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77–850 PDF 2001

S. HRG. 107–291

WOMEN AND AGING: BEARING THE

BURDEN OF LONG-TERM CARE

JOINT HEARING

BEFORE THE

SPECIAL COMMITTEE ON AGING

AND THE

SUBCOMMITTEE ON AGING OF THE

COMMITTEE ON HEALTH, EDUCATION,

LABOR, AND PENSIONS

UNITED STATES SENATE

ONE HUNDRED SEVENTH CONGRESS

SECOND SESSION

WASHINGTON, DC

FEBRUARY 6, 2002

Serial No. 107–17

Printed for the use of the Special Committee on Aging

(

SPECIAL COMMITTEE ON AGING

JOHN B. BREAUX, Louisiana, Chairman

HARRY REID, Nevada

HERB KOHL, Wisconsin

JAMES M. JEFFORDS, Vermont

RUSSELL D. FEINGOLD, Wisconsin

RON WYDEN, Oregon

BLANCHE L. LINCOLN, Arkansas

EVAN BAYH, Indiana

THOMAS R. CARPER, Delaware

DEBBIE STABENOW, Michigan

JEAN CARNAHAN, Missouri

LARRY CRAIG, Idaho, Ranking Member

CONRAD BURNS, Montana

RICHARD SHELBY, Alabama

RICK SANTORUM, Pennsylvania

SUSAN COLLINS, Maine

MIKE ENZI, Wyoming

TIM HUTCHINSON, Arkansas

PETER G. FITZGERALD, Illinois

JOHN ENSIGN, Nevada

CHUCK HAGEL, Nebraska

MICHELLE EASTON, Staff Director

LUPE WISSEL, Ranking Member Staff Director

(II)

C O N T E N T S

Page

Opening Statement of Senator John Breaux ......................................................... 1

Opening Statement of Senator Barbara Mikulski ................................................ 3

Statement of:

Senator Tim Hutchinson .................................................................................. 6

Senator Christopher Dodd ............................................................................... 7

Senator Rick Santorum .................................................................................... 9

Senator Larry E. Craig .................................................................................... 29

Prepared Statement of:

Senator Mary Landrieu .................................................................................... 31

Senator Olympia Snowe ................................................................................... 31

Senator Maria Cantwell ................................................................................... 34

PANEL I

Hon. Blanche Lincoln, a U.S. Senator from Arkansas ......................................... 10

Hon. Patty Murray, a U.S. Senator from Washington ......................................... 15

Hon. Susan Collins, a U.S. Senator from Maine ................................................... 17

Hon. Debbie Stabenow, a U.S. Senator from Michigan ........................................ 19

Hon. Hillary Rodham Clinton, a U.S. Senator from New York ........................... 22

Hon. Jean Carnahan, a U.S. Senator from Missouri ............................................ 26

PANEL II

Dr. Laura Young, Executive Director, Older Women’s League, Washington,

DC .......................................................................................................................... 35

Gail Gibson Hunt, Executive Director, National Alliance for Caregiving,

Bethesda, MD ....................................................................................................... 47

APPENDIX

Statement of Kathleen Kelly, Executive Director, Family Caregiver Alliance,

San Francisco, CA ................................................................................................ 59

Statement submitted by the American Association for Geriatric Psychiatry ..... 61

Statement on behalf of the Women’s Institute for a Secure Retirement ............ 65

(III)

(1)

JOINT HEARING ON WOMEN AND AGING:

BEARING THE BURDEN OF LONG-TERM CARE

WEDNESDAY, FEBRUARY 6, 2002

U.S. SENATE,

SPECIAL COMMITTEE ON AGING,

AND COMMITTEE ON HEALTH, EDUCATION,

LABOR, AND PENSIONS, SUBCOMMITTEE ON AGING,

Washington, DC.

The committees met jointly, pursuant to notice, at 9:35 a.m., in

room SD–106, Dirksen Senate Office Building, Hon. John Breaux

(chairman of the Special Committee on Aging) presiding.

Present from Special Committee on Aging: Senators Breaux, Lincoln, Stabenow, Carnahan, Craig, Santorum, and Hutchinson.

Present from Committee on Health, Education, Labor, and Pensions: Senators Mikulski and Dodd.

OPENING STATEMENT OF SENATOR JOHN BREAUX,

CHAIRMAN

The CHAIRMAN. The committee will please come to order. Good

morning, everyone. Thank you for being with us this morning for

indeed a very special opportunity and a special joint hearing of our

Senate Special Committee on Aging joined together with the Subcommittee on Aging of the Senate Committee on Health, Education, Labor and Pensions, chaired by our colleague, Senator Barbara Mikulski, who will be making opening remarks in just a moment.

I think that it is unique that two committees concentrating on

this very important subject have come together to hear from a very

distinguished group of colleagues who have special information and

special concerns about the subject matter before the committee

today.

We are meeting here today because America really is in a crisis.

And the good news is that people are living a lot longer. The bad

news is that people are living a lot longer without adequate longterm health care. So it truly presents a crisis of monumental proportions when you consider that the difficulties we have today will

only be compounded many times over as the 77 million baby

boomers become eligible for senior programs, entitlement programs,

and still face a nation without adequate long-term health care for

our nation’s seniors.

America is clearly the strongest nation in the world, perhaps the

strongest nation in the history of the world, and yet the only really

long-term care program that we have available for our nation’s senVerDate 11-MAY-2000 14:10 Apr 12, 2002 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 C:\DOCS\77850.TXT SAGING1 PsN: SAGING1
2

iors is a program that was never intended to provide long-term

health care for seniors, and that is the nation’s Medicaid program.

The Medicaid program was really a national health program

combined with the Federal Government and the states designed to

really provide health care for indigent low-income seniors. Because

of the absence of any other program, Medicare has become the

main program to provide long-term health care for everybody. So

you find the unusual and unfortunate and oftentimes extremely

embarrassing situation where seniors in this nation have to become

poor so they can enroll in a program where they can find health

care in a program that was never intended to do so.

It is interesting now that Medicaid now pays for about 40 percent of all the long-term health care delivered in this country, and

it was a program that was never intended to do that. So the real

challenge before our country is to find out what solution can we

reach to help our growing number of seniors live not only longer

lives but live better lives, particularly in the last years of their

lives.

So what we are here today is to hear from a special group of our

lady colleagues in our Senate to give us information about their experiences or any ideas or suggestions that they have.

We are truly in a sandwich generation. Everyone in this audience and probably everyone testifying and all of our members up

here know what it is to be in a sandwich generation. My own situation is very similar to millions of other Americans. My mother-inlaw, who has diabetes, had breast cancer, lives with us at our

home. I have a daughter at the same time who is in her third pregnancy and has been bedridden since the very first day, requiring

a great deal of care because she has two small grandchildren—we

have two small grandchildren. She has two small children.

So we are in that sandwich situation where we are taking care

of people in our parent’s generation, my mother-in-law, at the same

time trying to provide assistance to my daughter and her children.

And guess what? My wife does most of it.

You know, that is the situation where we find more and more

Americans in the female population who are providing most of the

care to people who need healthcare in this country. Three-fourths

of all the caregivers are women. And all the problems that that

presents, special needs that they have, is really what we are trying

to talk about today and find out how we as the strongest nation

in the history of the world can do a better job.

This is something that we can no longer ignore and sweep under

the carpet. I am delighted that we have this joint hearing. I am delighted to recognize our good friend and leader in the Senate, the

chairperson of the Senate Committee on Health, Education, Labor

and Pensions, their Subcommittee on Aging. Senator Mikulski,

comments.

[The prepared statement of Senator John Breaux follows:]

PREPARED STATEMENT OF SENATOR JOHN BREAUX

I am pleased to be here today with Senator Mikulski and the Health, Education,

Labor, and Pensions (HELP) Subcommittee on Aging. Hearings such as this to highlight long-term care and caregiving are more important now than ever as we anticipate the retirement of the baby boom generation.

3

I am pleased to have with us our women Senators, representing those that bear

the greatest burden of long-term care and caregiving. I know many of the Senators

testifying today will have their own personal experiences of grappling with these

issues. I also want to welcome the Older Women’s League and the National Alliance

for Caregiving who have been working on these issues for many years and have innovative ideas for addressing them.

Women make up a disproportionate share of caregivers in this country, with very

little public support. For example, women comprise more than 80 percent of the

family caregivers for chronically ill elders. The average American woman can expect

to spend 17 years caring for a child and 18 years caring for an elderly parent. I

know that my own wife has this experience. In addition, women live longer than

men, and therefore will need to personally access long-term care more frequently.

And yet our public policies do very little to provide a network of support to caregivers.

We lack a cohesive long-term care system in this country and we will pay a dear

price for this when the baby boomers retire. What we do have does little to support

long-term care programs that promote independent living such as home and community based care. Addressing the need for a comprehensive long-term care system in

this country requires most of all creating policies that recognize the role of caregivers. Otherwise, we will face a national crisis when the baby boom generaion retires.

Knowing the primary role women play in caregiving and in our long-term care

system, I am pleased to hear from our women Senators who will be integral to this

debate as we seek to create better long-term care policies in this country.

OPENING STATEMENT OF SENATOR BARBARA MIKULSKI

Senator MIKULSKI. Thank you very much, Senator Breaux, for organizing this hearing and for it to be a joint hearing of this Special

Committee on Aging, on which you have provided such wonderful

leadership, as well as our Committee on Health, Education, Labor

and Pensions. We have a Subcommittee on Aging, which I chair,

and my colleague Senator Tim Hutchinson is the ranking member.

We look forward to really working with you and coming up with

a framework and the funding for long-term care because we also

know you are on the Finance Committee, and at the same time I

am the senior woman in the U.S. Senate, I want to thank you for

inviting all of the women of the Senate to participate in this very

unique conversation.

Each and every one of them, as you will soon hear, brings their

own perspective, their own expertise, and their own recommendations for solutions.

We the women of the Senate do not have a caucus, but we meet

regularly to brainstorm on how we can look out for the day-to-day

needs of the American people, convert that into public policy, and

at the same time look at the long-range needs of our country in

terms of national security, economic security, and health security.

So I am glad that you have the women’s brigade here today, and

I am looking forward to hearing from my own colleagues and introducing them. Like you, Senator, my own family has faced the crisis

of long-term care. My very dear father suffered from Alzheimer’s.

My family and I watched him die one brain cell at a time. This was

the man who saw to our education, took me to cowboy movies and

bought me those good old cowgirl boots when I wanted to be a Dale

Evans. When a fire took his own business away from him and as

he rebuilt his business, he and my mother sacrificed for me to go

to college.

How heartbreaking it was to see the man who cared for me and

protected me now needed my care and my protection along with my

sister’s and my mother. What we saw was like all families; what

4

did we find when we saw what we needed in terms of long-term

care? We believe that the family is the first caregiver and ought to

remain so. But America’s families face a fragmented system. They

do not know where to go and often where to start when they face

the needs of a family member who has a chronic and often progressive illness like Alzheimer’s or Parkinson’s.

They also then are shocked by how expensive it is, and that no

matter how hard they work, no matter how hard they saved, no

matter how hard they prepared, that in order to qualify for any financial help from anywhere that they had to spend down.

So here they are, bewildered, overcome with grief about the situation, not knowing where they can go to get help, and not knowing

where they can get help to pay for the help. We have got to give

help to those who practice self-help and support the American family. In our own situation, I had access to the resources of Johns

Hopkins Hospital where I could take my dad for a geriatric evaluation to make sure we had the right evaluation for his situation.

We had hoped that it was a vitamin deficiency, and all he needed

was vitamins and for the family to pitch in and send mom and dad

on a love boat cruise. Alzheimer’s was the diagnosis.

But we used other support services like adult day care before we

had to face the need for a nursing home when dad became so ill

the family was facing that incredible 36-hour day that Alzheimer’s

families face. So we need to really come back to the family and how

we can support them.

I believe that honor your father and mother not only is a good

commandment to live by, but a good policy to govern by. Almost

the only down payment we have had on long-term care was the

Spousal Anti-Impoverishment Act that I authored in the U.S. Senate in my very first term with the wonderful help on a bipartisan

basis of the Finance Committee.

AARP tells us we have kept one million people out of poverty and

prevented liens on the family farm or the home because of that. We

have also worked on a bipartisan basis with Senator Hutchinson,

Senator Gregg, Senator Jeffords, Senator DeWine, and Senator

Kennedy to create the National Family Caregiver Support Program

under the Older Americans Act. That is to provide information and

assistance, counseling and support groups, respite care and supplemental services to family caregivers.

We have tried to take a look at the VA because everywhere we

go when they talk about veterans healthcare, they now talk about

long-term care. The greatest generation in America is faced with

wondering how they are going to pay for their prescription drugs,

and how are they going to pay for their long-term care. And we

have had a quiet program going on at the Veterans Administration.

I think we need to be louder about it.

So, Mr. Chairman and colleagues, I think we have tools with

which we can give help to those who practice self-help, and particularly to those Americans who have gone before us and saw us

through tough times, and we need to be sure that now when they

have their tough times, we need to get going and support them. So,

Mr. Chairman, I look forward to the rest of the hearing.

[The prepared statement of Senator Mikulski follows:]

5

PREPARED STATEMENT OF SENATOR BARBARA A. MIKULSKI

I’m very pleased to join with Senator Breaux to bring together the women of the

Senate, the Subcommittee on Aging, and the Special Committee on Aging to focus

on women, long-term care, and caregiving. I’m also pleased to welcome Ms. Gail

Gibson Hunt, Executive Director of the National Alliance for Caregiving in Bethesda, Maryland.

Many Americans do not think about their long-term care needs until a tragedy

strikes. When a person needs long-term care, it is a tragedy for the person who is

ill, for the family who is the caregiver, and for the taxpayer who has to share the

burden.

My dear father suffered from Alzheimer’s disease. My family and I watched him

die one brain cell at a time. I know what families live through when a loved one

ages and needs more care, eventually more than you alone can provide. Everywhere

I travel around Maryland, people come up to me and tell me what a big issue longterm care is for their family.

Women are more often the ones who provide care to loved ones and who eventually need care themselves. Three-quarters of caregivers are women. Women live

longer than men and are more than twice as likely to live in a nursing home. Caregivers and their families face mental, emotional, physical, and financial stresses and

strains. Some caregivers work three shifts—caring for children, working a full-time

job, and caring for an elderly parent at home.

In the 20th century, we made more scientific and medical breakthroughs than we

have during any other century in American history. People are living longer. More

Americans can remain in their homes and communities, delaying or preventing institutionalization. But our country’s approach to caring for this growing number of

aging Americans is piecemeal and fragmented. We have some good down payments

to build from, but we must do more.

I believe that honoring your mother and father is not only a good commandment

to live by, but also good public policy to govern by. One of the accomplishments that

I am most proud of is my Spousal Anti-Impoverishment Act. From my own family’s

experience, I saw how cruel rules forced elderly couples to go bankrupt before they

could become eligible for Medicaid to help pay for nursing home care. I changed

those rules so that a spouse living in the community could keep enough income to

pay the bills and live at home, while the other spouse is in a nursing home.

I fought hard on a bipartisan basis to establish and fund the National Family

Caregiver Support Program under the Older Americans Act. It provides information

and assistance, respite care, counseling and training, support groups, and supplemental services to caregivers who need them. These are vital supports to thousands

of caregivers across the country.

I’m also the Senator for the VA. One of the biggest future needs of the VA health

care system is long-term care. There is a great desire for these services. States are

building VA nursing homes, but there is no continuum of care. There must be assisted living and other ways for veterans to be able to live their last years with their

families and age in place. On the Medicare side, some of our biggest budget battles

have involved Balanced Budget Act givebacks to nursing homes, home health care

agencies, and other providers who care for our aging population.

