Bureau. American Community Survey 2014 1-year 

estimates. 2014. 

http:/ffactfinder.census.gov/faces/tableservices/jsf/pages/productview.xht 

ml?pid=ACS_14_1YR_S0103&prodType=table. Accessed February 1, 

2016. 

14. National Council on Aging (NCOA). The United States of Aging Survey 

2013. Washington, D.C.; 2013. http:/fwww.ncoa.org/improvehealth/community-education/united-states-of-aging/usa-survey-2013.html. 

Accessed September 24, 2013. 

15. Hagestad GO, Uhlenberg P. The Social Separation of Old and Young: A 

Root of Ageism. J Soc Issues. 2005;61 (2):343-360. doi: 1 0.1111/j.1540-

4560.2005.00409.x. 

16. Stowell-Ritter A, Bridges K, Sims R. Good to Go: Assessing the Transit 

Needs of New York Metro AARP Members.; 2006. 

http://assets.aarp.org/rgcenter/il/ny_transit_06.pdf. Accessed January 16, 

2015. 

17. Simonsick E. Just Get Out the Door! Importance of Walking Outside the 

Home for Maintaining Mobility: Findings from the Women's Health and 

Aging Study. JAm Geriatr Soc. 53(2): 198-203. 

18. Bureau of Labor Statistics. Time Spent in Leisure Activities in 2014, by 

gender, age, and educational attainment. 2015. 

https:/ /www. bls .gov/op ub/ted/20 15/time-spent -in-leisu re-activities-in-20 14-

by-gender -age-and-educational-attainment. htm. 

19. Sugiyama T. Outdoor environments, activity and the well-being of older 

people: conceptualising environmental support. Environ Plan A. 

2007;39(8): 1943-1960. 

20. Asphalt Green. Senior Summer Swim 2012 at Thomas Jefferson Park A 

Collaboration between Asphalt Green and Union Settlement.; 2013. 

21. The New York Academy of Medicine. Age-Friendly Business Resource 

Guide.; 2014. 

http://www.nyam.org/agefriendlynyc/docs/AgeFriendlyBusinessGuide.pdf. 

Accessed December 14, 2014. 

22. American Planning Association. Aging in Community Policy Guide.; 2014. 

https:l/www.planning.org/policy/guides/pdf/agingincommunity.pdf. 

Accessed December 14, 2014. 

23. Clarke P, Ailshire JA, Bader M, Morenoff JD, House JS. Mobility disability 

and the urban built environment. Am J Epidemiol. 2008;168(5):506-513. 

doi:10.1093/aje/kwn185. 

24. Thomson H, Petticrew M, Morrison D. Housing Improvement and Health 

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Gain: A Summary and Systematic Review. Glasgow: MRC Social & 

Public Health Services Unit University of Glasgow; 2002. 

25. Evans G, Wells N, Chan H, Saltzman H. Housing quality and mental 

health. J Consult Clin Psycho/. 2000;68(3). 

26. Office of Disease Prevention and Health Promotion. Access to Health 

Services I Healthy People 2020. 2017. 

https://www.healthypeople.gov/2020/topics-objectives/topic/Access-toHealth-Services/objectives#3980. Accessed May 8, 2017. 

27. Rittner B. Health care and public transportation use by poor and frail 

elderly people. Soc Work. 1995;40(3). 

28. Frongillo EA, Wolfe WS. Impact of Participation in Home-Delivered Meals 

on Nutrient Intake, Dietary Patterns, and Food Insecurity of Older Persons 

in New York State. J Nutr Elder. 2010;29(3):293-310. 

doi:10.1080/01639366.2010.499094. 

29. Smith A. Older Adults and Technology Use 1 Pew Research Center.; 2014. 

http://www.pewinternet.org/2014/04/03/older-adults-and-technology-use/. 

Accessed July 9, 2015. 

30. Cohen GO, Perlstein S, Chapline J, Kelly J, Firth KM, Simmens S. The 

impact of professionally conducted cultural programs on the physical 

health, mental health, and social functioning of older adults. Gerontologist. 

2006;46(6): 726-734. http://www.ncbi.nlm. nih.gov/pubmed/17169928. 

Accessed May 8, 2017. 

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Appendix: Select Age-friendly NYC Resources 

www. agefriend lynyc. org 

WHO Global Age-friendly Cities: A Guide 

AARP Network of Age-friendly Communities 

Toward an Age-friendly City: A Findings Report 

Age-friendly NYC: Enhancing Our City's Livability for Older New Yorkers 

Commission for an Age-friendly NYC 

Creating an Age-friendly NYC One Neighborhood at a Time 

American Planning Association Aging in Community Policy Guide 

Aging in Place Guide for Building Owners 

Age-friendly Local Business Resource Guide 

Aging: Health Challenges and the Role of Social Connections 

Resilient Communities: Empowering Older Adults in Disasters and Daily Life 

Cultural Arts Guide for Seniors 

Age-friendly College Link 

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Prepared Testimony of Meg Callaway, Project Director, Piscataquis 

Thriving in Place Collaborative, Old Town, Maine 

Good afternoon Chairman Collins, Ranking Member Casey and members of the 

Senate Special Committee on Aging. My name is Meg Callaway, and I direct the 

Thriving in Place Collaborative in Piscataquis County, Maine. 

Piscataquis has Maine’s second oldest population and it is the State’s most rural 

region. It is one of only two frontier territories remaining east of the Mississippi 

River, with fewer than six people per square mile and a land mass the size of Connecticut. It is home to 17,000 people and 27,000 moose. 

The Piscataquis Thriving in Place Collaborative is one of nine aging-in-community 

projects funded through the Maine Health Access Foundation’s Thriving in Place 

(TiP) initiative. These grant-funded projects convene partners including municipal 

leaders, social service providers, healthcare professionals, local businesses, and volunteers to assess the regional needs of older and medically vulnerable adults and 

to implement strategies that help them to stay at home and engaged in their communities. 

These projects serve rural communities, increasing access to such critical resources as housing, food, healthcare, transportation, socialization, and caregiver 

support. They accomplish this by building relationships and facilitating communication between community agencies and organizations to improve the coordination of 

existing community services and supports. Older adult volunteers are engaged in all 

projects to ensure that their experiences and priorities shape the direction of TiP 

efforts. 

While TiP projects share the goal of helping seniors remain engaged in their communities, their approaches vary. The situational needs of older adults on the rocky 

coast can be different from those of seniors living in the deep woods of Maine. The 

resources available to them can also be quite different. The success of the Thriving 

in Place initiative is largely due to the flexible funding the grants provide for communities to build on their own strengths and focus on the unique needs of their senior populations. 

In Piscataquis County, a local farm provides fresh meals for seniors recovering 

from extended illness. Renovations are underway of an historic building that will 

house a senior center for independent older adults, and an adult day services program for seniors needing greater support. We now have a central phone number 

that anyone can call for help with locating senior services. When callers have complex medical needs, we offer them a home nursing visit to develop a plan of care. 

We have stocked local libraries with books and DVDs about aging and caregiving 

resources. Volunteers provide social connection and fresh produce to homebound 

seniors through our local Senior Companion and Senior FarmShare programs. Family caregivers receive respite services from our local hospice volunteers. In their 

down time, local emergency medical technicians check in on frail older patients. 

The Aroostook County TiP, in rural northern Maine, has partnered with their 

nursing school and hospital, engaging nursing students to provide home-based assessments and post-discharge follow up. They visit to review discharge instructions 

and medications as well as deliver a supply of pre-made meals to assist seniors following a hospital stay. This collaborative program is yielding significant reductions 

in hospital re-admissions. 

TiP Downeast has established an in-home volunteer visiting program on the Blue 

Hill Peninsula and is working to bring evidence-based health programs deeper into 

rural, coastal areas. Both strategies aim to reduce hospital admissions and institutionalization. 

Several TiP programs are educating their communities about the importance care 

transitions and completing advance care directives. As TiP aligns and promotes 

these essential resources, new more efficient ideas for engaging older adults and reducing isolation continue to emerge. These programs are actively demonstrating the 

power of community to keep seniors healthy, connected to their communities, and 

truly thriving in the place they call home. 

