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73–971 PDF 2012

S. HRG. 112–421 

KEEPING OUR PROMISES TO WEST VIRGINIA’S 

SENIORS: STRENGTHENING THE AGING NETWORK 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

CHARLESTON, WV 

FEBRUARY 13, 2012 

Serial No. 112–13 

Printed for the use of the Special Committee on Aging 

( 

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

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BILL NELSON, Florida 

BOB CASEY, Pennsylvania 

CLAIRE MCCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

MARK UDALL, Colorado 

MICHAEL BENNET, Colorado 

KRISTEN GILLIBRAND, New York 

JOE MANCHIN III, West Virginia 

RICHARD BLUMENTHAL, Connecticut 

BOB CORKER, Tennessee 

SUSAN COLLINS, Maine 

ORRIN HATCH, Utah 

MARK KIRK III, Illnois 

DEAN HELLER, Nevada 

JERRY MORAN, Kansas 

RONALD H. JOHNSON, Wisconsin 

RICHARD SHELBY, Alabama 

LINDSEY GRAHAM, South Carolina 

SAXBY CHAMBLISS, Georgia 

DEBRA WHITMAN, Majority Staff Director 

MICHAEL BASSETT, Ranking Member Staff Director 
(III) 

CONTENTS 

Page 

Opening Statement of Senator Joe Manchin III ................................................... 1 

PANEL OF WITNESSES 

Statement of Shelley Moore Capito, U.S. Representative, Second Congressional District, WV ............................................................................................... 3 

Statement of Kathy Greenlee, U.S. Assistant Secretary for Aging, U.S. Department of Health and Human Services, Washington, DC ............................ 4 

Statement of Suzanne Messenger, State Long-Term Care Ombudsman, West 

Virginia Bureau of Senior Services, Charleston, WV ........................................ 15 

Statement of Brenda Landers, Director, Metro Area Agency on Aging, Dunbar, WV ................................................................................................................. 17 

Statement of Janie Hamilton, Director, Kanawha Valley Senior Services, 

Charleston, WV .................................................................................................... 19 

Statement of Helen Matheny, Director, Alzheimer’s Outreach and Registry 

Program, Blanchette Rockefeller Neurosciences Institute, Morgantown, WV 22 

Statement of James Clagg Volunteer, Milton Senior Center, Milton, WV ......... 24 

APPENDIX 

WITNESS STATEMENTS FOR THE RECORD

Kathy Greenlee, Assistant Secretary for Aging, U.S. Department of Health 

and Human Services, Washington, DC .............................................................. 38 

Suzanne Messenger, State Long-Term Care Ombudsman, West Virginia Bureau of Seniors Services, Charleston, WV .......................................................... 49 

Brenda Landers, Director, Metro Area Agency on Aging, Dunbar, WV ............. 56 

Janie Hamilton, Director, Kanawha Valley Senior Services, Charleston, WV ... 64 

Helen Matheny, Director, Alzheimer’s Outreach and Registry Program, 

Blanchette Rockefeller Neurosciences Institute, Morgantown, WV ................. 69 

James and Ellen Clagg, Volunteer, Milton Senior Center, Milton, WV .............. 75 

(1) 

KEEPING OUR PROMISES TO WEST VIRGINIA’S SENIORS: STRENGTHENING THE 

AGING NETWORK 

MONDAY, FEBRUARY 13, 2012 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Charleston, WV. 

The Committee met, pursuant to notice, at 9:46 a.m. in the 1st 

Floor Ceremonial Courtroom, W. Kent Carper Justice and Public 

Safety Complex, Hon. Joe Manchin presiding. 

Senator Manchin [presiding]. 

Also present: Representative Capito. 

OPENING STATEMENT OF SENATOR JOE MANCHIN III 

Senator MANCHIN. Good morning. How are you all? Thank you 

all for coming. We really appreciate it. 

Miss, are you ready? I can see we can start. 

First of all, let me welcome all of you. I want to thank Congresswoman Capito for being with me. I want to thank Senator Rockefeller’s office. Rocky is here, and their representatives are here, and 

my office is with me. I have Lauren Alfred with us, our senior age 

consultant, if you will. She runs our aging, our Medicaid and Medicare health care, and also education. So Lauren does a great job. 

We appreciate her. 

I now call this Special Committee on Aging hearing to order, and 

I want to thank all of you for coming. I’m pleased to have the opportunity to bring the Aging Committee to West Virginia to discuss 

commonsense ideas for the future of senior services in this country, 

because in West Virginia we know how to set our priorities around 

our values, and I think we’ve done it well with the services we give. 

As many of you know, when I was governor, we set a budget that 

got our fiscal house in order, but we did so while prioritizing our 

seniors and increasing resources for senior services by 83 percent. 