Our first responsibility is to the family and those that practice self-help. Tax credits, spousal anti-impoverishment, long-term care insurance for Federal employees,

and the National Family Caregiver Support Program are parts of what should be

the long-term care mosaic. But many pieces are missing—there is no comprehensive

approach. First there is the family caregiver, but no one can care for someone by

themselves for years and years. Family caregivers need advice, counseling, and support. Helping those who plan and practice self-help is a downpayment. But we must

do more. This is about getting behind our nation’s families.

I look forward to hearing from the other women Senators and all our witnesses

for their insights and ideas about the best ways to help women and families better

prepare for the burdens of long-term care.

The CHAIRMAN. Thank you very much, Senator Mikulski. Any

comments, Senator Hutchinson?

6

STATEMENT OF SENATOR TIM HUTCHINSON

Senator HUTCHINSON. Yes, thank you, Chairman Breaux and

Senator Mikulski. I am pleased to serve as your ranking member.

This is an excellent statement and you are absolutely right. The

way we best honor our parents, our mothers and our fathers, is not

in word, but in deed, and that is being done by millions and

millions of caregivers, who are primarily women. I want to thank

you for holding this hearing and highlighting the role of women as

caregivers.

Recent results, and to me this was stunning, of a survey

conducted by Bruskin Research for the National Family Caregivers

Association, the NFCA, shows that the number of persons who provided care for an elderly, disabled or chronically ill friend or relative during the past year is more than twice as large as what had

been previously thought.

Survey results indicate that 26.6 percent of the adult population

was involved in caregiving during the last 12 months, and that

translates into about 54 million people, of whom over 60 percent

are women.

So I am very pleased to have this very distinguished panel of our

colleagues here today. I know Senator Lincoln, my colleague from

Arkansas, will elaborate on this, but in Arkansas, almost one-quarter million caregivers provide assistance to friends or family members, and if that were paid through insurance, it would cost taxpayers and policyholders over $1.8 billion a year, according to our

Department of Health in the State of Arkansas.

Most of this caregiving is given willingly and given lovingly, and

it is a rewarding experience, but caregivers face many, many challenges. Poor health, depression, a sense of burden, concerns over financial costs are common among caregivers. Most over half of caregivers, work outside the home in order to help pay for out-of-pocket

expenses because there is no public assistance available.

Long-term care is an increasingly important issue, as we all

know, as we go into the 21 century, as the baby boomers age. It

is going to impact all of us. This is an issue that deserves our full

consideration and attention, and I applaud Chairman Breaux and

Chairwoman Mikulski for holding this hearing today.

[The prepared statement of Senator Tim Hutchinson follows:]

PREPARED STATEMENT OF SENATOR TIM HUTCHINSON

Chairman Breaux, Chairwoman Mikulski, I want to thank you for holding this

hearing highlighting the role of women as caregivers.

Recent results of a survey conducted by Bruskin Research for the National Family

Care-givers Association (NFCA) shows that the number of persons who provided

care for an elderly, disabled or chronically ill friend or relative during the past year

is more than twice as large as previously thought.

Survey results indicate that 26.6 percent of the adult population was involved in

caregiving during the past 12 months. Based on Census data, this translates into

approximately 54 million people, over half of whom (at least 60 percent) are women.

Family members and other informal caregivers are the main fabric of our longterm care system in the United States. In most cases, they provide uncompensated

care to family or friends with chronic illnesses or disabilities.

In Arkansas, almost one quarter million caregivers provide assistance to friends

or family members, and if paid for through insurance would cost tax payers and policy holders over $1.8 billion annually (according to the Arkansas DHS Division of

Aging and Adult Services).

7

Most caregiving is willingly undertaken and can be a rewarding experience for the

giver. But caregiving can also result in great financial, physical, and emotional

hardship—a burden which is borne primarily by women. Women on average live at

least seven years longer than men, and they comprise 70 percent of the population

age 85 and older.

Caregivers commonly experience poor health, depression, and a sense of burden.

Concerns over the financial costs of caregiving are a major source of worry for many

middle-income caregivers. They are often not eligible for public assistance, but cannot afford the out of pocket expenses associated with such care.

It is estimated that as many as 50 percent of family caregivers also work outside

the home which can potentially result in work disruptions and lost productivity,

both personally and in the workplace.

Caregiving will continue to be an issue well into the 21st century as the baby

boomer generation ages. This has brought the concerns of caregivers into the public

policy debate both on Capitol Hill and in State Legislatures around the country.

Many decision makers in both the public and private sectors are even themselves

directly or indirectly affected by this issue, as we will hear more about today.

This is an issue that deserves our full consideration and attention.

The CHAIRMAN. Thank you, Senator. Senator Dodd, any comments?

STATEMENT OF SENATOR CHRISTOPHER DODD

Senator DODD. Well, Mr. Chairman. We have a big panel with

us here this morning. Let me just ask unanimous consent that I

will be able to put a statement in the record and to commend both

of our colleagues here for holding this hearing, and thank our distinguished panel of colleagues and witnesses who are going to

share some thoughts with us.

This is a wonderful subject matter for us to be engaged in here

in the Senate, and obviously the statistics speak for themselves.

The numbers leap out at you. Rhetoric is wonderful, but just you

read the numbers and the problem is clearly evident. When you are

talking about 70 million Americans in the next 30 years that will

be over the age of 65, over 85 years of age the fastest growing segment in the country, and then looking at the disproportionate number of women who are already but will be asked to bear the responsibility of caring not only for themselves, because they will live so

much longer than their husbands. They will spend 17 years, the

average woman does, caring for children and 18 years caring for a

husband or a parent.

So it is pretty startling, the numbers, and clearly cries out for

some solutions. I would just mention briefly, I have often said there

are many things each one of us can claim, that we are proud of

having served in public life, but as long as I live I will never forget

the day in February 1993 when I stood in the Rose Garden of the

White House and watched President Bill Clinton sign the very first

law that he signed into law, the Family and Medical Leave Act,

which many of my colleagues here made possible.

And that little piece of legislation which said you did not have

to lose your job if you took care of somebody, including a parent.

It is unpaid leave and so it is awkward for people living with limited means, and we are trying to draft legislation now to make this

paid in some way without obviously putting tremendous burdens

on people, but it ought to be available to people who are living on

the margins economically as well.

But the FMCA and the legislation that Senator Mikulski has

talked about, the National Family Caregiver Support Program,

8

have made a difference for an awful lot of Americans, and we need

to try and figure out how we can make that available to more and

more people. So I thank you both for doing this.

[The prepared statement of Senator Dodd follows:]

PREPARED STATEMENT OF SENATOR CHRISTOPHER DODD

Chairwoman Mikulski and Chairman Breaux, thank you for convening this important joint hearing. As we now know, over the next 30 years, our nation will

dramaticaly change as the baby boom generation enters their retirement years. By

2030, the number of those aged 65 and older will more than double to an astounding

70 million Americans. Also, the number of those age 85 and older is expected to

grow faster than any other age group. And as this morning’s hearing will make evident, the problem’s presented by the aging of America are particularly critical for

women, as they represent a growing majority of the population as age increases

above the age of 65. Recognizing this, the role of women as both caregivers and recipients of long-term care services as they age themselves is a matter of great concern and I appreciate the opportunity to examine this critical issue.

As we’ll learn today, the majority of those that provide care for our elderly are

women. In fact, research shows us that approximately 75 percent of those providing

care to older family members and friends are women. And even though some studies

show a relatively equitable distribution of caregiving between men and women, the

same studies tell us that women caregivers spend 50 percent more time providing

care than their male counterparts. Combined with the fact that women also represent a significant majority of our elderly population, it is clear why this morning’s

hearing is so important. As both caregivers and recipients of care themselves, any

examination of the issue of how to best care for our senior citizens must consider

the important role of women in long-term care. Already lacking, the need for increased access to valuable long-term care services will only become more critical for

many of our nation’s seniors. This is clearly a problem that is not going to go away.

Today, women are thrust into many demanding roles, such as mother, professional, doctor, researcher, teacher, and caregiver. As statistics have shown us, it is

women who mostly take on the role as caregiver. They willingly take on the responsibility of providing care for loved ones, seeking information, listening, often taking

on financial responsibilities, along with their many other responsibilities. This is

laudable—though often thankless—very difficult work. Those that provide care to an

elderly family member or friend need to be recognized and supported for the valuable work that they are doing. Providing assistance to another is one of the greatest

gifts that a person can give. I believe that the federal government should do all

within its power to support long-term caregivers and examine new ways to support

their efforts.

I was particularly pleased to have the opportunity to author the Family and Medical Leave Act (FMLA)—legislation that has afforded millions the chance to take valuable time away from work so that they can care for a sick or elderly family member. The FMLA grants the opportunity to caregivers to take up to 12 weeks of unpaid leave during any 12-month period to care for an immediate family member

with a serious health condition. When I first began looking at the issue of family

and medical leave, I was surprised to learn how many among us take on the responsibility of caring for a sick or elderly family member. In fact, a study conducted in

my state of Connecticut last year asked participants, ‘‘during the past month, did

you provide regular care or assistance to a family member or friend who is elderly

or has a long-term illness or disability to someone 60 years or older?’’ Approximately, 15.2 percent or roughly 382,000 of Connecticut’s adults are engaged in elder

care in any given month.

The problem of insufficient long-term care resources has both great present and

long-term implications. A decade from now, we know that the baby boom generation

will begin to retire. With this our healthcare systems will be placed under tremendous strain. Clearly this is a problem that we must begin to think about today. I

look forward to hearing from our witnesses this morning concerning the question

of how to best develop a comprehensive long-term care infrastructure.

So, it is with great interest that I attend this morning’s hearing. I am also particularly interested in other issues that will greatly affect our nation’s senior citizens in the future. Access to prescription medicines, Social Security and Medicare

reform, and access to safe and affordable long term care services are all issues that

must be closely examined if we as a society are going to be prepared for the great

increase in aged Americans.

9

The one thing I am sure of, is that if we do nothing to address this problem, it

is our own loved ones requiring long-term healthcare that will suffer. At its core,

our discussion this morning is about the quality of care we provide to some of the

most vulnerable among us. We owe it to both our seniors and those that provide

for their care to address this problem.

The CHAIRMAN. Thank you, Senator. Senator Santorum.

STATEMENT OF SENATOR RICK SANTORUM

Senator SANTORUM. I too will put a statement in the record in

deference to my colleagues who are here who have prepared testimony. I just want to congratulate you for holding this hearing. We

have a huge problem right now, but as Senator Dodd alluded to,

it is going to get much, much bigger. We are going to see an 80

percent increase in the number of elderly in this country over the

next 20 years, 80 percent increase.

And as Chris said, the fastest growing group of people in America are people over the age 85. I had a little girl a couple of years

ago. I found out at that time that she has a one in three chance

of living to be 100, and one in six women in this country alive

today will live to be 100. This is an incredible problem that is out

there that is not—obviously the human cost is obvious, but the economic implications for our economy and with women such a vital

part of our workforce and the burden that we are placing on

women as a result of the aging population. It is a big issue. It is

an important topic, and the point that I just want to stress here,

it is not that bad right now compared to what it is going to be like

10, 20, 30 years from now.

And we really need to look at this in a comprehensive basis and

see what we can do about it, and I want to congratulate you for

doing this and all of you for testifying. Thank you.

[The prepared statement of Senator Santorum follows:]

PREPARED STATEMENT OF SENATOR RICK SANTORUM

Thank you, Chairman Breaux, Chairwoman Mikulski, fellow colleagues, and invited guests. If there is one thing that unites all of us here today, it is perhaps the

sentiment that this hearing could not be more timely or necessary.

We all know of the tremendous fiscal pressures that the coming baby boom retirements will impose on our public healthcare and retirement programs, and that steps

we take today to reform programs like Medicare and Social Security will go a long

way to help meet the needs of our beneficiary population down the road.

But a far less understood attendant policy challenge stemming from our aging society is the growing costs and need for long-term care services, and the unique factors that come into play with regard to the well-being of women. So I again thank

the Committee members for holding this forum today.

Perhaps more than any other socioeconomic group, women are disproportionately

affected by long-term care. For many centuries, women have served as the traditional, primary caregivers of long-term health care. Today, women still bear the responsibility of caring for their parents or loved ones when they need attention.

And due to the fact that women are living longer than men, they are more likely

to develop the sort of functional ailments that require long-term care services.

Today, the average woman can expect to live some seven years longer than her male

counterpart (to the age of 80 from birth, and to 85 if she surpasses 65 years of

age)—all the while increasing her demand for vital long-term health care that

ranges from help with day-to-day activities to sophisticated therapies. In addition,

more women are working outside the home than ever before, and with those professional responsibilities come the personal responsibilities of essentially serving as another parent to some loved family member. So we are witnessing a confluence of

disturbing trends that comprise the challenges that are currently facing and will

continue to face women and long-term health care services.

10

The social costs of emotional strain and anguish that often arise when daughters,

granddaughters, sisters and nieces are faced with such burdens are concerning in

and of themselves, to say nothing about such burdens’ effects on personal financial

well-being and productivity in our economy.

I know that there are numerous proposals that many Members of Congress and

President Bush has put forth to help ease the financial burdens of financing longterm care. Many of these are bipartisan ideas, and have a lot of merit, such as providing a tax deduction for long-term care premiums, giving employees the opportunity to purchase group long-term care insurance policies through their cafeteria

plans, and offering tax credits to help qualifying caregiving families pay for supplies, home improvements and other services so vital to keeping a loved one at

home.

As for my own efforts, one facet of the long-term care equation in which I am particularly interested and on which I have been working with Senators Rockefeller,

Lincoln, and McConnell is legislation to allow Medicare home health beneficiaries

the option to receive some or all of their Medicare home health services in an adult

day setting. The idea behind the Medicare Adult Services Alernative Act is to allow

caregivers more flexibility in attending to other things in today’s fast-paced family

life, knowing their loved ones are well cared for in a social and thereapeutic setting.

I look forward to hearing the experiences and perspectives that each of these witnesses will provide. And I hope that they will help illuminate the issues facing

women and long-term care, and help us identify what immediate and longer-term

steps we may take to prepare our country for the increasing costs and need for longterm care services.

The CHAIRMAN. Thank you. Thank all of the members of the committee, and I wanted to add that when I was talking about my wife

taking care of my mother-in-law, and our children, she also has the

real challenge of trying to take care of me, which is probably the

biggest problem of all.

Senator DODD. I was going to make that point. [Laughter.]

The CHAIRMAN. She is also doing that which is a real challenge.

And women find themselves as homemakers in many, many cases

trying to do all of that and which is incredible.

We have a very distinguished group of our colleagues and we are

just delighted. I will try and introduce them first as they arrive.

I was going to say that our colleague from Arkansas, Senator

Blanche Lincoln, and I are joined at the hip. I mean I want to

make it clear it is the political hip. [Laughter.]

And we are members of the New Democrats together, the Centrist Coalition together. She is a member of the Aging Committee.

She is a member of our Finance Committee. So we work very closely together on a regular basis. I am delighted for her leadership

and pleased to have her comments. Blanche.

STATEMENT OF SENATOR BLANCHE LINCOLN

Senator LINCOLN. Thank you. Well, a very special thanks to you,

Mr. Chairman, and to Chairwoman Mikulski, for having the foresight of bringing this very important issue up. It is certainly a

pleasure to testify today, and we want to thank you all and both

of the committees and the members of the committees for their

hard work on this very important issue.

I am glad to be in the company of other women senators on such

a distinguished panel that I sit with here, sharing our experiences

and our point of view. As we all know, the face of caregiving is female. Caregiving for the elderly and children falls predominantly

to women in our society. In our society, we women care for our children, our parents and often our husband’s elderly relatives.