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Testimony of Cathy A. Bollinger 

Managing Director of Embracing Aging 

York County Community Foundation 

before the 

U.S. Senate Special Committee on Aging 

Hearing- Aging With Community: 

Building Connections That last a 

lifetime 

May 17, 2017 

Jf/lft. YORK COUNTY '\\f COMMUNITY FOUNDATION 

14 W. Market Street, York PA 17362 

cbollinger@vccf.org 

717-848-3733 

www.ycd.org 
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Table of Contents 

Introduction ............................................................................................................................ page 1 

The Aging of York County .................................................................................................... pages 1-2 

Embracing Aging Areas of Focus ......................................................................................... pages 2-3 

Embracing Aging Strategies ................................................................................................. pages 3-6 

How Federal Government Can Support livable Communities ................................... pages 6-7 

Conclusion .............................................................................................................................. pages 7-8 

Addendum: 

Strategies for Creating Livable Communities ................................................................... pages 9-12 

Embracing Aging Committee Members ............................................................................ page 13 
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Introduction 

Good afternoon. Thank you, Chairman Collins, Ranking Member Casey, and members of the 

Special Committee on Aging, for your interest in age-friendly communities and for the 

opportunity to present testimony today. 

My name in Cathy Bollinger, managing director of York County Community Foundation's 

Embracing Aging initiative, which focuses on making York County a great place to age. York 

County Community Foundation (YCCF) is 56 years old, holds $135 million in endowment, and 

awards $5.5 million in grants each year to create a vibrant York County. 

The Embracing Aging initiative launched in fall 2013 with the release of a report, commissioned 

by YCCF, that identified areas of opportunity for York County to become more age-friendly. We 

formed committees to address the issues of attitudes around aging, community engagement, 

housing, health and wellbeing, and transportation and walkability. 

Embracing Aging was one of six communities chosen to participate in the National Association 

of Area Agencies on Aging's (n4a) Livable Communities Collaborative in fall 2013 through fall 

2014, and was featured in n4a's national report, Making Your Community Work for All Ages: 

What's Working released in May 2015. 

Our goal is to create a community that is a safe, welcoming, appropriate, and adaptable place 

to age. To accomplish this, we develop and implement strategies to improve attitudes around 

one's own aging, and senior adults as a group, so that we can understand and care about the 

needs and perspectives of all ages. We also provide strategic leadership and advocacy to create 

more high quality and forward thinking options to help older people live as they choose in their 

community. 

The Aging of York County 

York County is in South Central Pennsylvania, about 60 minutes north of Baltimore and 40 

minutes south of Harrisburg. Its 910 square miles contain 71 boroughs and townships and York 

City, each with its own municipal government and taxing authority. It is comprised of 16 

separate school districts, each with its own school board. The county includes a strong 

agricultural community, and its eastern border is flanked by the Susquehanna River. 

For decades, York County's primary industry has been manufacturing. Roughly 24% of the 

population has a Bachelor's degree or higher. As manufacturing has declined, we have been 

slow to diversify into other well-paying industries and to grow the kind of workforce that would 

attract such industries. Ten percent (10%) of people of all ages live in poverty and the 

percentage of households receiving food stamps grew 95% over the last decade. 

Older people are significant contributors to York's economy. The county is home to 

approximately 442,867 people, of whom about 37% are age 50 and older. Seventeen percent 

(17%) are age 65 and older and 2% are age 85 and older. Of the 73,119 people age 65 and 
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older, 17% are employed. If we removed age 55+ employees from York County's workforce 

mix, 13,421 jobs would be vacant. Almost $1 billion dollars ($939,045,895) would be removed 

from the economy without the 55+ employed population. Retail, healthcare, and restaurants 

would be the most affected industries if those dollars were not available in the community. 

Despite the healthy numbers of employed older adults, many struggle to meet their basic 

needs. The Elder Index measures how much income a retired older adult requires to meet his 

or her basic needs. The Elder Economic Security Standard'M Index (Elder Index) is maintained in 

partnership with the National Council on Aging (NCOA). Basic needs do not include extras such 

as vacations, entertainment, electronics, gifts, or meals out. As a result, those living below this 

level may be forced to make difficult choices among basic needs such as nutritious foods, 

prescription medications, or adequate heating or cooling. 

Based on the above, more and more older York Countians are finding it difficult to pay their 

property taxes. Of the 73,119 people age 65 and older, 23% live alone. Thirty-four percent 

{34%) of those living in housing units occupied by people age 65 and older are paying more than 

30% of their income toward housing costs. Nine percent {9%) of people age 65 and older have 

annual income below the poverty level. An additional 26% of 65 and older single and couple 

person households have income above the poverty level but below the Elder Index. 

Embracing Aging Areas of Focus 

Creating opportunities for people to age well improves the quality of life for individuals and 

families and creates a community that is an attractive place for them to live for the rest of their 

lives. Per our commissioned Embracing Aging report, we know York Countians want to live 

where there is high quality healthcare, supportive neighborhoods, and a variety of accessible 

housing options. Those who are aging want to live where people of all ages interact at parks 

and cultural events. They want to live where older people are respected and promoted as 

community assets. 

It is for these reasons that Embracing Aging focuses on enhancing and improving employment, 

volunteering, lifelong learning, arts and culture, social isolation, information and services, 

health and wellbeing, housing, transportation, and walkability. Although our initiative targets 

people age 50 and older, we know creating a community that works for older people works for 

every age. 

In addition to the above focus areas, we are working to improve attitudes about aging; 

attitudes about one's own aging and attitudes about senior adults as a group. We selected this 

focus knowing that if people don't understand and care about the needs and perspectives of 

older adults, they will not be able to fully create a community that is: 

Safe 

Deliberately accessible and inclusive to people of all abilities and mobility. 

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Welcoming 

Free of misconceptions about aging and increasing the appreciation of the wisdom, experience, 

social influence, and economic impact of older adults. 

Appropriate 

Refraining from "one size fits all" solutions and having options that are based on function rather 

than a person's age. 

Adaptable 

Creativity and flexibility are applied to products, goods, services, events, and opportunities to 

best meet the life needs of older adults. 

Personal biases impact people's thoughts, words and actions. We live in a society that is "drunk 

on youth" and too often views aging as only an impairment or decline. Ageism, systematic 

stereotyping and discrimination based on age is ever-present, largely automatic, and deeply 

rooted. It's the one "ism" that goes largely unchallenged and is not recognized as an issue by 

the general public. "Over the hill" grave stone images and greeting cards emphasize celebrating 

older birthdays as a bad thing, yet I don't know one person who says they don't want to wake 

up tomorrow. It seems more acceptable to make fun and joke about older citizens than other 

stigmatized groups. 

How we are raised, what we learned growing up, what we heard about older people, and how 

we saw them treated all contribute to one's aging biases. Children begin to develop negative 

stereotypes about older people starting at age six. People with negative self-perceptions can 

shorten their own lives. A longitudinal study showed that those with positive self-perceptions 

of aging lived seven and a half years longer than those with neutral or negative self-perceptions 

of their aging. (Levy, et al., 2002) 

Decline in health and functionality of people reminds us of mortality. One way we cope with 

fear of dying is to physically and psychologically put older people aside. This subconscious 

distancing can impact the decisions of policy makers, planners, developers, business owners, 

community leaders, and individuals. A person's worth isn't measured by what they used to look 

like or what they can still do. Older people have life lessons and experiences that are far more 

important than abilities and appearances. 

Embracing Aging Strategies 

Creating a community that works for people ages 8 to 80 takes an entire community working 

together. It's not something that can be done in a silo or overnight. Our long-term initiative is 

a collaborative effort that includes traditional and nontraditional sectors that leverage assets 

and develop shared solutions. Building relationships is a key component in creating systemic 

change in a community. This is especially important when discussing changes in policies, plans, 

and programs that effect social change. Most important in building an age-friendly community 

is assuring older people are around the table in the planning, implementing, assessing, and 

evaluation of ideas and programs. 