Caregiving is an issue I care about deeply. Over the past year,

I have hosted several forums on aging, long-term care, and

11

caregiving issues in Arkansas. Arkansas ranks fifth highest for its

population of 55 plus seniors and second for the percentage of seniors living in poverty. Three out of five elderly Arkansans are

women.

As a baby boomer, I consider myself part of that sandwich generation that Senator Breaux mentioned, a group obviously responsible for caring for children and aging parents simultaneously. And,

in fact, I am actually a part of another group called the ‘‘club sandwich’’ generation, whose members are also taking care of their

grandparents. My husband’s grandmother is now 104, living in an

assisted living apartment and unbelievable in terms of her abilities

to get around.

But it certainly does put us in a situation of not only having a

generation on either side, but a second generation on either side of

those generations. I am a proud mother of twin 5-year-old boys who

are extremely active, and as any parent knows, just keeping up

with two small children is as challenging as it is rewarding, and

I know that Senator Dodd can add to that a great deal since his

recent appearance on the scene of fatherhood.

But, obviously, my typical day of making sure that lunches are

packed, both for my husband and my children, meeting a bus, getting children to school, making sure that meals are planned so that

we do have somewhat of a resemblance of a normal family home

in terms of sitting down to dinner, involvement with getting kids

to soccer and karate practice. Thank goodness for cell phones because in addition to my two boys and my husband, I also help monitor the health of my aging parents, particularly my 73-year-old father who is in the later stages of Alzheimer’s disease, and more important, his primary caregiver, which is my mother.

And I know you all will not believe this, but she is an extremely

strong-willed woman and very independent-minded. Don’t know

where it comes from. [Laughter.]

But it is often difficult as we deal with our parents and those

who are caregivers. We must consider not only their sense of independence, but their sense of pride and their ability to provide dignity to the individual that they are taking care of. As Senator Mikulski brings to mind, the idea of looking at someone who in my

lifetime has been that strong provider, the one who taught me how

to fish or how to scalp cotton and chop soybeans, the man who was

there for me at every turn in my life, now recognizing that he

needs almost every second of his day to be cared for by one of us.

And I can tell you from personal experience that these responsibilities can seem awesome at times, not only from the physical

strength that is called upon by my mother in order to be a primary

caregiver, but also certainly the emotional strength. I know that I

am not alone in this, so I have been an advocate for passing legislation supportive of the growing number of frail elderly Americans as

well as their caregivers.

As a member of the Finance Committee and the Special Committee on Aging, I have a special interest in working with others here

in the U.S. Senate to prepare healthcare providers and Medicare

for the inevitable aging of America. I think the numbers that were

mentioned by all of our colleagues in their opening statements, parVerDate 11-MAY-2000 14:10 Apr 12, 2002 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 C:\DOCS\77850.TXT SAGING1 PsN: SAGING1
12

ticularly Senator Santorum on the 80 percent of where we are

going, is just phenomenal.

We also have the Geriatric Care Act of 2001, which calls for increasing the number of geriatricians in our country through training incentives and Medicare reimbursement for geriatric care.

Our nation’s healthcare system will face unprecedented pressure

as our population grows older. Demand for quality care will increase and we will need physicians who understand the complex

health problems that aging brings. I had a phone call from a constituent the other day in Jonesboro, AR who is caring for her aging

husband, and she had been seeing five different physicians in five

different places.

She had finally discovered the Don Reynolds Center on Aging in

Little Rock, and she called me with unbelievable delight that she

had actually found a place where she could take her husband and

all of her needs could be met.

The doctors talked to one another. The physicians as well as all

of the other medical professionals talked and exchanged ideas and

concerns about that one patient in order to give them the ultimate

of care. As seniors live longer, incidences of disease and disability

increase. Conditions such as heart disease, cancer, stroke, diabetes,

and also Alzheimer’s disease occur more frequently as people age.

The complex problems associated with aging require special

training of physicians in geriatrics. Geriatric medicine provides the

best healthcare for frail older persons.

Geriatrics promotes wellness and preventive care with an emphasis on care management and coordination that helps patients maintain functional independence, improve their overall quality of life,

and reduce unnecessary and costly hospitalization, institutionalization and other complications.

Today, there are fewer than 9,000 certified geriatricians in the

United States. Only three medical schools in our country, the University of Arkansas for Medical Sciences being one of them, have

a department of geriatrics. This is incredible considering that all

125 medical schools in our country have departments of pediatrics.

Why would only three of them have a department in geriatrics?

The number of geriatricians is expected to decline dramatically

in the next several years. In fact, most of these doctors will retire

just as the baby boomer generation attains Medicare eligibility.

I will speak more about my bill later this month in a Special

Committee on Aging hearing devoted solely to that issue, but I encourage my colleagues to look at it and the great need that we have

out there. I have also supported enactment of other legislation to

assist caregivers and to help our growing elderly population to prepare for their long-term care needs.

I helped enact the National Family Caregivers Act which will

provide funding to help caregivers gain access to support groups,

counseling and respite care. I appreciate the work that Senator

Collins did on that bill and that she worked with us on it. What

is important about this bill is that it focuses squarely on the caregivers in the family, most often the daughters and wives who make

tremendous sacrifices to care for their spouses, parents, and loved

ones in their senior years.

13

By helping these caregivers get the support they need, we open

the door for more effective care and create greater opportunities for

people to age in their homes rather than in nursing homes or institutions. Recently, we also made long-term care insurance available.

Senator MIKULSKI. Senator Lincoln, we do not want in any way

to limit your testimony. The time has expired, and Senator Murray

has to leave.

Senator LINCOLN. Certainly. What I would like to emphasize in

my testimony today, as well as in my written remarks, as I refer

to pieces of legislation, is that in these legislative remedies we are

looking for innovative and creative ways of addressing our seniors’

needs in long-term care.

Our hope is is that we can keep our loved ones in their homes

and that we will look for those innovative ways through legislation

in order to be able to make that happen. Thank you.

[The prepared statement of Senator Lincoln follows:]

PREPARED STATEMENT OF SENATOR BLANCHE LAMBERT LINCOLN

Good morning. It is my pleasure to testify today. I want to thank Senators Breaux

and Mikulski for calling for this hearing on such a significant topic. I am glad to

be in the company of other women senators, sharing our experiences and our points

of view. As we all know, the face of caregiving is female. Caregiving for the elderly

and children falls predominantly to women in our society. In our society, we women

care for our children, our parents, and often our husband’s elderly relatives.

Caregiving is an issue I care about deeply. Over the past year, I have hosted several forums on aging, long-term care, and caregiving issues in Arkansas. Arkansas

ranks fifth-highest for its population of 55-plus seniors and second for the percentage of seniors living in poverty. Three out of five elderly Arkansans are women.

As a baby boomer, I consider myself part of the ‘‘Sandwich Generation’’ a group

responsible for caring for children and aging parents simultaneously. In fact, I belong to the ‘‘Club Sandwich Club,’’ whose members are also taking care of their

grandparents. My husband’s grandmother is now 104 years old.

I am the proud mother of twin 5-year-old boys. As any parent knows, just keeping

up with two small children is as challenging as it is rewarding. In addition to my

boys, I also help monitor the health of my aging parents particularly my father, who

is in the later stages of Alzheimer’s disease.

I can tell you from personal experience that these responsibilities can seem awesome at times. I know that I am not alone in this, so I have been an advocate for

passing legislation supportive of the growing number of frail elderly Americans and

of caregivers.

As a member of the Finance Committee and the Special Committee on Aging, I

have a special interest in preparing health care providers and Medicare for the inevitable aging of America. I am the author of the Geriatric Care Act of 2001, which

calls for increasing the number of geriatricians in our country through training incentives and Medicare reimbursement for geriatric care. By improving access to

geriatric care, the Geriatric Care Act of 2001 takes an important first step in modernizing Medicare for the 21st century.

Our nation’s healthcare system will face unprecedented pressure as our population grows older. Demand for quality care will increase, and we will need physicians who understand the complex health problems that aging brings. As seniors

live longer, incidences of disease and disability increase. Conditions such as heart

disease, cancer, stroke, diabetes and Alzheimer’s disease occur more frequently as

people age.

The complex problems associated with aging require special training of physicians

in geriatrics. Geriatricians are physicians who are first board certified in family

practice or internal medicine and then complete additional years of fellowship training in geriatrics. Certified geriatricians pass a certificate of added qualifications administered by either the American Board of Internal Medicine or the American

Board of Family Practice.

Geriatric medicine provides the best healthcare for frail older persons. Geriatrics

promotes wellness and preventive care, with an emphasis on care management and

coordination that helps patients maintain functional independence, improve their

14

overall quality of life, and reduce unnecessary and costly hospitalizations, institutionalization and other complications.

Given our seniors’ dependence on prescription drugs, it is increasingly important

that physicians know how, when, and in what dosage to prescribe medicines to older

persons and have knowledge of possible interactions with other medications.

Today, there are fewer than 9,000 certified geriatricians in the United States. Of

the approximately 98,000 medical residency and fellowship positions supported by

Medicare in 1998, only 324 were in geriatric medicine and geriatric psychiatry. Only

three medical schools in the country the University of Arkansas for Medical Sciences

(UAMS) being one of them have a department of geriatrics. This is incredible, considering that all 125 medical schools in our country have departments of pediatrics.

The number of geriatricians is expected to decline dramatically in the next several

years. In fact, most of these doctors will retire just as the baby boomer generation

attains Medicare eligibility. I will speak more about my bill later this month in a

Special Committee on the Aging hearing devoted solely to this issue.

I have also supported enactment of other legislation to assist caregivers and to

help our growing elderly population to prepare for their long-term care needs. I

helped enact the National Family Caregivers Act, which will provide funding to help

caregivers gain access to support groups, counseling, and respite care. What’s important about this bill is that it focuses squarely on the caregivers in the family most

often the daughters and wives who make tremendous sacrifices to care for their

spouses, parents, and loved ones in their senior years. By helping these caregivers

get the support they need, we open the door for more effective care and create greater opportunities for people to age in their homes, rather than in nursing homes or

institutions.

Recently, we also made long-term care insurance available to Federal employees.

This is a major step forward in making long-term care insurance affordable and accessible for as many as 13 million people. That’s 13 million people who will have

an opportunity to protect themselves and their families against financial ruin as

they age. What’s also important about this law is that it’s going to serve as a benchmark for the private sector. The government is setting a standard by offering this

insurance, and I’m confident that we have created a model that industry will want

to follow.

Also, I co-sponsored the Long-Term Care Security Act, which will allow taxpayers

to deduct the cost of long-term care insurance premiums and would provide tax

credits for long-term care expenses.

An initiative I am also interested in pursuing is doing more to shift a greater portion of Federal funding from institutional care to community-based care. Currently,

we spend 75 percent of federal dollars on institutional care. We must create opportunities for home care, adult day services, and hospice centers to flourish. By channeling more federal funding to these community-based services, we can develop a

variety of options for care that are more responsive to the needs of our seniors.

Adult day services meet an essential element in the continuum of care for elderly

persons. Last year, the Arkansas Center for Health Improvement was asked by the

Arkansas Division of Aging and Adult Services in collaboration with the Robert

Wood Johnson Foundation to develop information on the status of adult day services

in Arkansas. I was disturbed by the finding that the general public has a very limited knowledge of the program and that many health care providers have a limited

understanding of adult day services as a community-based option to nursing home

or residential care facilities. We must do more to make sure that the elderly and

those providing their care are aware of community-based services, such as adult day

services.

I am also concerned that our Nation’s veterans and their dependents may not be

fully aware that they are entitled to benefits and services through the Department

of Veterans Affairs. One of the most important benefits the VA provides is comprehensive health care, including low-cost prescription medications. Last year I submitted a Senate resolution calling on the Secretary of Veterans Affairs to work with

the Commissioner of the Social Security Administration to better inform the Nation’s veterans and their dependents about benefits available from the VA.

What I want to emphasize in all of these legislative remedies is that we’re looking

for innovative and creative ways of addressing our seniors’ needs for long-term care.

Whether it’s tax credits, deductible insurance premiums, community-based care, or

focusing on caregivers, we need to find new ways to encourage people to prepare

for their long-term care needs and to explore options besides institutions.

Again, I am grateful to Senators Breaux and Mikulski for organizing this hearing.

I also appreciate sitting beside other women senators who each bring a unique perspective to their duties in the Senate, and particularly on the issue of women and

caregiving. I look forward to working together to come up with workable solutions.

15

Senator MIKULSKI. Thank you and we will look forward to your

hearing as well and your ongoing and continued leadership.

I am apprised that Senator Murray has to leave, and I would like

to suggest that she speak and then Senator Collins to make sure

the other party gets a chance to speak, and I would like to bring

to the committee’s attention that Senator Snowe might be appearing, but both Senator Snowe and Senator Kay Bailey Hutchison

have had long-standing leadership in this area.

The CHAIRMAN. Well, Senator Murray, obviously, thank you very

much for being with us. I mean you have been a leader in this area

on the Senate Health, Education, Labor, and Pension Committee,

and you have a story that we are aware of, and we look forward

to hearing you and know that you have been a terrific leader in

this area, and thanks for participating. Patty.

STATEMENT OF SENATOR PATTY MURRAY

Senator MURRAY. Thank you very much, Chairman Breaux,

Chairman Mikulski, for your leadership on this issue and for calling this very important and unique hearing. When I look at the

issues of long-term care, I really think back to my own experiences

in my family, starting with my mother.

My mother was my hero. She was the best basketball player at

five feet tall on her team when she grew up in Butte, MT. She

went to college to become a pharmacist. She loved every Notre

Dame team and could name all the players and list all of the

scores.

She raised seven kids on a shoestring budget. When I was 15

with siblings ranging in age from one to 16, my father was diagnosed with multiple sclerosis and had to quit his job and soon became wheelchair bound and homebound. My mom went back to

work, she got every one of us off to college, and she worked full

time as my dad’s caregiver.

When other moms were taking trips to Hawaii after their kids

were grown, my mom was lifting my dad out of bed and dressing

him every single morning. When my mom’s friends learned to play

bridge and golf, my mom learned how to get a motorized wheelchair in and out of a car.

When other moms cared for their new grandchildren, my mom

was making dinner and feeding my dad. My mom never became a

pharmacist. She only took one trip in her life, and that was here

to Washington, DC., when her daughter became a United States

Senator.

My mom never went to the opera, saw a movie, or went to lunch

with her friends, and, you know, she never complained, even when

it affected her own health. She accepted her role as a caregiver, but

I think for many families, like my own, caregiving is cloaked in silence. Caregivers like my mom cannot speak out for one simple reason: they do not want the person they are caring for to ever feel

that they are a burden. So we have to speak out for them.

Today, both my parents are gone, but thousands of people at

home are silently taking care of someone they love, and they need

us to speak out. I see two proposals that I think could help.

First, we need to double funding for the Family Caregiver Support Program. Senator Mikulski has proposed this and I strongly

16

support it. Second, I think we need a respite care benefit under

Medicare. You will recall that in 1997 President Clinton proposed

that idea and it would provide really needed support and relief for

family members who are caring for a relative in their home. Even

if it only provides up to 72 hours of respite care a year, I can assure you it would be a life line for thousands of families. Seventytwo hours a year for my mom would have been an incredible miracle.

My mother was a hero because she worked in silence, but today

we can break that silence and give families the support they need

as they care for loved ones. I am very grateful to you, Chairman

Breaux, Senator Mikulski, members of this committee, for holding

this hearing and allowing us to do the right thing for so many people who are caring for a family member in silence. Thank you.

The CHAIRMAN. Thank you very much, Senator Murray, and we

appreciate your being with us, and if you do have to depart, of

course, we understand that.