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Some of Embracing Aging's specific strategies for creating age-friendly communities include: 

Addressing Housing Needs 

Embracing Aging sees quality housing as the lynch pin to aging well. York County has a shortage 

of low-income and affordable housing for older adults. There are 878 people on waiting lists for 

782 low income apartments and over 1,000 people on the waiting list for 1,173 affordable 

housing apartments. 

Families and friends who want to convert a garage to an apartment or add an accessory 

dwelling unit' (ADU) are finding that 60% of York County's municipalities do not have 

ordinances in place to address AD Us. Of those municipalities that do have ADU ordinances, 

when a family wishes to add an ADU, they often face hurdles because municipalities are 

concerned with families renting the unit after their aging relative no longer needs the unit. The 

municipalities are also concerned with the impact AD Us may have on water and sewer systems. 

Embracing Aging is building relationships with municipalities to share information about AD Us 

and elevate their understanding and caring about the needs and perspectives of older adults 

when it comes to connected but private residences. 

Many lower income older adults who are home owners are living in conditions that are unsafe. 

Embracing Aging provided a multi-year grant to an organization to provide home repairs and 

maintenance services to York County older adult home owners without financial means. The 

grant was used to hire project coordinators to assess home owners' needs and oversee teams of 

volunteers, usually over the age of 50, which make the needed repairs at no cost to the 

homeowner. 

Aging in Place 

It is important for older people to be proactive in creating their plan for aging in community. 

This is the reason we created the Learn How to Live Longer and Stronger in the Place You Call 

Home program. This program helps older adults learn how to examine their housing, 

transportation, health, finances, and social interactions. They define their needs, assess their 

current situation, and are introduced to services and programs to help them fill the gap. This 

puts each individual in control of their own lives and strategies to address their needs. 

Improving Community Engagement 

Older people want to continue to make meaningful contributions through employment and 

volunteering. Embracing Aging has partnered with the local York County Economic Alliance 

(former York County Chamber of Commerce) to host industry forums to assess employer 

interest and receptivity about how to best recruit older workers and build an employment 

environment that works for employees of all ages. 

' ADUs are independent dwelling units that have either been added onto or within a single-family dwelling 

unit, containing separate kitchens, bathrooms, and bedrooms. 

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This assessment process is the foundation for an "age-friendly" business designation we are 

developing. Businesses can earn this designation based on strategies and best practices they 

implement to embrace older employees and customers. Modeled on The New York Academy 

of Medicine's Age Smart Employer Compendium of Strategies and Practices, we are 

encouraging businesses to implement strategies to better recruit older workers, optimize the 

performance and productivity of older workers, reduce unwanted turnover by boosting 

engagement of older workers, and promote meaningful and streamlined transitions from work 

to retirement. Examples of these types of strategies include stating on job listings that mature 

workers are welcome, having older adults serve as interns to try out the "job fit," and ensuring 

older employees continue to have opportunities to advance or learn new skills. 

Another strategy is to provide training for employees of all ages regarding ageism and 

generational differences. We have developed a program for businesses, organizations, school 

districts, and social groups entitled Embracing Aging: Challenging the Perceptions of Aging, 

which discusses aging stereotypes and their impact to increase understanding of older adults in 

people across different generations. Such training results in workforces that are more creative 

and productive and more open and supportive of older adult customers. 

Grantmaking 

Since December 2014, Embracing Aging has awarded almost $700,000 in grants to 

organizations for programs serving York Countians age 50 and older that reduce barriers to 

aging well. Some of these grants were for programs to enhance lifelong learning, including 

technology; volunteering; arts and culture; and addressing isolation. 

An example of such grants is three organizations that applied for funding to enhance 

recruitment, onboarding, and engagement of older volunteers to assist in providing services to 

their older clients. Wanting to maximize outreach and impact, we asked these organizations to 

work collaboratively to develop a volunteer model designed to help enrich opportunities for 

older adults to become more engaged as a volunteer to help others in the community. After a 

year of researching best practices, hosting meetings, and speaking with older York Countians to 

better understand their reasons for not engaging as a volunteer, a demonstration program, 

"Senior Volunteer Opportunities-New Connections, Meaningful Choices," will soon launch. The 

pilot will test new marketing strategies for reaching older adults regarding volunteer 

opportunities, as well as a new central volunteer recruitment entry point designed to best 

match seniors with ways to share their time and talents. The pilot also provides opportunities 

to socialize with other volunteers across York County, while learning about new topics that are 

applicable to both volunteering and their personal lives. By removing barriers to volunteering, 

the goal is to have more older adults sharing their time and talents in York County. Whether 

volunteering with other seniors, or with children and younger adults, we know a streamlined 

and robust volunteering system will impact many. It's a win-win for increasing well-being in 

individuals, and for creating a community that fosters engagement for all ages. 

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Infusing Age in Everything 

We believe that working to improve attitudes in order to increase understanding and caring 

about the perspectives of older adults is the foundation for building a community where all 

ages want to live. Without this perspective, infrastructure, policies, and planning will continue 

to be biased toward younger people. When planning new public spaces, services, and policies, 

we must ask ourselves the question, "Does this work for people of all ages?" 

To help municipalities, businesses, planners, and developers better understand what they can 

do to create safe, welcoming, appropriate, and adaptable places to age, we identified short, 

medium, and long-term examples of strategies they can implement. These strategies are 

included as an addendum to this testimony. 

Embracing Aging commissioned a study to define how York County's older citizens contribute to 

our local economy and civic engagement, and are major financial drivers behind local arts, 

cultural and social nonprofit organizations. It is our hope that sharing this data will help 

stakeholders better understand the advantages of connecting their priorities to building an agefriendly community and what role they might play in this work. In addition to the findings about 

York County's employees age 55 and older filling over 13,000 jobs and bringing almost $1 billion 

dollars to York's economy, we also learned that in 2015, 16 cents of every dollar expenditure in 

the York-Hanover economy was made by people age 65+. Based on the expected population 

growth and senior spending patterns holding, it's projected this will increase to 25 cents of 

every dollar in 2040. One and a half percent (1.5%) or 884 people age 65+ volunteered through 

York County Area Agency on Aging or York County Senior Centers in 2015, totaling 56,052 

volunteer hours. Using the Independent Sector value of volunteer rate of $23.56, this means 

that 1.5% of York Countians age 65+ contributed $1,320,585 worth of services through their 

volunteer efforts. 

Embracing Aging has also hosted experts who are leading the way in reframing views of aging. 

Author, geriatrician, and founder of the influential multi-blogger platform ChangingAging.org, 

Dr. Bill Thomas, addressed over 500 people in York regarding how communities need to shift 

attitudes about aging to create the systemic culture change required to truly be a livable 

community. While here, Embracing Aging arranged for meetings with the media and 

community leaders to discuss how they can help change the narrative on aging by calling out 

ageism and moving beyond the typical senior stories that reinforce negative stereotypes. 

How the Federal Government Can Support Livable Communities 

We are an aging society, and data demonstrates that each future generation will continue to 

live longer. The impact of this change has not yet been fully reflected in government policies 

affecting a community's infrastructure, Social Security, and Medicare. Reframing the dialogue 

from thinking of older people as a liability requires change. It requires new ways of thinking, 

new models, and new ways of living. 

The heavy lifting to support the infrastructure necessary for this change must come from 

government. We see this as the top priority at the federal/eve/. Providing funding to create 

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better transportation options, improve walkability, provide incentives for municipalities to 

address blighted properties, and planners and developers to preserve and build more low 

income/affordable housing with supportive services, are keys to improved livability. 

Examples of specific needs for transportation and walkability include improvements to the 

driving environment such as larger and well-placed directional signs, lighted roadways, clearer 

road markings, brighter stop lights, and dedicated left-turn signals. Accessible, safe and well-lit 

parking spaces and drop-off points are also helpful to the older driver. 