[The prepared statement of Senator Murray follows:]

PREPARED STATEMENT OF SENATOR PATTY MURRAY

Thank you Chairman Mikulski and Chairman Breaux for your leadership on this

issue and for calling this unique hearing. When I look at issues like long term care,

I think back to my own experiences in my family starting with my mother. My

Mother was my hero. She was the best basketball player on her team where she

grew up in Butte, MT. She went to college to become a pharmacist. She loved every

Notre Dame team and could name all the players and could recite all the scores.

She raised 7 kids on a shoestring budget.

When I was 15, my Dad was diagnosed with Multiple Sclerosis and had to quit

his job, so Mom worked. She got every one of us kids off to college, and then she

worked full time as my Dad’s caregiver. When other mothers were taking trips to

Hawaii after their kids were grown, my mom was lifting my dad out of bed and

dressing him every single morning. When her friends learned to play bridge and

golf, my mom learned how to get a motorized wheel chair in and out of the car.

When other moms cared for grandchildren, my mom was making dinner and feeding

my dad.

My mom never became a pharmacist. My mom only took one trip—one that she

treasured forever——when she came to Washington DC to see her daughter become

a U.S. Senator. My mom never got to go to the opera, or see a movie with friends,

or go out to lunch with her neighbors. You know: she never complained even when

it affected her own health. In my memory, she was one of the happiest people alive.

She accepted her role as a caregiver. But I think for many families like my own,

caregiving is cloaked in silence.

Caregivers like my mom can’t speak out for one simple but important reason: they

don’t want the person they are caring for to ever feel they are a burden. So we must

speak out for them.

Today both my parents are gone. But thousands of people are at home today silently taking care of someone they love. They need us to speak out. And I see two

proposals that could help.

First, we should double funding for the family caregiver support program. Senator

Mikulski has proposed this, and I fully support it. Second, I still think we need a

respite care benefit under Medicare. You’ll recall that in 1997, President Clinton

proposed this idea. It would provide vital relief for family members who are caring

for an aging relative in the home. Even if it only provides up to 72 hours a year

of respite care, it would be a lifeline for thousands of families.

My mother was a hero because she worked in silence. But today, we can help

break that silence and give families the support they need as they care for loved

ones. I’m grateful to Senators Mikulski and Breaux for holding this hearing and allowing us to do the right thing for so many people who are caring for a family member in silence.

Senator MIKULSKI. Thank you. Mr. Chairman, I want to introduce Senator Susan Collins, a dear friend and colleague. I also

need to acknowledge the role of the Republican women in the

17

economic security and health security facing families and women.

Senator Kay Bailey Hutchison has been a strong advocate particularly on the economic security issue. She and I worked, when she

took the leadership, on the issue of expanding spousal contributions to IRAs, recognizing the role of the homemaker and she has

also worked on other issues.

The senior senator from Maine, a member of the Finance Committee, our own colleague from the House of Representatives, has

long been a champion of long-term care, making sure that women

have access to the health care they need, and also for a very sensible prescription drug benefit. So they are going to try to get here,

but I want everyone to know that we really worked on a bipartisan

basis. We are going to hear from Senator Sue Collins, her own

ideas, but though they are not here at the hearing, I want you to

know that the Republican women are at the table when we discuss

these issues.

Senator Sue Collins has been a champion of making sure the elderly have the benefits that they need. She has been a real advocate in terms of the issues of Medicare givebacks, in terms of the

spartan reimbursement for nursing homes, and particularly the

skimpy ones for home health care. She and I teamed up because

we had visiting nurses visiting in Maine and in Maryland in snowmobiles in order to make sure people got their home health care.

She has been an advocate in these areas, and she has also

worked very hard on the issue of diabetes, which is a chronic and

progressive illness, that if not properly managed, requires longterm care from kidney dialysis to other support services. She is the

‘‘Legislator of the Year’’ of the Visiting Nurses Association of America and the Juvenile Diabetes Foundation has recognized her. I introduce Senator Sue Collins.

STATEMENT OF SENATOR SUE COLLINS

Senator COLLINS. Good morning, and thank you very much,

Madam Chair, and for your very gracious invitation to testify and

your very kind introduction. I want to commend you and Senator

Breaux and all of the members of this committee for your leadership in holding this very important hearing.

As we have heard so eloquently this morning, this is an issue

that touches every American family. Each of us has had the experience of trying to figure out how to ensure compassionate care for

a much loved elderly relative, but the simple fact is that this issue

affects women even more than men.

Women can expect to live 7 years longer than men on average

so we are more likely personally to need long-term care. In addition, as has been mentioned, 75 percent of all caregivers are

women. Senator Santorum mentioned that his daughter has a one

out of three chance of living to 100. She also has a very good

chance of ending up taking care of her father. [Laughter.]

That should give us all pause. The challenges for women are particularly great because it comes at a time when more women than

ever before are working outside of the home. The fact is that the

average caregiver in the United States today is a 46-year-old

woman who works full time outside of the home and yet spends an

additional 18 hours a week caring for her 77-year-old mother.

18

Long-term care is the major catastrophic healthcare expense

faced by older Americans. It is therefore particularly troubling that

while women are at greater risk of needing long-term care than

men, they are usually far less prepared for the financial consequences. In a recent poll of baby boomers, 33 percent of the

women surveyed reported having less than $25,000 in their retirement plans.

That amount would not even cover a single year of nursing home

costs. To help address this problem, I have joined with Senator Mikulski in calling for a doubling of funding for the National Family

Caregivers Support Program authorized by the Older Americans

Act. I have also joined with my colleagues, Senator Lincoln, Senator Grassley, Senator Breaux, and a bipartisan group in sponsoring the Long-Term Care and Retirement Security Act.

This important legislation would give a tax credit for long-term

care expenses of up to $3,000 to help families already struggling

to provide long-term care to a loved one. It will also encourage

more Americans to plan for their long-term care needs by providing

a tax deduction to help them afford private long-term care insurance.

Finally, I cannot let this opportunity pass without noting that we

still have work to do to prevent an additional cut in home

healthcare payments from going into effect in October of this year.

Home healthcare is a less expensive alternative to nursing home

care for many older Americans. Moreover it allows them to receive

the care in the security, privacy and the comfort of their own

homes. So I want to also remind all of our colleagues that we still

have work to do in that area as well.

Just as women have more at stake when it comes to long-term

care, we also stand to gain the most from public policies that help

families meet their long-term care needs. As a member of both this

distinguished committee as well as the Health Committee, I look

forward to continuing to work with my colleagues to address these

important issues. Thank you for the opportunity to appear today.

[The prepared statement of Senator Collins follows:]

PREPARED STATEMENT OF SENATOR SUSAN COLLINS

Mr. Chairman, Madam Chairman, thank you for your leadership in calling this

hearing on an issue of critical importance to us all, but of particular concern to

women long term care.

The simple fact that women can expect to live as many as 7 years longer than

their male counterparts puts them at far greater risk of needing long-term care.

Moreover, not only are women far more likely to need long-term care, but they are

also the ones who most often shoulder the burden of providing long-term care to

their loved ones. Today, almost 75 percent of our nation’s caregivers are women

wives caring for husbands, daughters caring for parents, even daughters-in-law caring for parents-in-law.

And this is at a time when more women are working outside the home than ever

before. The average caregiver in the United States today is a 46-year old woman

who works outside the home and spends 18 hours a week caring for her 77-year old

mother.

Long-term care is the major catastrophic health care expense faced by older Americans. It is therefore particularly troubling that, while women are at greater risk

of needing long-term care than men, they are usually far less prepared for the financial consequences. In a recent poll of baby boomers, only 27 percent of women surveyed had more than $100,000 in their retirement plans. Thirty-three percent of the

women surveyed reported having less than $25,000, an amount that would not even

be sufficient to cover 1 year of nursing home costs.

19

To help address this problem, I have joined with Senator Mikulski in calling for

a doubling of funding for the National Family Caregiver Support Program authorized by the Older Americans Act. I have also joined with Senators Grassley, Breaux

and a bipartisan group of our colleagues in sponsoring the Long-Term Care and Retirement Security Act. This critically important bill will give a tax credit for longterm care expenses of up to $3,000 to help those families already struggling to provide long-term care to a loved one. It will also encourage more Americans to plan

for their long-term care needs by providing a tax deduction to help them purchase

private long-term care insurance.

Just as women have more at stake when it comes to long-term care, they also

stand to gain the most from public policies that help families meet their long-term

care needs. As a member of both the HELP Committee and the Special Committee

on Aging, I look forward to working on these issues and thank the Chairmen for

the invitation to testify.

The CHAIRMAN. Thank you, Susan.

Senator MIKULSKI. Let me turn now to Senator Debbie

Stabenow, and by the way, Senator Lincoln, we like that phrase

‘‘the club.’’ We talked about the sandwich generation. Is that ‘‘club

sandwich’’ your line? We are going to start to talk about that and

make sure it has got the bacon in it.

Senator Stabenow is our next witness. Senator Stabenow is a sister social worker. She has a master’s degree in social work. She is

essentially a certified do-gooder, but brings incredible background

from experience in the Michigan legislature and also the House of

Representatives and now in the Senate where she has really championed the issues of the elderly from a prescription drug benefit to

the issue of home health care.

The National Committee to Preserve Social Security and Medicare has recognized her with a top award, and the National Association for Home Care has named her a ‘‘home health hero.’’ A national magazine has also named her one of the ten powerhouses in

Washington. So let us hear the kilowattage.

STATEMENT OF SENATOR DEBBIE STABENOW

Senator STABENOW. Well, good morning, and I want to thank my

colleague, Senator Breaux, for your leadership on the committee, as

well as Senator Mikulski. I am here today sitting at the witness

table as opposed to sitting in my usual seat which would be as a

member of the committee, and I look forward to joining the committee as we move forward on these issues.

My colleagues here have spoken very eloquently about the fact

that we share a bond as mothers, sisters, daughters, grandmothers,

who all are playing a role in long-term care for our loved ones. My

mother also is my hero, and my father was ill when I was growing

up, and she was, in fact, a nurse, a director of nurses at the local

hospital, but, in addition to caring for us, cared for my father and

she really is my hero. She is now at 75 on two golf leagues and

doing water aerobics and so my guess is she will be caring for me

rather than me caring for her. And I am very pleased to have her

genes.

But there is no question that while women constitute far and

away the highest number of consumers of long-term care in both

the community-based services and facility-based settings, we also

comprise an overwhelming percentage of both the formal and informal caregiving workforce, and it is so critical that we understand

that, and I would hope that we would have the same sense of urVerDate 11-MAY-2000 14:10 Apr 12, 2002 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6633 C:\DOCS\77850.TXT SAGING1 PsN: SAGING1
20

gency on a policy level that we have in our homes when our mothers, or fathers, or grandparents need care.

When something happens in our own family, I know for us the

world stops until you fix it. There is a sense of urgency about

healthcare, particularly long-term care, and I would hope that we

could engender the leadership on our two committees that same

sense of urgency in the policy arena of what it means to say to a

family we will have to wait a year, or 2 years, or 5 years, or 10

years.

Our families are struggling everyday, whether we are paying attention to the issue or not. We have all heard the statistics. I have

very specific information that I would like to leave in the written

testimony as it relates to Michigan and what has been happening.

My great concern is that we are seeing at every level cutbacks,

both because of downturns in the community we have seen in the

Michigan economy and downturns and cutbacks in Medicaid and

the challenges of Medicare and so on.

But we are going in the opposite direction of where we need to

be in terms of the need. We are seeing under Medicaid waivers

that we are seeing cutbacks, and in fact we are in a situation

where we have also seen 18 nursing homes closed in Michigan

since 1998, half of them voluntarily, and one of them, in fact, is

being closed by the State of Michigan this week due to performance

deficiencies.

I also would join with my colleague, Senator Collins, in speaking

about the critical needs of home healthcare and the cutbacks that

occurred through the BBA and the need to continue to restore

those funds, and I would remind all of us that another 15 percent

cut is scheduled for this fall and would devastate services, absolutely devastate services available to families nationwide.

I think probably more than any other combination of issues, the

one I hear the most about and have heard about from years from

the people I represent have been requests for home healthcare and

the challenges of prescription drug costs. And I need to mention

that today because I believe they are combined as more and more

people are attempting to be at home rather than in a nursing home

or a hospital. Much of that relates to their ability to have access

to prescription drugs, and that is an incredibly challenging issue

for us, and I believe underlines the majority of the cost increases

that we are seeing in all level of healthcare today, and one that we

certainly need to address.

There are many positive things that we have been trying to move

forward on as a Congress. In 2002, we reauthorized the Older

Americans Act, as we all know, and included a National Family

Caregivers Support Program, which is very positive, and I think

one of the most important things is that we included respite care,

which again we all hear over and over again, and I know we have

experienced in my family the need for that time out so that when

you are the caregiver and have the day-to-day pressures of

caregiving, it is very important to give those caregivers a time out.

In conclusion, I would just say again it is a privilege to be here

with my colleagues, each of whom including Senator Mikulski, who

is on the dias, who have been champions on this issue, both because of our own personal experiences, but also because of the peoVerDate 11-MAY-2000 14:10 Apr 12, 2002 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 C:\DOCS\77850.TXT SAGING1 PsN: SAGING1
21

ple we represent, and I am hopeful that we will be able to address

the challenges and create the sense or urgency that is needed and

the sense of urgency that is felt in each family struggling with

issues of long-term care and that we will be able to bring that

sense of urgency here to the U.S. Senate. Thank you.

[The prepared statement of Senator Stabenow follows:]

PREPARED STATEMENT OF SENATOR DEBBIE STABENOW

It is a pleasure to join my colleagues today at the witness table rather than in

my usual seat as a member of this Committee. We women are here today to emphasize the role that we, our mothers, our sisters, our daughters and our grandmothers

play in providing long-term care for loved ones.

While women constitute far and away the highest number of consumers of longterm care services—in both community based and facility based care settings—they

also comprise an overwhelming percentage of both the formal and informal care-giving workforce.

You all have heard the statistics and what they tell you is that wives are caring

for husbands, mothers are caring for children, and grandmothers are caring for entire extended families. Our economy is reliant upon this uncompensated care provided by loving family members, most of who are women. Many of these woman face

difficult choices between family and work and because of time away from the workforce may jeopardize their retirement savings, as well. Unfortunately, Michigan’s women are facing ever decreasing choices in acquiring or retaining long term care

services and help for themselves or their families.

For instance: • In-Home Care: The Center for Medicare and Medicaid Services (CMS) started the Medicaid waiver program for the elderly and disabled as an optional

Medicaid program in 1981. Michigan was one of the last states in the nation

to implement a statewide waiver in 1998. In FY 2001, the waiver served almost

15,000 clients. However, that same year, the Michigan Department of Community Health (DCH) decided to stop new enrollments in the waiver program, except for people transitioning out of nursing homes. In FY 2002, the DCH decided not to provide waiver slots to people moving out of nursing homes. The

waiver program is now closed to anyone in the community who qualifies for

Medicaid and is in danger of moving to a nursing home. The only options for

such an individual are enrolling in the Medicaid Home Help program (which

uses the most restrictive Medicaid income and asset tests) or moving to a nursing home.

The DCH has also placed restrictions on the amount of care that can be received by the waiver clients that are still being served. The DCH has only provided enough funding for an average stay of 270 days, and waiver agencies estimate that the average stay will greatly exceed that figure this fiscal year. For

this reason, waiver agencies have been forced to cut back on the services received by frail elders and younger people with serious disabilities. • 18 nursing homes closed in Michigan since 1998—half of them voluntarily—and one of which is being closed by the State of Michigan this very week

due to performance deficiencies. • Assisted living facility beds—both licensed and unlicensed—remain

unaffordable to many in the long-term care market, which again is predominated by women.