In addition to sufficient financial resources to support transportation infrastructure and 

operations, the federal government can leverage better planning as it approves and awards 

types of funding for affordable housing. Applicants should have to demonstrate that the 

building sites identified for new or rehab construction with a period of affordability are fully 

integrated into community systems, accessible to critical services, and with a certain level of 

walkability. A senior affordable housing project built about ten years ago in southern York 

County is a prime example of federally funded isolation. It is miles from a grocery store, as well 

as other services. 

York County Community Foundation's Embracing Aging initiative isn't large enough to fund 

infrastructure, and we imagine other communities also lack the funding required for 

infrastructure changes. We welcome the opportunity to partner with government, from the 

federal to the municipal level, in leveraging the relationships we've developed over time to 

convene the entities necessary to help do this work. 

Although Embracing Aging intentionally puts 90% of our focus and funding for advocacy and 

programs that increase the quality of life for the vastly larger number of older people who can 

be actively engaged in community life, we recognize the importance of continued funding for 

in-home community based services, especially with the trend of people living longer. The Older 

Americans Act funding has been flat for several years, while the numbers of people requiring 

these services are growing exponentially. Research and funding are also needed for improving 

end of life healthcare, as well as having a healthcare plan that does not permit discrimination 

against people with preexisting health conditions. Substantially increased insurance premiums 

for older adults would result in millions of people losing coverage and worsening the fiscal 

health of Medicare. 

We need the federal government to lead by example in being a fully committed partner in this 

work. Your focus on making America a great place to age speaks volumes to other levels of 

government, as well as to community stakeholders. 

Conclusion 

York County, like communities across the nation, is experiencing a demographic shift where 

adults over the age of 50 make up the largest percentage of our population. We see this trend 

as a tremendous opportunity to engage municipalities, businesses, and the service sector in a 

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community effort to improve aging services, housing, infrastructure, amenities, and cultural 

offerings and help redefine what it means to age well. 

Chairman Collins, Ranking Member Casey, and members of the Special Committee on Aging, 

thank you for the honor of sharing the work of York County Community Foundation's 

Embracing Aging initiative. I greatly appreciate the opportunity to be a witness at today's 

hearing and for the work of the U.S. Senate Special Committee on Aging. 

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ADDENDUM 

Strategies for Creating Livable Communities 

To create a community that is a safe, welcoming, appropriate, and adaptable place to age, we 

need to understand and care about the needs and perspectives of all ages. 

Safe 

Deliberately accessible and inclusive to people of all abilities and mobility. 

Short-Term Examples: 

• Physical places and outdoor spaces are well-lit and maintained 

• Free mobile app to report broken or uneven sidewalks, missing curb cuts, traffic signals 

that don't allow time for a safe crossing and other problems that make life hard for 

pedestrians, especially if they are older or have a disability (Washington DC [DC311] 

AARP 201S Inspiring Communities report) 

• Rest areas with comfortable seating are offered; chairs and benches fit a variety of body 

shapes and have a back and armrests designed and placed in a way that helps a person 

to sit and stand up again 

• Clearance from obstructions such as street vendors, parked cars, and trees 

• Parking lots and sidewalks are clear of wet leaves, puddles, and snow and are kept free 

of ice 

• Older adults are invited to serve as "secret shoppers" and provide feedback on 

accessibility and inclusiveness 

Mid and long-Term Examples: 

• Wider, smoother sidewalks are installed to serve older pedestrians and people pushing 

strollers 

• Brighter stop lights and pavement markings, larger lettering on street-name and 

directional signs, protected left-turn signals, converting two-way stop intersections to 

four-way stop intersections 

• Ramps or suitable stairs (not too high or steep) with railings on both side are present; 

stairs, inclines and drops are clearly marked 

• Stores offer shopping carts that include a seat for older adults to sit in 

• Offer a private place to have sensitive conversations 

Welcoming 

Free of misconceptions about aging and increasing the appreciation of the wisdom, experience, 

social influence, and economic impact of older adults. 

Short-Term Examples: 

Media and marketing include older people in public imagery, depicting them positively 

and without stereotypes 

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• Older people are consulted by public, voluntary, and commercial services on ways to 

serve them better; advisory councils, boards, etc. include older adult representatives; 

places understand older consumers well enough to truly know what they do and need 

• Offer places where people can sit and rest 

• Staff is trained not to discriminate about the tastes or preferences of a customer based 

on age or to demonstrate other "ageist" behavior; to identify and respond to seniors in 

a way that ensures their safety, well-being and dignity; to be helpful and courteous, e.g. 

employee offers to carry tray for person with mobility concerns 

• Provide magnifying/reader glasses to assist with reading smaller print 

• Ensure programs, services, and produces are relevant, appealing, and culturally inclusive 

Mid and long-Term Examples: 

• Learning about aging and older people is included in primary and secondary school 

curricula; older people are provided opportunities to share their knowledge, history and 

expertise with other generations 

Places advertise the age-friendly amenities of their facilities 

Businesses and organizations identify what information older adults are looking for and 

how they prefer to access information 

Offer scholarships or vouchers for goods, services, or events of significant cost 

• Provide transportation service to and from events 

Offer grandchild care 

Appropriate 

Refraining from "one size fits all" solutions and having options that are based on function rather 

than a person's age. 

Short-Term Examples: 

• Employers guarantee a job interview to all applicants who meet the essential 

requirements for the position, no matter their age; offer flexible work-life balance to 

those caring for spouses/parents; free 24/7 info and referral help; workplace training on 

topics including fall prevention and dementia awareness, lifestyle education for 

employees with health conditions such as diabetes or heart disease; and free 20-week 

physical fitness program {AARP Inspiring Communities, pg. 14) 

Design takes into consideration the scale of a range of individuals and how they 

experience an environment: eye level, pace of walking, views, clarity of information, 

flexibility of use, etc. 

• Offer assistance with getting bags to the car, getting something from a shelf; minimize 

excessively loud music and noise; provide personal shopping service for older adults or 

make staff available to help read product labels, get products from shelves, and offer 

directions 

• Use sans serif type fonts like Helvetica and Calibri, which don't have small features at 

the end of their strokes; use 12 pt. fonts or higher; leave 1 inch margins and space 

between lines of text; use vivid colors {avoid light shades like pastels and grays); create 

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high contrast between text and background; use simple and clear designs without too 

much decoration; web sites offer an option to increase font size 

• Offer hearing devices 

Mid and Long-Term Examples: 

• Homes automatically have Universal Design elements included when built 

Housing is located close to services and facilities 

Design buildings and public spaces that are inviting and accessible to all ages. Spaces 

should be designed to include items of interest for a variety of age groups. Provide an 

adequate amount and variety of seating and amenities including water fountains, 

restrooms, and recycling wastebaskets. If steps are necessary, provide dual handrails 

and provide ramps for wheelchairs, baby carriages, etc. 

Adaptable 

Creativity and flexibility are applied to products, goods, services, events, and opportunities to 

best meet the life needs of older adults. 