Other poorly funded community services face even greater cuts and reductions as

the current state budget crisis in Michigan deepens. As with so many issues and

systems, the major problem with long-term care is that there is a serious deficiency

in funding—and consumers in this area are uniquely unable to pay for it.

While I know I must keep my remarks short, I must also briefly mention that

funding for home health care was severely cut in 1997 by the BBA and I have been

working ever since to restore funding. I would like to remind everyone that another

15 percent cut is scheduled for this fall that will devastate services available to families nationwide.

This is the bad news. But, there are positive stories to tell, as well. In 2000, Congress reauthorized the Older Americans Act. In the reauthorization a new ‘‘National

Family Caregiver Support Program’’ was created. It provides funding to states

(which pass the funding on to Area Agencies on Aging) to provide information and

services to family caregivers. A key component of the services provided is respite

care. Respite care can take many forms, but in essence it is there to help relieve

the burden of family members caring for loved ones. While this includes help for

22

elderly spouses caring for an ill husband or wife, it also includes providing support

for a growing trend in our country—grandparents caring for grandchildren.

Last year, Michigan received its first allotment for the Family Caregiver Program,

$3.8 million dollars. Area agencies on Aging held forums and roundtables throughout the state to make sure resulting services and programs would be tailored to

meet the needs of the community. I am already getting positive feedback about this

program and I hope that it continues to grow and provide much needed help to families.

In conclusion, I feel is a privilege to join with my Senate colleagues today—both

women and men—to voice a concern that families are facing across the nation.

Long-term care needs are not being met and women bear much of the burden of

filling in the gaps that currently exist. I am hopeful that today’s hearing can begin

the debate that will lead to offering more choices and affordable solutions for families.

The CHAIRMAN. Thank you very much, Senator.

We are pleased to have Senator Hillary Clinton as our next presenter, fresh from glowing accolades from her opening night performance at the Correspondents’ Dinner last night where she was

a terrific hit. It is hard to believe that almost 10 years ago, you

were before Congress testifying as the chair of the Task Force on

Health Care over on the House side. I remember it quite well when

you were advocating a national health policy and really talking

about some of the same issues that 10 years later we are still talking about, and it shows you the urgency of Congress trying to find

a solution to these very difficult problems, which only get more difficult everyday.

So we are delighted to have you back with us and look forward

to your suggestions. Hillary.

STATEMENT OF SENATOR HILLARY RODHAM CLINTON

Senator CLINTON. Thank you very much, Senator Breaux and

Senator Mikulski and my colleagues. I am pleased to testify along

with so many people who have made a real contribution to the ongoing discussion about how we are going to deal with the inevitable

transformation of the baby boom into the senior boom, and we are

going to be faced with decreasing resources as we look forward. The

increasing needs of a population that will become much more dependent, not only on their families but on society.

We have heard some extremely moving testimony as well as stories from the senators on the panel about their own families, and

we can only multiply that literally millions and millions of times

over to understand the extraordinary pressure that exists today on

so many caregivers, and it is not only something that has to be

borne by individual families who are heroically dealing with the

challenges of caring for not only older relatives but in many instances children with long-term disabilities, people in the prime of

life who are struck down, and I hope that this hearing bringing together the resources of the Senate will begin to address the problems.

We have already touched on the number of women who far outnumber men in the aging population, and these women suffer disproportionately from our failure to develop a coherent long-term

care financing system, and many women who are not only caring

for the loved ones, but are also facing their own deteriorating

health and frailty, because older women are twice as likely as men

to live in nursing homes and twice as likely to live in poverty.

23

Because we have an inability in our system to finance and support long-term care, we rely on informal unpaid caregiving and the

brunt of that is borne by women. Seventy-five percent of unpaid

caregivers are women who on average provide 50 more hours of informal care per week than men.

Third, and finally, an underlying reason why our caregiving systems are in disarray and why these important functions are undervalued, underfinanced, and too often uncompensated in our society

is because it is work that women perform in their homes. We too

often take for granted the contribution that women make as caregivers, and for too long this work has been invisible. No one paid

for it. It did not show up in the GDP.

Now just because family caregiving is unpaid does not mean it

is costless. The costs include not just time and lost economic opportunities, but also the personal and emotional strain, fatigue and

very frequently poor health. These costs should be recognized.

These caregivers must be supported through respite care and other

services.

Now, we have made progress, and I particularly applaud my colleagues, especially Senator Mikulski, for taking the leadership position on this, but as economists and as our own common experience

tells us, when work is undervalued, it will unfortunately be undersupplied, and we are quickly realizing that our country is suffering

not just from a budget deficit but what Mona Harrington has called

a ‘‘care deficit.’’ In nursing, in child care, in the teaching profession,

and in long-term care, we see shortages and looming crises that

threaten the provision of care on which our children, our parents,

our families, and our society depend.

We have estimated that in New York alone, we have 3.5 million

informal unpaid family caretakers. Now thanks to the vigorous advocacy of leaders like Senator Mikulski and others, Congress has

passed the National Family Caregiver Program. I think we should

expand on the successes of this program. I am working on a bill

to extend the concept of the National Family Caregiver Program,

which has worked so well for the elderly to other populations, parents who care for chronically ill children, families of disabled individuals, many of whom report to me that they desperately need

respite services.

We also should address the need for greater long-term care financing. Medicaid now pays for nearly 40 percent of all long-term

care spending, but Medicaid, originally designed as a safety net

healthcare coverage system for low-income families, was not designed as a long-term care financing system for middle-income families.

Yet the expenses of long-term care can wipe a family out and

many middle class families find themselves quickly spending down

their savings and ending up on Medicaid for publicly financed support. I believe that will only increase the problem if we do not address it.

We need new financing tools that are better suited to middle income seniors and families with modest incomes and assets. I have

talked with many New Yorkers about what we want out of such

a system. I remember talking to a 72-year-old woman who just

looked at me with just this great sort of expression of what am I

24

going to do? I am taking care of my 94-year-old mother with Alzheimer’s and my 52-year-old daughter just had an automobile accident and I am now taking care of her.

These stories are not unique anymore. And what we believe

would work is a joint state-Federal program to help make longterm care affordable. We want to have a program separate from

Medicaid with flexibility so that individuals can decide what services to buy, whether it is paying for home health, an adult day care

program, transportation services, or nursing home, and I look forward to working with my colleagues on a bill to capture the features of that kind of flexible plan.

And let me just end by saying that this conversation has to take

place within the context of our current budgetary situation. Every

option that we think would be needed for available healthcare is

going to become harder to provide if we look into the future and

see that we are spending the Social Security and Medicare surpluses to pay for operational expenses today. That will put not only

our individual families but our entire society in a much more difficult hole to dig our way out of.

So I hope that as we look at a broad array of the needs of the

aging and include those who are the unpaid informal caretakers,

we recognize that we all have a stake in working out a system that

will provide for the help that we need so people can keep their

loved ones at home. When necessary, there will be social supports,

but I think realistically we are not going to be able to come up with

the options that we should if we do not have the resources to provide that help. Thank you very much.

[The prepared statement of Senator Clinton follows:]

PREPARED STATEMENT OF SENATOR HILLARY RODHAM CLINTON

Thank you Senator Mikulski, Senator Breaux, Senator Hutchinson and Senator

Craig for your leadership on issues concerning the provision of long-term care in our

society.

I am so pleased to be able to testify today, and I look forward to hearing the testimony of other to gather insights on how, as a member of the Subcommittee on

Aging, I, along with my colleagues, can help address this urgent challenge.

Our country’s piecemeal long-term care financing system is in dire straits, and

this system will be under increasing strain in coming years as life-spans increase,

and as the Baby Boom becomes the Senior Boom.

And the reason this is of particular importance to women is three-fold. First,

women outnumber men among the aging pouplation. Thus women suffer disproportionately from our failure to develop a coherent long-term care financing system, a

problem that is exacerbated by the fact that older women are also twice as likely

as men to live in a nursing home, and twice as likely to live in poverty.

Second, our the inability to finance and support long-term needs in this country

means that many must rely on informal, unpaid caregiving, and you can guess who

bears the brunt of that burden: women. Seventy-five percent of unpaid caregivers

are women, who on average provide 50 more hours of informal care per week than

men.

Third and finally, an underlying reason why our caregiving systems is in disarray,

and why these important functions are undervalued, under-financed, and too often

uncompensated in our society is because it was work that women performed in the

homes. We too often take for granted the contribution that women made as caregivers. For too long, this work was ‘‘invisible,’’ no one paid for it, and it didn’t show

up in the GDP.

Just because family caregiving is unpaid does not mean it is costless. The costs

include not just time, and lost economic opportunities, but also personal strain and

fatigue, and poor health. Thes costs should be recognized and these caregivers must

be supported, through respite care and other services.

25

But we’ve made some progress, and now confront new challenges. Women have

more opportunities now than they did then, and more responsibilities. So many

women in New York have told me how they feel there’s not enough time in the day

to do everything—holding down a job, shuttling kids to soccer practice and taking

a parent to the doctor; helping a child with homework and bathing a parent at

night. Some who can afford to purchase care do, and we need to look at how we

make high quality care available and affordable, but the many who continue providing care informally, need our support as well. These responsibilities should, after

all these years, finally get the visibility they deserve, rather than being taken for

granted.

As economists will tell you, when work is undervalued, it will unfortunately be

undersupplied. And we are quickly realizing that our country is suffering not just

from a budget deficit, but what Mona Harrington has called, ‘‘a care deficit.’’ In

nursing, in child care, in the teaching profession, and in long-term care, we see

shortages and looming crises that threaten the provision of care on which our children, our parents, and our families all depend.

Thanks to to vigorous advocacy of leaders like Senator Mikulski and others, Congress passed the National Family Caregiver Program, and we must expand on the

successes of this program. I am working on a bill that would extend the concept of

the National Family Caregiver Program, which has worked so well for the elderly,

to other populations as well—parents who care for chronically ill children, families

of disabled individuals, many of whom report to me how desperately they need respite services.

We must also address the need for greater long-term care financing. Medicaid now

pays for nearly 40 percent of all long-term care spending. But Medicaid, originally

designed as safety net health coverage for low-income families, not as long-term care

financing for middle-income families. Yet the expenses of long term care can wipe

a family out, and thus many middle-class families find themselves quickly spending

down all their savings and end up on Medicaid for publicly financed support. Now

a large bulk of Medicaid spending consists of long-term, not acute care expenditures.

We need new financing tools that are better suited to middle-income seniors, and

families with modest incomes and assets. I have talked with many New Yorkers

about what they want out of such a system. They like the idea of a joint state-federal program, to help make long-term care affordable. They want to be responsible

for their share of costs, but they don’t want to lose all their assets either. They like

having a program separate from Medicaid, and they also like flexibility, so they can

decide what services to buy—whether it’s paying for a home health aide, or an adult

day care program, or transportation services, or nusing home care. I am working

on a bill to capture the features of the plan that would best meet their needs.

Again I thank the Committees for exploring the imporant intersection of gender,

long-term care, and caregiving, and I look forward to working with both committees

to explore these and other ideas for improving long-term caregiving not just for

women, but for all Americans.

The CHAIRMAN. Thank you very much.

Senator MIKULSKI. Excellent.

Now we would like to turn to our colleague Senator Jean

Carnahan of Missouri, also a member of this Special Committee on

Aging. Senator Carnahan comes with extensive experience from the

State of Missouri. She has been long an advocate for Missouri’s

families. As first lady, she was well-known for being a champion

of the needs of children and the needs of parents to be able to care

for their children as well as the elderly. She has received numerous

awards for her positions on public policy including the state’s Martin Luther King Special Achievement Award, the March of Dimes

and others.

But I think we have all admired the way Senator Carnahan has

just come to the Senate, picked up her responsibilities, has put

Missouri first, and made sure that the Missouri families are

thought of everyday when she is doing her job. We look forward to

hearing from you with your background.

26

STATEMENT OF SENATOR JEAN CARNAHAN

Senator CARNAHAN. Thank you, Senator. Missouri author Adele

Starbird writes about a visit she made with her mother in a nursing home. The conversation went like this. Her mother says, ‘‘Well,

things are going well for me. I am on an entirely new tract. I am

just trying to be pleasant all the time.’’ Adele responds, ‘‘Is it a great effort?’’ Her mother says, ‘‘Did you ever try it?’’ Adele: ‘‘No, I’m going to wait until I’m your age before trying

anything so drastic.’’ They both laughed, and then she grew serious. ‘‘It is the only

thing that is left now that I can do for anybody. I can’t read or

write, but I can at least be pleasant and not add to the troubles

of others. You know I think that every human being is already carrying about as much as they can bear, and I don’t want to make

it harder.’’ Adele concludes: ‘‘Pleasant. She was more than pleasant. She

was gallant.’’ Well, I tell this story as a prelude to my remarks today because

today’s hearing focuses on women as caregivers, but you cannot

truly understand what it means to be a caregiver until you look at

the whole picture, and the whole picture includes a human being

who is a recipient of that care. Whether that person is your husband, or mother, or father, chances are they do not want to be a

burden. Chances are they do not want their kids caring for them

when it should be the other way around.

The first stage in the caregiving process occurs when the aging

family member moves from independence to dependence, and for

many seniors this involves leaving their home of some 30, or 40,

or even 50 years. The decision is usually precipitated by an event

that forces the change to occur. The reason can be declining health

or finances, a fall or an accident or the death of a spouse.

While it may be clear to the family that their loved one can no

longer live on their own, it is not always clear to the individual.

I speak about this from personal experience. After my mother

passed away, it was clear to me that my father would be better off

in my home. The problem was I lived in Missouri, and he had lived

all of his life in the Washington area.

He was asthmatic, he was diabetic, and he was subject to insulin

reactions. He needed reliable care to make sure that he ate properly and that he exercised regularly. Most of all, he needed the love

and support of his family. While I recognize that he should move

in with me, that was not at all clear to him. In fact, it was a real

test of my powers of persuasion. I gave him all the logical reasons

why he should come home with me, and although he listened, he

was not convinced.

Finally, in one desperate appeal, I took him by the hand, I looked

him in the eye, and I said, ‘‘Dad, remember what you hear in

church on Sunday morning, that sometimes you have to make a decision based on faith, and this is one of those times. You need to

believe that this is going to work.’’ Well, there was a pause and finally he looked at me, and he said

where is my suitcase? Well, I am happy to say that my father lived

with me and my husband, and our four children for the 71⁄2 years

27

before his death. I cherish the memory of those days and I would

not trade them for anything. Thank you.

[Prepared statement of Senator Jean Carnahan follows:]

PREPARED STATEMENT OF SENATOR JEAN CARNAHAN

Thank you, Mr. Chairman.

Missouri author Adele Starbird writes about a visit with her mother in a nursing

home. The conversation went like this:

Mother says: ‘‘Well, things are going well for me I am on an entirely new track.

I’m just trying to be pleasant all the time.’’

Adele: ‘‘Is it a great effort?’’

Mother: ‘‘Did you ever try it?’’

Adele: ‘‘No, I am going to wait until I’m your age before trying anything so drastic.’’

We both laughed and then she grew serious.

‘‘It’s the only thing that’s left now that I can do for anybody.

‘‘I can’t read or write, but I can at least be pleasant and not add to the troubles

of others.

‘‘You know I think that every human being is already carrying about as much as

he can bear, and I don’t want to make it harder.’’

Adele concludes: Pleasant. She was more than pleasant she was gallant.

I tell this story as a prelude, because today’s hearing focuses on women as caregivers. But, you cannot truly understand what it means to be that caregiver unless

you look at the whole picture. The whole picture includes a human being who is

the recipient of that care. Whether that person is your husband, mother, or father,

chances are they do not want to be a burden. Chances are they do not want their

kids caring for them when it should be the other way around. The first stage in the

caregiving process occurs when the aging family member moves from independence

to dependence. For many seniors, this involves leaving their home of some 30, 40,

or even 50 years.

The decision is usually precipitated by an event that forces a change to occur. The

reason could be declining health or finances, a fall or an accident, or the death of

a spouse. While it may be clear to the family that their loved one can no longer

live on their own, it is not always clear to the individual.

I speak about this from personal experience. After my mother passed away, it was

clear to me that my father would be better off in my home. The problem was I lived

in Missouri, and he lived in the Washington area all his life. He was asthmatic and

diabetic and subject to insulin reactions. He needed reliable care to make sure he

ate properly and exercised regularly. Most of all, he needed the love and support

of his family.

While I recognized that he should move in with me, this was not clear to him at

all. In fact, it was a real test of my powers of persuasion. I gave him all the logical

reasons why he should come home with me. Although he listened, he was not convinced.

Finally, in one final desperate appeal, I took his hand and said this to my father:

‘‘Remember what you hear in church on Sunday morning? That sometimes you need

to make a decision based on faith. This is one of those times. You need to believe

that this is going to work.’’ There was a pause. He replied to me ‘‘Where’s my suitcase?’’ I am happy to say that my father lived with me and my husband and our

4 children for the remaining 71⁄2 years of his life. I cherish the memory of those

days. I would not trade them for anything.

Thank you.

The CHAIRMAN. Thank you very much, Senator Carnahan. Thank

everybody on the panel. I mean these were just, Barbara, terrific

personal experiences, and there are millions just like all of ours

that are out there, and to add to the question now, you know, what

do we do? I mean, you know, Senator Clinton was here 10 years

ago talking about this, and we have all been talking about this.

You know as the strongest nation in the history of the world, we

ought to find a way to help take care of elderly. I have just one

question. Senator Dodd and I were talking about this. I sponsored

and have worked on trying to make long-term health care insurVerDate 11-MAY-2000 14:10 Apr 12, 2002 Jkt 000000 PO 00000 Frm 00031 Fmt 6633 Sfmt 6601 C:\DOCS\77850.TXT SAGING1 PsN: SAGING1
28

ance more affordable, and it is very expensive now. Nobody can afford it hardly.

We have legislation in with Senator Gramm, Senator Grassley, myself and others that provides a $3,000 tax credit for family caregivers that is phased in, also up to $5,000 tax deductions for the

purpose of long-term healthcare insurance.

Senator Dodd and I were talking, and Chris was making the

point that the president’s budget calls for tax credits for tuition for

private schools, tuition tax credit, and if, as which is clear, we have

a very tight budget situation, what about offering, as an alternative

to a tuition tax credit, offering tax credits for the purchase of longterm healthcare insurance?

Do any of you have any thoughts about that? I mean everyone

does not have to—Susan, what do you think? Let us start there.

Senator COLLINS. Well, I have been a cosponsor of your bill for

a long time so I am a strong supporter of it, and I think it would

make a real difference. What I have found with a lot of my constituents is that they have assumed that Medicare is going to pay

for long-term care, and despite the fact that that has never been

the case other than for that short period of time after hospitalization, I think that perception is still out there.

One of the things I like about your bill is I think it would start

to encourage all of us who do not have long-term care insurance to

start buying it now and that would help with the affordability.

The CHAIRMAN. OK. Anybody else?

Senator STABENOW. I would just add to that. I think it is an excellent idea. When I was in the House of Representatives, I also

sponsored similar legislation, but the common comment that I

heard on the bill that I had introduced was that it was not a large

enough amount. I think the real concern is whether or not $3,000

will be able or $5,000 will truly be able to make a dent as we look

at the costs long-term, and I would go back along with this because

it certainly is a start, and I certainly would support it.

But that is the most common comment that I heard regarding

the $3,000. The other piece, though, really does go back to the

whole question of prescription drugs, and I think we have to, when

we look at long-term care, also be looking at the fact that the majority of these people are looking at very large, hundreds of dollars

a month, prescription drug costs, and that that is very much a part

of what is happening.

So I would hope as we do this, and I know, Senator Breaux, you

have been focused on that, as well as many members have. But the

tax credit makes sense, but somehow we have got to also address

this huge issue, which is more out-of-pocket costs even than longterm care.

The CHAIRMAN. Senator Mikulski.

Senator MIKULSKI. Well, I just wanted to thank my colleagues for

their outstanding testimony and to say a couple of things. I think

we have issues really that we could do this year. If we are going

to talk about tax breaks, then we ought to talk about targeted ones

and I think this whole idea of giving help to those who practice

self-help is really important.

The other is I want to remind my colleagues that again working

on a bipartisan basis, because this is the way we get it done, we

29

passed the long-term care insurance opportunity for Federal employees so that Federal employees can buy long-term care insurance. They will receive no government employer subsidy, but because we are buying it in bulk, we will be able to reduce those

rates.

That is coming out—the legislation passed 18 months ago. It was

done with our colleagues here. Senator Grassley was a leader, our

colleague Senator Cleland, others on the Government Affairs Committee. The point that I am making is Federal employees will be

able to buy this, Federal retirees will be able to buy this, and then

we are going to get lessons learned on really what is the best way

to fund long-term care also through private insurance. So that is

a good match.

The National Family Caregiver Support Program passed because

we were able to reauthorize the Older Americans Act that had not

been reauthorized in almost a decade. I am going to be holding a

hearing, Senator Breaux, on the National Family Caregiver Support Program. I welcome advice and insight on an oversight hearing. Is it working and how can it work better?

But I do think the issue of BBA givebacks continues to be a toxic

cloud that is over our nursing homes, our home healthcare, and

even our own acute care facilities, and I think we really need to

address that along with this prescription drug benefit.

But, you know, when we really work together, each and every

one of my colleagues, both at the witness table and up on the dias

here, has made a difference, but when we work together, we can

make change, and I look forward to doing that.

The CHAIRMAN. Thank you. Now, our ranking member of the

Senate Aging Committee who has been here and working with us

very closely, Senator Craig.

STATEMENT OF SENATOR LARRY E. CRAIG

Senator CRAIG. Well, Mr. Chairman, chairmans, chairpersons,

thank you very much, but certainly to Senator Collins and Senator

Stabenow, let me thank you and your colleagues for your phenomenal testimony today. I think all of us were not only interested in

hearing it, but you began to share with us the leadership roles you

have taken on some of these critical issues.

As I for a short period of time chaired the Aging Committee before Senator Breaux picked it up, and I began to focus more clearly

on the issues of aging, there were some figures that stood out in

my mind that spoke to me more loudly than anything I had seen

or heard. And that was that we tend to focus on those in need of

care in the aging community that are visible to us, and those are

a small, small minority of those that are truly being cared for in

the homes of Americans.

Within our culture is a marvelous commitment, and that is to

care for our own as best we can. It is not just a sense of obligation.

I do believe it is a part of us, and what we have focused on and

what you have focused on, and I heard Senator Mikulski say it, to

try to help those who help themselves. Clearly, the cost of care

today to that busy person out there, and you are right, in most instances it is the woman that gives the care, is not only expensive

30

from a true dollar standpoint, it is phenomenally expensive from a

time commitment.

While I do not think it is in this country’s best interest to want

to change that culture, it clearly is in this country’s best interest

to help it, to improve it where we can, because my guess is that

providing all of the resources, there will still be that great sense

of obligation on the part of the daughter or the son to want to care

for his or hers as best they can as long as they can. And, yes, there

are a variety of options out there for those who have more, but

clearly as a baseline in this country, for those who feel it necessary

to keep their aging parents or relative within their homes, there

ought to be some benefits that help them assure that care can be

given.

I think one of the most important hearings that Senator Breaux

and I held was a hearing that spoke of the need to know and how

to be able to handle and cope with an aging parent who develops

disabilities and becomes a physical burden as well as an emotional

burden, and how to train and be trained and to be educated in how

to handle this in a way that with some limited skills can certainly

improve the time spent and lessen the pressures borne.

We can help there, though, and all of you have offered legislation

or have spoken out in leadership roles for that purpose, and let me

thank you all so very much for doing that. That is part of what we

can do. Sometimes it is the little incentive. Sometimes it is the bigger incentives.

Senator Stabenow, I cannot disagree with you on the issue of

prescription drugs. This Senate in a bipartisan way must lead on

that issue. It is without question the driving force in healthcare

costs today, and that is probably the larger issue that has to be

dealt with and should be dealt with, as the other issues of creating

the incentives and/or the help for those who want to keep their

aging parent or relative within their home. Thank you all very

much. Susan, thank you. Mr. Chairman, thank you.

The CHAIRMAN. Thank you, Senator Craig, for your contribution.

Senator CRAIG. Let me ask unanimous consent that my opening

statement be a part of the record.

[The prepared statement of Senator Craig follows along with prepared statements of Senator Landrieu, Senator Snowe, and Senator

Cantwell:]

PREPARED STATEMENT OF SENATOR LARRY CRAIG

Good morning. Thank you for attending this Joint hearing between the Senate

Special Committee on Aging and the Health, Education, Labor and Pensions Subcommittee on Aging.

We are all aware that women play a role in addressing the long-term care needs

of their family members and loved ones. In fact, Idaho, consistent with the national

average, has almost one quarter of its households providing care to family and

friends over the age of 50. Through this hearing, we will all get a better understanding of the vast amount of care that is actually provided and the large toll that it

can take on women providers.

We have the honor today of hearing testimony from many of my female colleagues

who will share their unique experiences in caring for their own family members and

friends. These individual stories, I believe, will be representative of the stories of

thousands of women across this country.

On our second panel, we will be hearing from two of the outstanding advocacy

groups on this issue. The Older Women’s League will share with us specific financial

and health concerns that can be raised for females when assisting a family member

31

with their long-term service and support needs. And the National Alliance for

Caregiving will speak about the role of women caregivers.

The title of this hearing the ‘‘Bearing the Burden of Long-Term Care.’’ This is not

meant to imply that caring for family members and friends is something that is

univiting and should be avoided. In fact, in my experience, most individuals want

to help take care of their family members. Instead, we are holding this hearing to

shed light on the issue so we can begin to assist the many daughters and wives who

are struggling with the daily task of caring for older family members.

Again, I would like to thank the witnesses for testifying and I look forward to

hearing your testimony.

Thank you.

PREPARED STATEMENT OF SENATOR MARY LANDRIEU

Good Morning. I would like to thank the committee for allowing me the opportunity to testify on women and aging, a subject that affects all Americans today,

either directly or indirectly. I would especially like to thank my Senior Senator John

Breaux who has been an extraordinary leader in this area. He is relentless in his

pursuit of common sense solutions to the issues involving the elderly and for this

he should be commended. I am proud to join him in his fight to address the needs

of aging women.

The statistics on this issue confirm what common sense has told us for some time.

The first of the baby boom generation will turn 65 in just ten years and with the

advances of medicine more of them are living longer. It is expected that by 2040,

there will be nearly four times as many Americans over age 85 as there are today.

While these numbers affect the elderly population as a whole, they have a disproportionate effect on women. On average, women outlive men by seven years. On

the other end, three quarters of all caregivers are women.

Because women live longer, they are exposed to more chronic diseases and disabilities—heart disease and lung cancer, osteoporosis and breast cancer. In addition to

supporting programs aimed at better research and treatment of these diseases, Congress must do all that it can to ensure that the programs that serve women with

these diseases are as up to date and effective as possible.

This is particularly true of Medicare. Fifty-seven percent of Medicare’s 39 million

beneficiaries are women. As we know, our Medicare system has not kept pace with

medical advancements and as a result has become outdated. Medicare should adopt

the best management, payment, clinical and competitive practices used by the private sector to help maintain high-quality services and keep spending growth in line

with private sector spending. In addition, strong and effective federal administration

of Medicare should be assured.

We also must do what we can to help improve education and accessibility to longterm care insurance. Less than 1 percent of long-term health care expenditures are

paid for by insurance. As a result, seniors are plagued by an ongoing concern about

the cost of long term care for themselves or a loved one. These are not decisions

that our parents and grandparents should have to make alone. We must strengthen

programs that help provide greater access to insurance programs for these purposes.

Finally, I would like to stress how important programs like independent living

services, rehabilitation services and community based support programs are for our

senior citizens. Many elderly women have spent their lives engaged in the service

of others, whether serving as a wife for their spouse, a mother to their families or

a leader in their communities or their professions. It is often very hard for them,

because of health needs, to become ‘‘dependent’’ on others. There are many very successful programs that provide the assistance support and care these women need

in a setting that allows them to continue to be independent and productive citizens.

Again, I am proud to join my colleagues in support of this important hearing. I

hope it is the first of many opportunities forus to engage in a discussion of future

solutions to what is a very real problem.

Thank you.

PREPARED STATEMENT OF SENATOR OLYMPIA SNOWE

I would like to express my appreciation to the Chairman and Ranking Member

of the Special Committee on Aging, Senators Breaux and Craig, and to the Chair

and Ranking Member of the HELP Subcommittee on Aging, Senators Mikulski and

Hutchinson, for holding this hearing and bringing attention to the dual challenges

women face when it comes to long-term care. Women not only have to worry about

32

their own long-term care arrangements, they are also the predominant caregivers

for their family members.

The fact is, long term care is a women’s issue. First of all, these issues affect

women the most, as women are the primary recipients of long-term care. Two-thirds

of home care consumers are women, and women are three-fourths of all nursing

home residents over age 65. More than 80 percent of family caregivers for chronically ill seniors are women and the average woman can expect to spend 17 years

caring for a child and 18 years caring for an elderly parent. Women also make up

more than 90 percent of paid long-term care workers in the U.S.

Long-term care issues have been of critical interest to me throughout my tenure

in Congress. As the Co-Chair of the Congressional Caucus on Women’s Issues for

10 years and as a member of the House Select Committee on Aging, I focused on

issues affecting the health and economic equity of women. In fact, Senator Wyden

and I served together on the Select Committee on Aging and have worked together

on issues ranging from long- term care, to funding for Alzheimer’s disease and

osteoporosis research.

Improving the availability and quality of care for patients with Alzheimer’s disease has been a priority for me. In 1984, my efforts resulted in a requirement for

the Administration on Aging to place a priority on grant applications from students

who specialize providing care for Alzheimer’s patients. In 1987, I introduced the Alzheimer’s Disease Coordination Act, which was included in the Older American

Amendments of 1987.

Another concerning of mine has been the quality of care that long-term care patients receive, and in 1987, I introduced the Long-Term Care Patient’s Rights Act,

which was including in the Budget Reconciliation Act. As a result, states are now

required to inform people of their rights when they become a patient in long-term

care facility. And, my good friend Senator Mikulski and I both worked on the spousal impoverishment issue in 1987 one of the very few provisions of the Medicare Catastrophic Coverage Act that Congress did not repeal in 1989.

More recently, my focus has turned to providing tax credits to family caregivers

to reduce the financial burden of caring for a loved one at home, and providing additional Federal support for respite care services. As a member of the House in 1986,

I introduced the first resolution to designate National Family Caregivers Week with

Senator Glenn, who was a member of the Senate Aging Committee, in an effort to

bring attention to the needs of our family caregivers.

My interest in increased funding and emphasis on Alzheimer’s disease resulting

in the Alzheimer’s Disease and Related Dementias Research Amendments, which

was signed into law in the 102d Congress. I was also successful in expanding the

Older Americans Act to provide supportive services for family caregivers. These

services, which caregivers can now receive today, include training, access to support

groups, respite care and information and referral for other related services. Through

my efforts the Older Americans Act also now provides improved services to protect

the rights of older individuals who are in a guardianship.