Short-Term Examples: 

Allowing public transit to stop at the corners along the fixed routes when a consumer 

waves so they don't need to manage long walks to the bus stop 

• Older adults have the option of participating with a friend or caregiver; times of events 

are convenient during the day; admission doesn't require older adults to wait a long 

time in a queue 

• Retirement is a choice; not mandatory 

• Users have the choice of speaking to a real person or of leaving a message for someone 

to call back 

• There is wide public access to computers and the Internet, at no or minimal charge, in 

public places such as government offices, community centers, and libraries 

• Products and product promotions offered for purchase of a single item (e.g. tomato, 

apple, etc.); senior discounts offered; packaging food products in a range of sizes 

• Having "older adult only" parking spaces in a parking lot 

• Provide distance markers and directional signage along pathways to identify location in 

case of emergency 

• Provide music-free or reduced music hours; play music from different time periods 

• Put task lights under shelves to read labels or on tables to read menus 

• At least one service or checkout counter is accessible for customers in wheelchairs 

• Products are offered and conveniently located that assist with one's activities of daily 

living 

• Coordinating and bundling of services, delivery, and after-hour instructions are offered 

Mid and Long-Term Examples: 

• Small, independent housing units, often referred to as Accessory Dwelling Units (ADUs) 

can be located inside a main house, attached to the house (like an apartment over the 

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garage), or as a detached structure (like a backyard cottage) without municipal fees and 

zoning code red tape 

• College students are invited to move into independent living residencies serving older 

adults and pay discounted rent in exchange for socializing with the building's older 

residents (AARP Inspiring Communities, pg. 9) 

• Multiple restroom stalls have grab bars and higher toilets; do not make older adults 

walk to a handicap accessible stall, which is usually the furthest away from the 

bathroom door 

• Playgrounds include walking trails, benches with backs and armrests, and adult outdoor 

exercise equipment 

• Combine needs to serve multiple groups; e.g. high school student's driver education 

hours used for delivering meals to older adults 

• Senior centers are located on high school campuses 

• Provide an alternate method for obtaining your goods and services if the building is not 

age-friendly 
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Embracing Aging Committee Members 

Embracing Aging Advisory Committee 

The Embracing Aging Advisory Committee is comprised of ten community representatives with expertise 

is specific areas. The committee meets six times per year and helps advise the work of the initiative. 

Bruce Bartels, Chair- Retired President and CEO, Wells pan Health 

Penny Blackwell- Retired Judge and Co-Founder of Elder Abuse Task Force 

Felicia Dell Executive Director, York County Planning Commission 

Angela Dohrman- Chief Operation Officer/Senior Vice President, SpiriT rust Lutheran 

David Kalinoski Associate State Director, AARP 

Joan Krechmer- Executive Director, Jewish Family Services of York, Elder Care Specialist and 

Certified National Guardian 

Ann Kunkel- Director Case Management, Wellspan Health 

Mary Ligon- Associate Director of Gerontology, York College of Pennsylvania 

Mark Shea -Director, York County Area Agency on Aging 

Anne Walko Senior Planner, York County Planning Commission 

Ed quina Washington- Director of Community Relations, City of York, Pennsylvania 

Hahn Home Fund for Embracing Aging Distribution Committee 

The Hahn Home Fund for Embracing Aging Distribution Committee is comprised of community 

representatives age 50+ with expertise in grant writing and reading. This committee helps in the 

development of large grants to create systemic change in EA's focus areas, as well as reads/scores the 

competitive grant applications. The committee meets four times a year. 

Bruce Bartels, Chair- Retired President and CEO, Wellspan Health 

Maureen Campbell- Retired Higher Education Administrator, Harrisburg Area Community 

College 

Maria Belinda Crough- Retired Sr. Director, Compensation/HRIS, Johns Hopkins University 

Randy Freedman- Retired Executive Director, York Jewish Community Center 

Joan Fulton- Retired Executive Director, York County Assistance office, PA Dept. of Human Services 

Charles Hoffman Retired Director of Finance, John Gross Company 

Karen Hook- Consultant, Hahn Home 

Betsy Keefer- Retired Agency CEO, Girl Scouts of America Association 

Pat McGrath- Retired Business Manager, Girl Scouts of America Association and former 

Interim Executive Director, Osher Lifelong Learning Institute, Penn State- York 

Erin Miller- Vice President, Wilmington Trust, N.A. 

Hahn Home Fund Board 

The Hahn Home Fund supports the Embracing Aging initiative. It began with the vision of one woman, 

Anna Gardner, who died in 1913 and gifted her estate to help care for older women in the community. 

In 2007, the Hahn Home Board created an endowment at YCCF and in 2012, the board voted to expand 

on Anna Gardner's legacy to launch the Embracing Aging initiative. It continues to meet to coordinate 

the care of the last two women it supported through the estate. 

Michael Hady- Chair, Business Development Partner, York Traditions Bank 

Ronald Blevins- Retired Vice Chairman & Treasurer, The Wolf Organization 

Rick Smith- Associate Broker, Berkshire Hathaway 

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63 

Prepared Testimony of Anamarie Garces, Founding Member, Miami-Dade 

Age-Friendly Initiative and Co-Founder and CEO, Urban Health Partnerships, Miami, Florida 

Chairman Collins, Ranking Member Casey, and members of the Aging Committee, thank you for the opportunity to testify before you today and for the work 

you are doing. My name is Anamarie Garces, and I am a founding member of the 

Miami-Dade Age-Friendly Initiative (www.AgeFriendlyMiami.org) and am co-founder and CEO for Urban Health Partnerships, one of the lead partners of the initiative. The Miami-Dade Age-Friendly Initiative is a collective impact effort focused on 

policy, systems, and environmental changes toward creating a community for all 

ages and abilities where older adults can stay active, engaged, and healthy with dignity and enjoyment. It is led by a diverse group of partners including AARP Florida, 

the Alliance for Aging, Health Foundation of South Florida, Miami-Dade County, 

Miami-Dade Transportation Planning Organization, United Way of Miami-Dade, 

and Urban Health Partnerships along with an advisory committee of over 50 key 

stakeholders and community members. 

Miami-Dade is the most populous county in Florida and home to over 2.6 million 

people. It is also home to the largest population of older adults age 60 and over in 

Florida, which is more than half a million people. That number is expected to rise 

by more than 50 percent to over 800,000, by 2040. Miami-Dade is large and sprawling with a diverse population. 67 percent of the County identifies as Hispanic and 

most who are bilingual speak Spanish. 

Miami-Dade has identified age-friendly as an important approach to reducing social isolation and addressing how we can build a community that supports the 

wants and needs of older adults. 

It recently joined the AARP Network of Age-Friendly Communities, making it the 

fifth largest community in the country to join the network. 

The WHO domains of livability can be broken up into two categories, the built 

environment, or the environment we can see and touch, such as housing, streets, 

parks, and infrastructure; and the social environment, such as the opportunities, 

support and services, that are available. Both are important and interdependent. 

Miami-Dade has focused on the built environment first recognizing that if services 

or opportunities for social engagement are available, but residents do not have access or do not feel safe accessing them, it will isolate them from the resources and 

individuals that they need. Some of the age-friendly strategies that have been implemented in Miami-Dade include: 

Age-Friendly Policies in Transportation, Community Healthy and Design and Land 

Use 

• Ensuring older adults were included in policies and performance measures by 

updating Miami-Dade’s Comprehensive Development Master Plan and Long 

Range Transportation Plan (LRTP). For example, the LRTP includes an objective to promote transportation improvements that provide for the needs of the 

elderly and disabled. 

Age-Friendly Parks 

• As a partner in the initiative, the Parks, Recreation & Open Spaces department 

helped identify and incorporate age-friendly parks standards in several parks 

in Miami-Dade. 

• In addition to physical amenities and features in the parks, they also provide 

Active Older Adults programming. These include programs such as Enhance 

Fitness, the Walk4Life Walking Program, and Thai Chi Classes for older adults. 

• A toolkit demonstrating physical amenities to ensure access, safety, and comfort 

within parks as well as evidence-based programs was produced. 

Age-Friendly Awareness 

• We hold summits, workshops, and events for community leaders, municipal 

staff and stakeholders on the importance of respecting and including older 

adults in planning housing, transportation, and parks projects. 

Age-Friendly Neighborhoods and Streets 

• In 2012, our Safe Routes to Age in Place project was launched to empower older 

adults in Little Havana to recognize their needs and identify changes to improve safety within their neighborhood. Little Havana, or La Pequen ̃ a Habana, 

was recently named a national treasure. It is a diverse neighborhood in MiamiDade known for its Cuban-American residents and is home to immigrants from 

across Central America and the Caribbean. Little Havana was chosen because 

of these factors and because it has a high proportion of older adults living in 

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64 

the area, a high proportion of households without a car, and a disproportionate 

number of pedestrian injuries in the area. Participants engaged in educational 

workshops, led a walking audit, and led a discussion with elected officials and 

transportation agencies to advocate for the changes they wanted to see. We also 

developed an Advisory Committee to provide input to the Florida Department 

of Transportation Little Havana Pedestrian Safety Study. 