To make long-term care policies more affordable, I have worked to improve the

tax deductibility of long-term care insurance policies and introduced legislation to

accomplish make this a reality. In 1996, as part of the Health Insurance Portability

and Accountability Act, Congress expanded the tax treatment of long-term care policies so that they are treated the same as other health care insurance coverage expenses. I was also successful in ensuring that long-term care policies that offer per

diem benefits, which offer a set dollar amount each day for services, are treated the

same as policies that provide reimbursement for specific long-term care services.

Today, we need to refocus and reinvigorate our efforts on long-term care. The

challenges will only grow more difficult, and it has been nearly 10 years since Congress took a comprehensive look at long-term care during the health care reform debate. When Americans were beginning their love affair with the automobile in 1900,

there were three million people in the U.S. over age 65 and the average life expectancy was 47. Today, there are 35 million people over age 65 and the average life

expectancy is 79 for women and 74 for men. Between now and 2050, the number

of people over age 65 will more than double to 82 million seniors—1 in 5 Americans—56 percent of whom will be women.

And, the number of people afflicted with Alzheimer’s disease now will almost double by 2020 to seven million—with 70 percent receiving care at home. The number

of patient’s with Alzheimer’s disease will double again to 14 million, reaching epidemic proportions, by the year 2050 unless scientists discover preventive therapy or

a cure. We are in a race against time, a race against the aging of the Baby Boomers

and the diseases of aging, and a race to find solutions to a pending national crisis

in long-term care.

33

We used to think about the retirement of the Baby Boomers as if it were a far

off event like the arrival of the 21st century. Now, here we are, with only ten more

years before the first Baby Boomers retire, which is the leading edge of a large

storm front of Baby Boomers who will follow them into retirement. This issue won’t

just go away, and there is no simple one-size- fits-all solution.

What must drive our effort is the reality that while Congress debates the issue,

thousands of family caregivers have stepped forward to take care of their loved ones.

These family caregivers mostly women are caring for chronically ill family members

or those with disabilities on a 24/7 basis because they want them to be able to stay

at home in a loving and caring environment. More than 26 percent of all adults in

the U.S. have taken care of a loved one or close friend during the last year. With

Alzheimer’s disease alone, there are more than 5 million families caring for their

loved ones three times more than in 1987 and, almost 4 in 10 have been providing

that care for more than 5 years. The average caregiver provides care for 8 years,

and one-third provide care for 10 years or more. Family caregivers put aside vacations and hobbies, have less time to spend with other families members, pass up

job promotions, incur substantial out-of-pocket expenses, and many suffer from

physical and mental health problems as a result of their caregiving. And, at some

point, the caregiver deserves a break, a respite, from their compassionate commitment.

When Senator John Glenn and I introduced the first legislation on Family Caregivers in 1986, we did so in order to bring attention to the important work they do

and the crucial role they play in the nation’s long-term care system. And we have

made some progress. Two years ago, Congress established the National Family

Caregiver Support Program as part of the Older Americans Act reauthorization.

States can use these funds to provide respite care in the home, or in an adult day

care center, or even over a weekend in a nursing home or assisted living facility.

But we need to do more. And one key area where we can help right now is to

change the tax code to provide assistance with respite care costs. Family caregivers

not only take care of their loved ones, but in fact they save us a lot of money. If

federal, state, and local governments were suddenly faced with providing this care

through paid home care staff, they would have to find an additional $196 billion

each year in their budgets. One key area where we can help right now is to change

the tax code to provide assistance with respite care costs. We should take an important step toward lessening the financial and emotional cost of Alzheimer’s disease

by providing relief to patients and their families. Legislation that I have introduced

would permit families to deduct the cost of home care and adult day and respite

care from their Federal income taxes, if care is provided to a dependent suffering

from Alzheimer’s disease.

We also should expand the dependent care tax credit to apply to respite care

costs. I have introduced a bill to accomplish this and in so doing also restore the

original intent of the credit to provide the largest possible benefit for low-income individuals by expanding the credit and making it refundable. My legislation would

increase the percentage of work-related dependent care costs that qualify for the tax

credit from 30 percent to 50 percent for families earning $15,000 or less, and phase

the credit down to a 20 percent tax credit for those earning $45,000 or more annually. The dependent care tax credit was created in 1976 to help low- and moderateincome families alleviate the burden of employment-related dependent care. We

need to update the credit so it reflects today’s world.

Respite care, while important, is just the tip of the long-term care iceberg. In

order to address the serious and growing long term care challenges, we owe it to

current and future generations of women and their families to make long-term care

our priority.

We should take steps to ensure the long-term care that seniors receive today is

of the highest quality. We need to have effective regulatory and enforcement procedures and more focused attention on those providers with a history of compliance

problems and poor quality care. We need to examine Medicaid funding for long term

care services, and we need to permanently eliminate the 15 percent cut in home

health care payments.

Next, we need to look at longer-term solutions that will benefit future generations

of retirees. We should provide tax incentives for people of all ages, but especially

younger people, to purchase long term care insurance. Then, we need to support a

national campaign to get the message out that people need to consider purchasing

long-term care insurance and invest in the security of knowing you will be cared

for when you need long term care.

Finally, I believe we need to take a comprehensive look at long-term care issues

because a piecemeal approach, by definition, will leave important issues

unaddressed.

34

This should be our nation’s long-term care agenda, and I would like to thank you

again for holding this hearing and calling attention to these important issues and

how they affect women. These issues will not go away, but will only become more

difficult to address as time goes on. I sincerely hope this hearing can generate a

new spirit of interest and cooperation encouraging us to work together to move

these important issues forward. Thank you.

PREPARED STATEMENT OF SENATOR MARIA CANTWELL

Thank you, Senator Mikulski and Senator Breaux. I appreciate the opportunity

to testify at today’s hearing, and I want to express my gratitude for the leadership

you both have shown on this topic over the years.

I believe that Congress has a responsibility to ensure that families have adequate

resources to care for their loved ones. I know that I am extremely lucky—I have

the honor of representing the people of the State of Washington here in the Senate,

and my mother is healthy. But not everyone is as blessed as I am. Women are major

stakeholders in the debate on long-term care policy because we are over-represented

as both caregivers and recipients of care.

As the Committee knows, with only about 1.6 million individuals residing in nursing homes, most people who need long-term care receive it in home and communitybased settings. In fact, the American health care system relies heavily on informal

caregiving—to the tune of $200 billion in uncompensated care annually. And there

is no doubt that as the baby-boomers retire in the coming decades, as well as continue to tend to their own parents’ needs, long-term care services will be in much

greater demand.

Issues surrounding long-term care—availability, quality, cost, and other public

policies—have a disproportionate impact on women. And worries about long-term

care do not begin when illness or disability strikes women personally. Because

women make up nearly three-quarters of the informal, unpaid caregivers in this

country, the worries begin when middle-aged women start to provide care for their

elder parents, parents-in-law, other family members, or friends.

Most informal caregivers are in their mid-forties to mid-fifties, work full time, and

may also be primary caregivers for their children or grandchildren. In order to

accommodate the extra hours and commitment required of them, informal caregivers often must curtail their own professional advancement, reducing both their

current earnings as well as future retirement benefits. And while women are most

likely to need respite from our caregiving duties, we are least likely to receive it.

Many factors exacerbate the problems facing women when we decide how to address our long-term care needs. We live an average of seven years longer than men.

We are more likely to live with multiple chronic health problems requiring longterm care services such as arthritis, hypertension, or osteoporosis. And we are also

more likely to face poverty than men during retirement, making purchase of private

long-term care services difficult if not impossible.

I believe both state and federal policy makers have a duty to ensure the long-term

care security of our constituents. I wholly applaud the work done in the last few

years by Senators Mikulski and Breaux to establish the National Family Caregiver

Program. And as today’s hearing demonstrates, this will not be the end of the debate. We need to continue to focus on how to improve access, how to ensure quality,

and especially how to lower both private and public costs of these vital services.

Thank you, Senators Mikulski and Breaux for inviting me to testify at this hearing. I am confident that together we will be able to ensure that women and our families have adequate resources to care for our loved ones.

The CHAIRMAN. Without objection, so ordered.

We have another panel that we would like to welcome up at this

time: Dr. Laura Young, who is Executive Director of the Older

Women’s League, known as OWL, which is a wonderful acronym,

which is the only national grassroots membership organization to

focus solely on issues that are unique to women as they age.

It is now in its 22nd year. The group has established itself as a

reputable source for information on caregiving and long-term care.

Dr. Young is representing OWL as its Executive Director. Before

that, she was a Senior Vice President for the National Mental

Health Association. And I look forward to Dr. Young’s testimony.

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Senator Mikulski, you want to do a joint introduction because

you have to leave?

Senator MIKULSKI. Yes. I am very happy, first of all, to welcome

Dr. Young, and also excited that Gail Gibson Hunt is going to testify. She is the Executive Director of the National Alliance for

Caregiving. It is located in Bethesda, Maryland along with the

home of the National Institutes of Health. The Alliance plays a

very important role because it supports family caregivers through

research, outreach and public awareness. It does it by bringing together organizations like AARP, the National Council on the Aging,

even the Department of VA, to get everybody in the same room to

really talk about the same issues. That in and of itself is to be commended.

Ms. Hunt herself is an expert on aging and elder care. She has

worked tirelessly to improve the quality and availability of those

services, and before taking her position with the National Alliance,

she was the president of a management consulting firm specializing in aging issues.

She oversaw the first National Caregivers Survey in 10 years

and three studies on the impact of caregiving in the workplace.

This is exactly what we need to know, and again I would like to

say to both of you, we will be holding an oversight hearing on the

National Family Caregiver Support Program later on in the spring,

and we really want to have your participation.

Mr. Chairman.

The CHAIRMAN. Dr. Young, we have you going first.

STATEMENT OF DR. LAURA YOUNG, EXECUTIVE DIRECTOR,

OLDER WOMEN’S LEAGUE, WASHINGTON, DC

Dr. YOUNG. Thank you. Chairman Breaux, Chairwoman Mikulski, and distinguished members of the committee, I appreciate your

invitation to testify today on the critical issue of women,

caregiving, and long-term care reform.

The Older Women’s League, or OWL, as we are known, commends you for addressing the concerns of America’s caregivers and

especially for your recognition of women, who bear the burden of

caregiving. As the executive director of OWL, the only national

grassroots membership organization dedicated exclusively to the

unique concerns of women as they age, I can assure you that our

members have a very personal stake in the issue of caregiving, as

caregivers and care recipients.

Allow me to paint you a picture of the typical informal caregiver.

She is a married woman in her mid–40’s to mid–50’s, employed full

time, spending an average of 18 hours per week on caregiving. In

addition to juggling her career with caring for a parent, partner or

spouse, she may well be primary caregiver for her children and increasingly her grandchildren as well.

While society owes a huge debt to these women, here is the reward we offer. Caregivers risk their own financial security, face

emotional and physical health challenges, and have few affordable

accessible services to turn to for support.

The financial picture for caregivers is not pretty. About half of

caregivers in the paid labor force report their career is affected by

caregiving: arriving late for work, leaving work early, or taking unVerDate 11-MAY-2000 14:10 Apr 12, 2002 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6601 C:\DOCS\77850.TXT SAGING1 PsN: SAGING1
36

scheduled leave days. Often the consequence is a move to part-time

or more flexible jobs, and about one in five caregivers end up leaving the workforce entirely.

A cut in work hours equals a cut in wages, a tradeoff women can

ill afford since we still make only 73 cents for every dollar a man

earns. Midlife is often a woman’s peak earning period, yet it is also

the time her wage earning is interrupted by caregiving. It is estimated that caregivers lose an average of half a million dollars in

lifetime wages. You cannot save what you do not earn.

Social Security benefits are also affected by caregiving. Caregivers suffer an average loss of $2,100 annually, and given that the

average older woman in America today has little over $15,000 in

annual income, these lost Social Security benefits have a significant impact.

It is not just wages that are affected. Part-time or more flexible

jobs are less likely to offer benefits such as health insurance or

pension coverage, and while the gap has been shrinking, women

still have not caught up to men in rates of pension coverage, and

caregiving with its interruption of work patterns is one of the culprits.

Mental and physical challenges are also part and parcel of

caregiving. A substantial number of adults who provide care to a

parent, age 65 or older, report symptoms of depression. This can

impair a caregiver’s ability to provide care and endanger her own

health as well. The incidence of depression is higher among informal caregivers and women are diagnosed with depression twice as

often as men.

There is physical impact as well, and studies show that two out

of three informal caregivers are in ill health. Routine caregiver

tasks can cause acute and chronic physical strain, particularly

when caregivers lack appropriate training.

As a result of all of this, women are more likely than men to face

poverty in retirement: 12 percent vs. 7 percent. As the number of

women who provide informal caregiving increases, the number of

poor older women will inevitably increase.

The sad truth is that America assumes women will continue as

informal caregivers. As long as words like ‘‘love’’ and ‘‘commitment,’’ ‘‘duty’’ and ‘‘family’’ are used in relation to caregiving, society will always see it as women’s work and devalue it. My written

testimony lays out nine policy recommendations to support caregivers, protect their health and retirement security, and I hope you

will consider such changes.

But we also must confront difficult and pervasive social norms

that expect women to care for others more than they care for themselves. It should not be lost on us that today’s caregivers end up

as tomorrow’s care recipients. Women make up more than twothirds of nursing home residents, and the typical nursing home

resident is a 75-year-old woman.

Ninety percent of women ages 65 and over report one or more

chronic conditions, and 75 percent have two or more. Women’s increased longevity means that we make up 60 percent of adults over

65, and by age 85, there are more than twice as many women in

America as men.

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So what does this mean for the long-term care debate? Simply,

the current long-term care structure needs a major overhaul as it

does not work for women. Women’s lower lifetime earnings make

most long-term care insurance policies unaffordable, and since

Medicaid only assists the poorest of seniors, many low income

women cannot seek assistance until they spend down virtually all

their savings and assets. With the average nursing home costs running about $30,000 a year, this solution does not work for most

women.

OWL is also gravely concerned about the caregivers inside the

long-term care industry: home health aides, nursing home aides,

and other paraprofessionals who provide the bulk of day-to-day

care. This workforce is 93 percent female and paid very little. Although we ask these workers to care for our frail elders, paid caregivers face poverty level wages, inadequate training and little opportunity for advancement with sometimes dangerous working conditions.

There is extremely high turnover rate in these jobs that further

threatens the delivery of quality care. Thus, the cycle continues

with our formal caregivers unable to provide the best care to our

elders and ill-prepared to afford their own long-term care needs

later in life.

OWL believes we need to build a new paradigm for long-term

care policy that values caregiving and caregivers, without requiring

women to sacrifice their economic security and retirement to

achieve it. The picture painted of women caregivers and long-term

care appears very bleak. It is now time to paint a new picture.

Thank you for picking up the brush.

The CHAIRMAN. Thank you, Dr. Young. Appreciate your testimony.

[The prepared statement of Dr. Young follows:]

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STATEMENT OF GAIL GIBSON HUNT, EXECUTIVE DIRECTOR,

NATIONAL ALLIANCE FOR CAREGIVING, BETHESDA, MD

Ms. HUNT. Thank you for the opportunity to speak this morning

on the role of women as participants in our nation’s long-term care

system. As we have heard over and over this morning, long-term

care has a female face. Because we live longer, more of us will now

and in the future will require long-term care at home, in community settings and in nursing homes.

We know who provides that care. Data from the Paraprofessional

Healthcare Institute estimate that 86 percent of the paid caregivers

are women. Those are the ones doing the hands-on care for the sick

and frail in home health agencies and personal care workers in

nursing homes and assisted living.