• Today, there is a lot happening in Little Havana toward safer, complete streets 

for everyone on a broader scale. 

• There are specific built environment designs that impact the willingness and 

ability of older adults to get outside, interact with their community, and prevent 

isolation. Older adults struggle with sharing walkways with bicyclists. On busy 

corridors such as Calle 8, or 8th street, in Little Havana, seniors expressed 

their concern with trying to walk or get out of their homes because they fear 

cyclists on sidewalks, participants said, ‘‘Pasan a todo dan sin timbre or 

corneta.’’ English translation: ‘‘People pass at high speeds without a bell.’’ Another adult added, ‘‘De todas formas deben de ponerles a las bicicletas su propia 

linea porque aqui hay muchas personas que no oyen bien.’’ English translation: 

‘‘By all means bicyclists should have their own lane since older adults have a 

hard time hearing.’’ These features are currently being considered in the redesign of current thoroughfares in their community. 

• Another important piece is access to transit. In a recent interview with a community resident, she said the Golden Passport was important to her family. 

When her elderly father came to the realization that he was no longer able to 

drive around Miami-Dade, the Golden Passport allowed him to give up his keys. 

Miami-Dade’s Golden Passport program, provides free bus passes for adults 

65∂. Due to the program, he was able to get out and enjoy the last years of 

his life with dignity and support. 

• Another aspect is shade. Utilizing a Digital Laser Infrared Thermometer Temperature Gun it was determined that shaded bus stops were 10–20 degrees less 

hot than non-shaded bus stops in Miami-Dade County. The average temperature in Miami is 82 degrees year round. Due to concrete or a heat island effect 

that is created at bus stops without shades, older adults can experience temperatures of more than 100 degrees, while waiting at their stops. 

Age-Friendly Business 

• The Safe Routes to Age in Place Advisory Committee recommended an AgeFriendly Business District, so we developed one. Older adults told us that once 

they had safer streets, a financial incentive, and places to go, they would be motivated to walk more. Initially, 25 businesses provided purchasing incentives for 

older adults to walk every Tuesday to their stores within a quarter-mile of the 

target location. 

• A Toolkit was developed to help other communities and businesses implement 

age-friendly strategies. 

Age-Friendly Survey and Action Plan 

• Today, the Initiative is continuing its work by surveying and engaging the community to update its action plan and identify next steps. 

An age-friendly community is called age-friendly and not senior-friendly because 

the strategies used are not only good for older adults, but for everyone, from the 

very young, to the very old. The same curb cut or ramp that may be added to ensure 

a wheel chair can get onto a sidewalk, is the same one that can make it easier for 

me to push my son in his stroller. Extra time added to a crossing signal can help 

ensure that an older adult, or anyone, won’t lose their footing if they try to rush 

across the street too quickly. 

A walkable community with safe streets and places that people want to utilize is 

good for the economy, encourages active transportation and physical activity, empowers older adults to access resources, and offers more opportunities to socialize 

and engage with the community. This is a long-term approach to addressing isolation where the community is built or modified to facilitate access, engagement, and 

opportunity. 

We need your continued leadership to ensure age-friendly, livable communities 

are a priority in cities, to help build infrastructure that works for all ages and connects us to our resources and to our citizens, and to ensure aging continues to be 

in the conversation in all aspects of decision making as we build the policies and 

plans for the future of our country. 

Thank you for the opportunity to testify today and to share some of the strategies 

Miami-Dade is using to connect the community and to plan for our aging population. 

I welcome your questions. 

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Additional Statements for the Record 

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66 

Statement of Amy Schectman, President, Jewish Community Housing for 

the Elderly, Boston, Massachusetts 

Thank you to the Senate Special Committee on Aging for holding a hearing on 

‘‘Aging With Community.’’ Given the focus of your last hearing, you are well aware 

of the fact that loneliness has been firmly identified as the biggest public health 

hazard to older Americans, and community is the best antidote to loneliness ever 

invented. That’s why Jewish Community Housing for the Elderly (JCHE) is so committed to our model of aging in community—our mission is that every older person 

has this opportunity to live a full life of connection and purpose in a dynamic, supportive environment. 

I want to emphasize how housing that’s broadly affordable is the key component 

to age-friendly communities. 

JCHE builds, owns, manages and provides direct services in 1,200 apartments 

across four campuses in eastern Massachusetts. We offer a rich array of programs 

and services so that everyone can find a way to connect to community, and do it 

with a laser-sharp focus on affordability. The median income in our properties is 

$10,473 per year. 

Our high quality housing with supportive services creates high functioning 

healthy senior communities and connected lives in a way that no other interventions 

can possibly achieve. 

A walk down the hallways of any JCHE housing will convince even the biggest 

sceptic. From first thing in the morning through quite late at night, folks gather 

in welcoming spaces to chat, participate in fitness activities together where they 

spur each other on, argue about current events constructively, volunteer with children from nearby schools, participate in life-long learning opportunities and write 

memoirs and notes to grandchildren in our computer centers. No one ever needs to 

feel lonely, and for those for whom making the initial contact is hard, our staff helps 

them find the right connection opportunity in our residences and out in the wider 

world. 

With housing the centerpiece of community building, affordability is essential. According to Harvard University’s Joint Center on Housing Studies, severely housingcost-burdened households spend 70 percent less on health care needs and 40 percent 

less on food than those living in affordable housing. Poor nutrition and lack of preventative health care have been shown to increase public expenditures dramatically 

but ineffectively. For this and other reasons, Harvard concluded that ‘‘housing is the 

linchpin of well-being for older adults’’ and argues that making sure we have 

enough and appropriate housing takes on an urgency for the Nation as a whole. The 

Bipartisan Policy Center, in their Housing Commission report, argues for a system 

in which elders at or below 30 percent of area median income are guaranteed access 

to housing assistance [subsidies] and that in addition the Federal Government provide funding for short-term emergency housing stabilization assistance for those 

with incomes between 30–80 percent of area median. 

Supportive senior housing also provides opportunities for community and social 

connections to seniors in our neighborhood and gives them access to the expertise 

of our staff and programs offered. For example, at JCHE we invite community members to attend a variety of offerings at our sites, including many of our life-long 

learning lectures and intergenerational programs. Because all of our buildings are 

fully accessible and dementia-friendly, everyone is able to enjoy our offerings. 

The challenge we face and that America faces is the amount of need for stable 

homes and community versus our supply. We currently have a waiting list of 1,779 

households for 1200 apartments with very slow turnover (given our emphasis on 

supports, we only lose 3 percent per year of our residents to nursing home placements despite the fact that 38 percent are over the age of 85 and 17 percent are 

over 90). The waiting list would be longer if so many weren’t so discouraged when 

they hear the length of the wait. 

And yet the most effective and efficient Federal housing program has been 

starved of new development funds for the past 5 years. The Section 202 housing program allowed us to build and staff high quality housing where seniors earning up 

to 80 percent of area median could pay only 30 percent of their income in rent. Consequently, the production of new affordable senior housing has slowed dramatically 

at the very time in our nation’s history when the need is rising rapidly and agefriendly communities are emerging as a priority. 

A few anecdotes illustrate the way a stable home in a supportive environment is 

a centerpiece for social connection and community building for seniors: 

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67 

Betty 

‘‘These days, I’m feeling happy. I think it has something to do with the 200 neighbors I have at JCHE,’’ Betty suggests. 

After undergoing surgery to remove melanoma from her face, Betty was worried 

about how her neighbors would react to the scars from the surgery. She dreaded 

having to explain what happened every time she ran into someone. 

To her relief, her neighbors, many of whom have had their share of health troubles, were as compassionate and understanding as she could have hoped. 

‘‘People didn’t dwell on the bandages but they did surround me with kindness,’’ 

Betty says. One neighbor asked what she could do to help, to which Betty replied, 

‘‘just smile.’’ 

Another neighbor gave her a book written in large print that Betty could read 

even with bandages partially obscuring her eyesight. A neighbor stopped by with 

bread, and someone else came with dessert. A resident who had just moved in and 

wasn’t even unpacked yet, arrived at her door with blueberry pancakes. 

Betty’s best friend at JCHE, Sylvia, accompanied Betty to her post-operative visit. 

When she found out Betty was cancer free, she cried as only a soul mate can upon 

receiving such good news. 

‘‘It was an ordeal,’’ Betty admits. But through it all, ‘‘I never felt alone. The community was there for me in all the ways that matter.’’ 

Selma 

‘‘When I say that I never exercised before I came to JCHE, I am not exaggerating,’’ Selma laughs. 

Selma was that kid in high school who always skipped gym class, and never 

dreamed that one day she would become an exercise maven. 

Then a few years ago, Selma felt like she was coming apart. First, she broke her 

shoulder. Then, she suffered back fractures. One day, the pain in her legs was so 

severe that she could barely move. 

That’s when her physical therapist suggested that JCHE’s exercise program is exactly what she needed to regain her strength. 

So Selma became acquainted with our fitness center, and started receiving personalized instruction from our staff. 

She began exercising 5 days a week without having to leave her building. 

‘‘I was amazed by the results. I felt healthier and more alive. At 87!’’ she exclaims. 

Then Selma had a bit of a setback after she fell trying to step on a curb. 

‘‘It really shook me up. I was so nervous about curbs and stairs that I stayed at 

home all the time.’’ 

Selma quickly realized that staying at home wasn’t making her any healthier, and 

so as difficult as it initially was, she returned to the gym. 

Our fitness staff instructor, Stacy, understood that Selma was scared to start exercising again and risk re-injury, so she designed a custom training regimen that 

helped Selma slowly regain her confidence and overcome her fear. 

‘‘We started by stepping up on a treadmill that wasn’t moving. Then I moved on 

to stairs. Eleven months later, with Stacy’s encouragement, I am regaining my confidence.’’ 

‘‘I know it’s what’s keeping me alive,’’ Selma admits. 

[Each JCHE site has a fitness center with senior-friendly exercise equipment 

where fitness staff, including bilingual staff, provide personalized instruction. Understanding the risks that seniors face by falling, JCHE has an integrated falls prevention program that combines strength and balance exercises with assistance from 

JCHE’s maintenance department to help residents reduce the occurrence of falls in 

their apartments.] 

Simon and Malka 

Simon and Malka arrived to the U.S. 25 years ago from St. Petersburg (formerly 

Leningrad), Russia to reunite with their son, who had immigrated a few years earlier. 

‘‘We were excited about our new adventure, but were also anxious. I left a very 

respected position, and we were not sure what was ahead,’’ Simon recalls. 

Simon asked his son to find a home for them that would ease their anxiety and 

facilitate such a major lifestyle change. Their son found JCHE. 

Right from the start, Simon and his wife participated in the wide array of programs available at JCHE. They quickly became part of a community. They attended 

classes, concerts and holiday celebrations. 

‘‘There were so many opportunities at JCHE that our lives felt active and productive,’’ Simon says. 

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68 

When Simon’s wife fell ill, Simon, then 87 years old, was grateful for the medical 

services JCHE arranged. The medical professionals who visited his wife were reliable, kind, and attentive to all her needs. 

‘‘JCHE made sure that my wife is comfortable and that gives me some room to 

breathe.’’ 

Had it not been for the love and care Simon and his wife found at JCHE—had 

they been living in relative isolation outside of a vibrant community—Simon believes his wife would have ended up in a nursing home. JCHE made it possible for 

the couple to remain together—an unbelievable blessing. 

‘‘My wife and I have taken care of each other for many, many years. If we lived 

somewhere else, she would be in a nursing home away from me just at the time 

in our lives when being together is most important.’’ 

Sari 

Sari never had the benefit of formal education as she spent all of World War II 

in hiding in a basement to escape the Nazis. When she moved to the U.S. she needed to start working immediately; she always thought of herself as somehow lesser 

because of her lack of education. 

Nevertheless, every Tuesday for the past 8 years, Sari rode JCHE’s van with her 

neighbors to the Everett Elementary School in Dorchester. For 3 hours, they practice reading with third, fourth and fifth graders to help the kids improve their reading skills. 

It’s part of our Generations Together program that encourages residents and 

young people, ranging in age from preschoolers to college students, to develop relationships that are mutually beneficial. 

Right from the start, Sari knew she would love this program. She built meaningful connections with the students, who opened up to her about their families and 

told their parents about Sari. 

‘‘I’ll never forget when one of the boys flew down the stairs, holding a picture of 

his dad who lived far away. It made me feel so special that he wanted to show me 

a photo of someone so important to him,’’ Sari recalls fondly. 

‘‘A while ago, I overheard my daughter speaking on the phone with one of her 

friends. I heard her say something about her 90-year-old mother and something 

about tutoring. It took me a minute to realize that she was speaking proudly and 

she was speaking about me. I don’t need to think of myself only as an immigrant 

who never went to college. I’m a tutor. My work is important and I do it well.’’ 

Audrey 

‘‘Helping others has always given my life meaning,’’ explains Audrey. 

As a doctor in her native Shanghai, China, Audrey treasured the opportunities 

to assist her patients. When she and her husband moved to JCHE, she discovered 

many ways to volunteer and give back to the community. 

But volunteering came to a screeching halt when Audrey was diagnosed with cancer. 

‘‘My prognosis was good, but my attitude was not,’’ Audrey confesses. 

As is common for cancer patients, the feeling that she was running out of time 

took a physical and emotional toll on Audrey. She rarely left her apartment, in part 

because she felt that she needed to conserve her energy. 

‘‘But withdrawing only made me feel sick and lonely,’’ Audrey recalls. 

Then, something happened. Audrey started to pay close attention to her neighbors 

and noticed that all the seniors at JCHE—much like people in all walks of life— 

were carrying one burden or another. But, unlike her, they didn’t disengage from 

their neighbors; instead, they were active and appeared to thrive, regardless of 

whatever health ailments or personal setbacks they encountered. 

‘‘This is a very positive environment. With the encouragement of staff, I began 

to reconnect.’’ 

Today, Audrey is one of the most active members of the JCHE community. She 

helps her neighbors with translations, volunteers in our Chinese library and serves 

on the tenant council. Audrey enrolled in a program that helps Tufts medical students learn to communicate with older patients, and she even started a new program that brings in medical professionals to JCHE to share health information in 

Cantonese and Mandarin. 

She feels engaged, hopeful, and above all, she feels like her life once again has 

purpose. 

‘‘JCHE is a very special place. It inspires people to approach life positively, put 

their burdens aside and really live life!’’ 

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69 

Sarah, Resident Service Coordinator 

For four years, JCHE’s Resident Service Coordinator, Sarah, worked with Linda, 

a resident for whom JCHE had proved to be an absolute lifeline. 

‘‘That’s what makes working at JCHE so rewarding for me,’’ Sarah says. 

Linda had struggled with serious mental health issues throughout her life. She 

suffered abuse as a child and has long lost all contact with family. She has been 

homeless. Tragically, she calls the last place she lived, ‘The Heartbreak Hotel’. 

Not surprisingly, when Linda moved in four years ago, she needed a lot of help. 

She had no material possessions, so we helped her secure a bed and other basics. 

We connected her with doctors and arranged transportation. We talked and talked 

with her to orient her to life here. 

Slowly but surely, this support strengthened Linda’s ability to take care of herself. 

Now she checks in every day, but mostly for a friendly chat. She has made friends 

and is active in many of the programs and activities JCHE offers. 

When Linda first arrived at JCHE, Sarah admits she was concerned that Linda 

was the person that others would cross a room to avoid. 

But that just wasn’t the case. 

‘‘JCHE is a very strong community and Linda has a place within that community,’’ Sarah emphasizes. 

Linda, who had so often been given the cold shoulder, has found that at JCHE, 

she is welcomed and warmly embraced. 