But I am here to talk as Director of the National Alliance for

Caregiving in terms of long-term care. One thing that has not been

said today, and we have heard a lot of statistics about family

caregiving, is the value of the unpaid family care in this country

is estimated by the United Hospital Fund at nearly $200 billion a

year, and that is more than the cost of nursing home and home

healthcare combined. So keep that in mind.

Make no mistake about it. Family caregivers are the unpaid extension of our country’s healthcare system. Without them, the longterm care system would collapse, and we have heard a lot about

who the family caregiver is, the 46-year-old baby boomer woman.

One thing to keep in mind, though, when we are talking about

caregiving: approximately a quarter of U.S. households contain

someone, male or female, caring for an elderly relative or friend,

and nearly three-quarters of them are our mothers, sisters, daughters or nieces.

We know that a third are caring for more than one person, and

more than 40 percent have children at home under 18. We also

know that half of these women are really providing at least one activity of daily living. That is really intensive hands-on personal

care: bathing, dressing, feeding, toileting. Nearly a third of them

are providing personal care for three or more of these activities.

We have heard about the impact on their lives, but first of all,

I think it is important—nobody has really mentioned this—we need

to remember that most people view family caregiving positively. As

difficult and frustrating and isolating as it is, when asked for a single word that defines caregiving for them, most caregivers will pick

a positive term, ‘‘loving,’’ ‘‘rewarding,’’ or ‘‘helpful.’’

The biggest reward is seeing that their loved one is getting good

care. Nonetheless, as we have heard, caregiving often carries emotional, physical and financial burdens. One financial burden that

has not been mentioned is the fact that on average caregivers

spend $171 a month on out-of-pocket expenses or the equivalent of

an IRA each year for many women who may not have a pension

in the workplace.

We have heard about the impact on caregiving in work as well.

So what can be done to help these women who are holding up the

long-term care system with their unpaid labor? First of all, they

need more recognition that their efforts are appreciated and meaningful. The National Family Caregiver Support Program was a step

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in that direction, but it needs to be increased substantially and

given more visibility.

Another form of recognition would be a White House Conference

on Caregiving, a national public awareness campaign.

Second, caregivers need financial support, such as Senate 627 be- gins to offer in the form of a tax credit, the $3,000 tax credit Senator Breaux mentioned.

Third, they need information about resources, their loved one’s

illness, treatment, prognosis, and services for themselves as well as

the family member. And training in the hands-on skills necessary

to do the personal care they are doing.

Last, they need services whether in the form of respite, counseling, or support groups or in the form of assistance from paid or volunteer caregivers to help with those many personal care tasks.

This past July, the Alliance and the Partnership for Caring convened a Caregiver Empowerment Summit to develop a National

Caregiving Agenda for empowering family caregivers. We had a

three-point action plan: to strengthen the national coalition of

groups engaged in addressing the problems of caregivers; develop

a national public awareness campaign; and develop a grassroots

campaign to promote activism among caregivers.

Each congressional office received a copy of the agenda, and we

encourage you to take a look at it and join the Alliance and the

other Summit participants in implementing these steps.

In closing, the Chinese have a saying that ‘‘women hold up half

the sky.’’ In the case of long-term care, women hold up most of the

sky, and we need to continue to support them doing so. Thank you.

[The prepared statement of Ms. Hunt follows:]

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The CHAIRMAN. Thank you, Ms. Hunt and Dr. Young. Thank you

very much. I think that you have made some good points, and as

Senator Mikulski and I were talking, you really have sort of a

smorgasbord of ideas about what we may be able to do, Dr. Young,

that you listed, and you know, the thing that bothers me is we do

not really have anything comprehensive. We got a lot of little ideas

here, a little bit there, a little bit here, a little bit there. Hopefully,

if you do a lot of little bits, you may add up to something good.

But I am really concerned that we do not really seem to have a

comprehensive policy as a nation, again a nation that is as strong

as the United States, which has such a huge growing senior population. I mean our obligation, again, is not to just get people to live

longer, but also to live better lives, particularly in the last part of

their lives, and we do not really have long-term health insurance

available. It is extremely expensive. It is not covered by Medicare.

We have really bastardized Medicaid and humiliated people to

having to become poor in order to qualify for some type of nursing

home assistance, and that really is not enough. And I am just wondering, you know, the Federal Employees Health Benefit Plan, our

Federal insurance, this year for the first time will offer long-term

healthcare insurance.

I am a big believer in trying to help provide affordable insurance

to the general population so that we at a young age can start buying health insurance that covers long-term care for when we need

it. The bill that we have, as you are aware, has a up to $5,000 deduction, and it obviously has to be made refundable for lower income people to help them buy long-term care insurance.

It seems to me if we can get a large number of people in that

pool buying insurance, helping those who do not have enough

money to buy it themselves, that that would go a long ways to saying that we as a nation have some type of a comprehensive program to provide long-term care.

Can either of you just comment on that concept?

Dr. YOUNG. I think it is a good concept. I think it is a great beginning, and I think that you are right, there needs to be a comprehensive overhaul that will effect all different kinds of opportunities and programs and education and benefits for people who are

primary caregivers.

That certainly is a great first step, but it is just a first step. It

really is not going to address millions and millions of poor women

who are involved in caregiving today, who even with that benefit

are not going to be able to afford the insurance. The impact of

having——

The CHAIRMAN. Well, they could if it is a refundable tax credit.

Dr. YOUNG. It is if it is refundable, but again we have to look

at the wage basis that they are starting with and what the eventual cost of the insurance will be. Also, the devil will be in the details of what the insurance will really cover and what it will provide and for how long and what the benefits are. As we well know,

there is a kind of social insurance covenant with our country

around what Medicare and Medicaid would provide, and we have

seen cutbacks and changes and shifts in those programs over the

lifetime of what they will cover and what they will reimburse.

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So I think that it is a great first step; it addresses the need. It

brings it to the forefront in a very important way, but it is just a

first step.

The CHAIRMAN. Well, I really look forward—and I recognize Senator Mikulski—but as a member of the Finance Committee, and I

think that the tax code offers a great deal of potential to try and

use the Federal Government in a direct manner of trying to provide

a program that is comprehensive and that does provide long-term

care coverage in a way that would allow everyone to have access

to it. And we are going to be working on that hopefully this year.

Senator MIKULSKI. Senator MIKULSKI. Senator Breaux, I think you are really right,

and that is why I am so supportive of it and why I worked for the

Federal employee benefit. First of all, people need to be able to afford the insurance. Second, we have to make sure the insurance is

not a new racket or scheme, because we know where there is need,

there is greed, and where there is greed, there are scams and

scum.

This is why part of the Federal employee package has a lot of

education in terms of even the checklist on what a good solid policy

is. When I bought my own long-term care policy, I turned to the

web site of the National Association of Insurance Commissioners

that had a basic checklist to go down to see the questions you needed to ask yourself as you went forward.

This is all important. I think would be a very important tool to

the middle class, knowing that the poor have other demands on

them, but it would be a very important tool in the middle class.

I worry about the financing of long-term care, but I also worry

about the human capital, and this takes me to my next point.

There are really two groups of caregivers. One is the informal

caregiving at home, and I was really stunned by hearing that if we

factored out, I guess, at the minimum wage, there is $200 billion

of family caregiving going on that no government, no insurance

company, nobody could take care of. So we need to strengthen

them, and I think you have given excellent testimony.

Then I want to go back to quote ‘‘paid caregivers,’’ and I wonder

what your thoughts are on this, because this is a human capital

crisis, as well as a financing crisis. The human capital is the family

and how we can strengthen the family, and I think you have given

excellent recommendations, but could we talk about the workforce?

Because when we look at the people who work at nursing homes,

they are often underpaid, undertrained, in many instances particularly either nursing homes or in the invisible aspects at home,

home health, there are people with language challenges I wonder

what your thoughts on that are, which is how we can strengthen

the human capital over in terms of the paid caregiving, because I

think it is really a stretch here.

Am I right about this, and could you share your thoughts and insights on this? Because I think those of us involved in job training

and workforce oversight would appreciate your input. I mean, you

know, I spoke with such affection of my dad, but when we had to

turn to a nursing home, it was the nurses and the nurse aides that

were turning someone who was kind of a beefy grocer who looked

like a lacrosse player. I mean really that was a big challenge.

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Dr. YOUNG. I would speak to it actually by telling you about my

own story. I lost my mother last year to progressive dementia and

Alzheimer’s disease, and she also experienced psychotic depression

as a consequence of that, and had lived a number of years in assisted living, and even though finances in her case was not the

overriding issue, when she required a level of care that could only

be provided in a nursing home, the problem was because of the

level of training, the poor wages, the lack of support, the number

of staff that were available, the quality of care that she received

was really abysmal.

And it was not because the people there did not want to give

good quality care. I met wonderful, caring, trained people who really cared about our frail elderly and wanted to be supportive, but

the lack of resources, the way we finance and support the wages

that go, and the kind of reimbursement schedule that goes, to nursing homes so that they can actually provide the level of care necessary, so that people are well taken care of in a kind of a preventative way in terms of caring for them physically as well as mentally and emotionally, I think really needs to be challenged.

I think that you would like recommendations. We will get back

to you with a set of them.

Ms. HUNT. I wanted to follow up on the long-term care insurance

question that you raised, Senator Breaux. I am a supporter of longterm care insurance, and I think this program that they are offering to Federal employees and retirees in the military is really a

good step in the direction, but you have to remember that that is

not going to take care of today’s caregiver.

We are the ones who are going to have to be concerned about

Baby Boomers’ long-term care in the future. For today’s caregiver,

the person they are caring for is not going to be eligible for longterm care insurance. So we need to be sure that we also keep in

mind supports like the National Family Caregiver Support Program, lifespan respite programs, for example, and other kinds of

programs, the tax credit, the $3,000 tax credit for today’s caregiver.

Senator MIKULSKI. What about the human capital issue?

Ms. HUNT. Well, I think that there is no question that this is a

concern. There have been briefings by the Paraprofessional

Healthcare Institute, which is the group particularly focused on the

aides, the people doing home health, and the fact that it is not just

an issue of not having enough training and having language problems, as you mentioned, and not having a living wage, and not having a career ladder, but there are not enough of them. That is just

an issue by itself, too.

Senator MIKULSKI. Why would there be?

Ms. HUNT. Why would there be when you can work at McDonald’s and in some cases you can get benefits, and you cannot get

them in these other circumstances, but I guess what I am saying

is there are groups which are beginning to address the concerns of

the paid caregiving, particularly the paraprofessional, workforce.

There is a bill that is looking at nursing, at the nursing shortage,

but that does not really deal with the paraprofessional.

Senator MIKULSKI. No, that is my bill.

Ms. HUNT. The person that you are talking about?

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Senator MIKULSKI. That is my bill with Tim Hutchinson and Ted

Kennedy, John Kerry, Jim Jeffords and some others. I do not want

to go into this in great detail at this hearing, but again, turning

to experiences in Maryland, what we see, again, at the nursing

home, there are the nurses, then there are the paraprofessionals

that support the nurses, and some medical supervision on a daily

and a weekly basis.

I am looking at a continuum of opportunity. My bill also focuses

on the community college—for many women who would like to

enter the career or men who want to enter the career of nursing,

the whole idea of going to Johns Hopkins or University of Maryland is more of a reach than they could do with their family lives,

but going to the community college, particularly where life experience is always factored in, can move along. You see in my mind the

community college and the 2-year nursing degree offers an opportunity for long-term care.

The second thing is I would hope that if we look at the experiences of trained paraprofessionals, really trained, certificate programs, then those certificate programs could be parlayed into the

community college, so if they took the 6-week program on ‘‘x’’ or ‘‘y’’ that constitutes an allied health program, that certificate could

count toward courses in nursing—and we all know the innovation

of this.

So you see where there would be the career ladder, they could

move up, move up in income, where they begin to have new opportunities we have already attracted people. We just do not pay

them, and there are these other issues. So I know that my time is

up.

If I could, Senator Breaux, one of the other questions I worry

about is fragmented services. Even if you have got the money,

where in the dickens do you begin, where do you go, who do you

know that is reliable? I mean really the whole idea of knowing

about day care, geriatric evaluation. Now we hope that this has

been addressed in the National Family Caregiver Support Program, and I must also acknowledge the role that Senator Jeffords

and Senator Mike DeWine played. We could not have done the authorization without Senator DeWine and Senator Jeffords.

Senator Gregg had particular issues, and that is why we had a

lot of wrinkles, but we worked again in a bipartisan way. What do

you think about it? Has the Caregivers Program addressed the information issue or is it uneven, and the fragmented nature of the

system?

Ms. HUNT. Well, I think that is a lot to lay at the feet of $125

million, but, yes, I think that is a beginning. I think the National

Family Caregiver Support Program, which as you know sends the

money down through the state units and then to the area agencies,

has been helpful, particularly because the area agency is given the

responsibility of being the sort of one-stop shopping place that caregivers and family members, the older person, is supposed to go to

get information about what is available in the community.

That needs to be strengthened even more, no question about it,

because you still hear about people who say I had no idea there

was adult day care for my parent with Alzheimer’s or I had no idea

what range of services were available. So information and finding

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integrated information or places where you can go and you can get

information is really still a need, but it is getting better.

One thing that I think has been helpful, in a small way, is the

Benefits Checkup, which is an Internet resource of the National

Council on Aging. You can enter information about the older person’s income, and where they live, and it tells you the public benefits that the person is eligible for, and I think that that is something that people would have had to seek out before in several

places, and now they are able to go to this.

It is an Internet resource so you have to be a little bit Internet

savvy to use it. But I think that it is helpful, and I think that there

are other kinds of programs like that that are working to provide

more integrated information for family caregivers.

Dr. YOUNG. I am hoping that in conjunction with that program

that there, in fact, is the kind of outreach and education to people

in communities that really let them know what is available to

them. I think for a lot of people who are involved, the kind of caregivers, the informal caregivers we have been talking about, their

lives are so challenged on a daily basis about all of the activities

and things that they have to pull together and collaborate on and

get done and accomplish in their lives, that their ability to do that

kind of research takes them into yet another task, another challenge, and I would hope to see that ultimately we could even do

a kind of public education outreach that is similar with what has

been done with the CHIP program that would allow States to really speak to communities about what is available to them, how to

get information in the same kind of aggressive way that we educate

people about what is available in terms of insuring their children.

Senator MIKULSKI. I have no other questions.

The CHAIRMAN. Thank you very much, Senator Mikulski. I want

to thank Senator Mikulski for joining with our committee and putting our two committees together on this issue. I think that as

many people in Congress who get interested in this, the better

chance we have of coming up with a comprehensive long-term

health plan for the seniors and the caregivers in this country.

We will pay very dearly for not having a comprehensive longterm plan in place as the baby boomer generation begins to retire.

It is already a huge problem. When we add 77 million more seniors

to the program with life expectancy of women being around 80

years of age and growing, the fastest generation growing in terms

of growth in population are people 85 years of age and older, and

we all know that, and so this presents a huge problem and huge

challenges to this country, but I am certainly of the opinion that

we have the wherewithal, the determination to move toward solving it.

We are going to work very hard in this Congress to come up with

something that begins that process. I believe very strongly in the

concept of health insurance, long-term care, with the Federal Government helping to pay for a portion of it, or maybe all of it for

people who do not have the wherewithal to do it themselves.

We heard some great stories from our colleagues, our Senate colleagues, about their personal experiences, which, you know, duplicate millions and millions of other Americans who do this everyday,

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and we thank them and thank you, Dr. Young and Ms. Hunt, for

your testimony as well.

And we also have a written statement from Kathleen Kelly, who

is Executive Director of the Family Caregiver Alliance, which will

be made a part of the record.

With that, we will have this committee adjourned.

Senator MIKULSKI. Edifying and challenging. Thank you.

[Whereupon, at 11:10 a.m., the committee was adjourned.]

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