‘‘I’m so proud to work here and know that I can be part of a wide and strong safety net for folks who rely on it to maintain their health and dignity.’’ 

Estelle 

‘‘I am 93, but I feel just the way I did 30 years ago,’’ Estelle asserts. 

Estelle lived in Florida for many years, but after her husband passed away and 

her eyesight began to decline, Estelle decided it was time to move to Boston to be 

near her daughter. 

‘‘I’m not sure what I expected before I moved in, but I never expected to still be 

growing and learning.’’ 

The emphasis on lifelong learning is a centerpiece of life at JCHE. We offer a diverse array of opportunities for seniors to develop new skills, take up new hobbies, 

and pursue their passions. 

Estelle admits that one of her concerns about moving to Boston was not wanting 

to be a burden to her daughter—especially with her poor eyesight. ‘‘At JCHE, I don’t 

worry about being a burden to her, because of the unbelievable around-the-clock 

support I receive.’’ 

Estelle takes a Spanish class in her building. It’s challenging, but she’s sticking 

with it. 

‘‘Someone asked me what I would say is someone said you can’t learn anything 

at age 93. Well, I told her, I guess I am proving them wrong!’’ 

www.jche.org 

Statement of the Altarum Institute Center for Elder Care & 

Advanced Illness 

Chairman Collins and Ranking Member Casey, congratulations on a fine hearing 

highlighting strategies that enable tens of millions of older Americans to age in 

their own communities, whether urban, rural or suburban. The Center for Elder 

Care & Advanced Illness (CECAI) is a research organization, working in the public 

interest, which focuses on designing, implementing and scaling policy solutions that 

address the health and social services challenges facing the U.S. today. We focus 

particularly on cost-effective changes and adaptations that are needed to ensure 

that all of us can live comfortably and meaningfully in old age—either at home or 

another setting of choice—and at a sustainable cost to our families, to the community, and to taxpayers. 

The astonishing health care advances made during the 20th century and the early 

part of this century have provided us with a tremendous gift: the opportunity to live 

longer lives. Along with this comes the responsibility of helping our communities 

and our care systems adapt to be able to deliver a different mix of support—less 

aggressive ‘‘curative’’ care and a greater emphasis on supportive services that allow 

people to live as independently as possible. This shift toward community care will 

soon become the norm for one-fifth of the population: In 13 years, all baby boomers 

will have reached the age of 65, and the number of ‘‘old-old’’ people over the age 

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1Ortman JM, VelkoffVA, Hogan H. An Aging Nation: The Older Population in the United 

States. Washington, DC: U.S. Census Bureau. 2014. https://www.census.gov/prod/20l4pubs/ 

p25-1140.pdf. 2Favreault M, Dey J. Long-Term Services and Supports for Older Americans: Risks and Financing. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation. 2016. 

https://aspe.hhs.gov/basic-report/long-term-services-and-supports-older-americans-risks-and-financing-research-brief. 3Thomas KS, Dosa D. More than a meal: Results from a pilot research study. For Meals on 

Wheels America. 2015. Retrieved from http://www.mealsonwheelsamerica.org/theissue/research/more-than-a-meal. 4 National Council on Aging. National Study of the Chronic Disease Self-Management Program: A Brief Overview. http://www.ncoa.org/assets/files/pdf/center-for-healthy-aging/National-Study-Brief-FINAL.pdf. 5Schwartz AL, Landon BE, Elshaug AG, Chemew ME, McWilliams M. Measuring Low-Value 

Care in Medicare. JAMA Intern Med. 2014;174(7):1067-1076. doi: 10.1OOl/ 

jamaintemmed.2014.1541. 6Lynn J. MediCaring Communities: Getting What We Want and Need in Frail Old Age at 

an Affordable Cost. Washington, DC: Altarum Institute. 2016. Available at http:// 

medicaring.org/book/. 

of 85 will more than triple,1 from 4 million to 18 million by 2050. In fact, if we live 

to advanced old age, most of us will need assistance during our last few years.2 A 

chief challenge, therefore, is to devise ways in which supportive services can be expanded in communities across the country. 

The Aging Network—comprised of 53 publicly chartered State Units on Aging, 

more than 600 Area Agencies on Aging, American Indian, Alaska Native and Native 

Hawaiian tribal organizations, and tens of thousands of community-based organizations—provides the bulk of the social services and supports that older adults need 

to remain in their communities. Primarily funded by the Older Americans Act 

(OAA), the Aging Network meets a range of health-related needs by providing homedelivered meals, subsidized transportation, personal care, evidence-based health promotion and disease prevention, long-term care ombudsman and elder justice services, respite care and other services for family caregivers, and employment programs 

for older workers. While a growing body of research is demonstrating that these 

cost-effective services improve health care outcomes, 3 4 flation-adjusted unding for 

the OAA continues to decline—even as the number of seniors rises. 

At this juncture, many older adults with functional limitations face lengthy waiting lists for basic supports needed for independence, including home-delivered 

meals, subsidized transportation and housing adaptations. Services that are needed 

frequently or on a daily basis, such as personal care, are often available only to 

those who have the means to pay out of pocket—or to those whose incomes and assets are low enough to qualify for Medicaid. This is why many middle-class seniors 

find themselves spending down their lifetime financial resources until they are eligible for Medicaid. 

In addition to unnecessarily impoverishing seniors, another poor outcome associated with the shortage of community services is over-utilization of hospitals and 

emergency room care by Medicare beneficiaries who have chronic conditions and 

functional limitations. In these settings, too many wind up receiving high-cost medical interventions that will yield little net benefit in their remaining lifetimes. A 

large body of research has established that there is a considerable amount of lowvalue, wasteful spending in Medicare in the frail elderly population.5 We urge policymakers at all levels of government to more closely examine how low-cost community services can successfully support seniors and lower health care costs through 

delaying or preventing excessive hospitalizations and ER visits, and to encourage reinvestment of some of these savings for enhancement of supportive services. With 

thoughtful leadership, enhanced flexibility and excellent oversight, this shift is entirely possible. Most readily, it can be accomplished through an expansion of the 

Program of All-Inclusive Care for the Elderly (PACE), or through appropriately 

adapted Accountable Care Organizations or managed care organizations.6

In addition, communities can do more to organize local volunteers willing to help 

older adults age in place with dignity, engagement, and meaning. Accomplishing 

this on a wide scale requires recognition at the national level—in the form of an 

initiative announced by the Department of Health and Human Services or the 

White House, or introduction of legislative policy to create locally chartered ‘‘Caregiver Corps’’ across the country. Policy to do this was introduced by Ranking Member Casey in 2014, and a similar bill in the House of Representatives has been sponsored by Rep. Lujan-Grisham of New Mexico. Both bills aim to organize volunteers 

of all ages who are willing to provide practical assistance (though not personal care) 

and companionship to older adults. In doing so, volunteers would provide respite for 

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family caregivers, supplement the assistance provided by home care aides, and create connections between generations. 

As the U.S. age wave gathers momentum, thoughtful steps can also be taken to 

boost the Older Americans Act (OAA). With this bipartisan statute up for reauthorization in FY 2020, the 115th Congress has an opportunity to hold hearings on possible targeted improvements. For example, consideration could be given to assessing 

resources and outcomes in relation to the number of older adults receiving services 

and to those who qualify for services but are wait-listed. 

CECAI appreciates the opportunity to provide input on aging with community. 

While it is clear that all communities have unique assets and strengths that they 

can draw upon to improve care for their older residents—neighbors, friends, parents, 

spouses and colleagues—available resources in the form of existing programs, workforce, local economic and cultural factors, and other infrastructure and assets will 

necessarily vary. With careful planning, however, many of the changes that every 

community needs to make can be spearheaded by energetic advocates organizing at 

the local level, working alongside leaders and stakeholders who are committed to 

identifying and mitigating service supply shortages and to improving quality and reliability. We are delighted to submit these comments and would welcome an opportunity to assist the Senate Special Committee on Aging in any way to improve aging 

with community. 

Æ 

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