I have Sandy Vanin with us. Sandy was my senior director at that 

time, and we really put our money where our mouth was. We 

placed food trucks in all 55 counties. We targeted funding for Alzheimer’s, respite care and elder watch programs, provided seniors 

with the support they needed to continue to live in the comfort of 

their own homes, and I am proud of what we have done in West 

Virginia, and I am committed to bringing these commonsense lessons to Washington so that we can keep our promises to our greatest generation. 
2 

In recent years, the need of senior programs and services has 

only increased as our seniors are living longer and facing difficult 

economic times. Last year, the first of the 77 million Baby Boomers 

turned 65, and now every day for the next 18 years over 10,000 

seniors will turn 65 and become eligible for senior services and entitlements. I myself will turn 65, and I tried to find out who in my 

staff put that in. 

[Laughter.] 

They have all denied it, but we think it was Lauren, making 

these issues all the more salient to me. As my generation ages— 

and I don’t think that I am; I’m still in denial, and we’ve talked 

about all this before, I’m having a hard time—there’s no doubt that 

we will place unprecedented demands on the national budget and 

resources because of my age, not my needs right now, thank goodness. Now more than ever, we need to be ready to help seniors stay 

healthy and independent as they age. 

Today’s hearing will focus on how we can strengthen our system 

of Federal, state, and local senior service agencies known as the 

Aging Network to meet the growing needs and challenges of the 

Baby Boom generation and preserve these critical services for future older Americans. If you can think about how many times you 

hear us in government talk about one-stop shopping, even in the 

retail private sector, one-stop shopping, make it easy and convenient, we want one-stop service. I want to make sure that as we 

grow older, we know exactly that we can go one place and find out 

everything that we have available to us, are entitled to, and what 

we can access. 

The Older Americans Act, which was signed into law in 1965, 

funds the majority of programs and supports for our seniors, including Meals on Wheels, caregiver help, health promotion, elder 

abuse prevention. Every five years, Congress takes a fresh look at 

programs in the Older Americans Act to assess whether they’re 

meeting the needs of the people they serve. This year, Congress is 

due to reauthorize the Older Americans Act, and I look forward to 

bringing many of the ideas and comments that we receive today to 

Washington to improve the new bill. 

As Congress revisits this legislation and at the same time works 

to tackle our rising deficit, I believe we must identify inefficiencies 

and redundancies in the system because wasteful spending should 

be the first to go. Our National Aging Network is made up of 56 

state units on aging, 629 Area Agencies on Aging known as AAAs, 

20,000 service providers and thousands of volunteers. In a system 

this big, there are bound to be inefficiencies and a great deal of 

room for improvement through coordination, flexibility, and innovation. This is one of the key issues that we’ll address today. 

I have asked stakeholders from across West Virginia’s aging network, from the state government to local volunteers on the ground, 

to come together to discuss their ideas for bringing services to more 

seniors more efficiently, and you have come, and I appreciate that. 

We’re also fortunate to be joined by U.S. Assistant Secretary for 

Aging, Kathy Greenlee. Kathy comes from the State of Kansas, and 

the governor of the State of Kansas at the time was Kathleen 

Sibelius, who is now Secretary of DHHS. I worked with her as a 

governor. I know that Kansas has a lot of the same concerns and 
3 

demographics that we have, and I appreciate you being here, 

Kathy. 

I’d like to thank all the witnesses who have joined us here this 

morning. I am eager to hear your thoughts and ideas for improving 

the way we deliver services to seniors. 

What we’re going to do, I’m going to turn to my friend and colleague, Congresswoman Capito, for her opening remarks now, and 

we will continue with our first panel. 

Congresswoman. 

STATEMENT OF HON. SHELLEY MOORE CAPITO, U.S. 

REPRESENTATIVE, SECOND CONGRESSIONAL DISTRICT, WV 

Representative CAPITO. Thank you. I’d like to thank the Senator 

for including me today. This is a great display of bicameral bipartisanship. 

Senator MANCHIN. The way it should be. 

Representative CAPITO. Yes, the way it should be. But as you 

know, West Virginians are all pretty close, and the Senator and I 

have known each other for a very long time. So I appreciate him 

including me in this. 

I’m just going to briefly say that there is no more timely issue 

for—even though I’m not turning 65 this year, I am in that sandwich generation where I have my parents and then still my children. They’re almost out of the nest, but—well, they’re out of the 

nest, but they would like to think—but you know what I’m saying 

here. There’s a lot of pressures, and I think it’s important in terms 

of coordination of care, of the financial resources, the legal issues 

that you touched on in terms of senior financial abuse, the 

vulnerabilities of our seniors, and the transitioning of our parents 

into a different way of living and a different way of coping with 

their situation. 

And as you all probably know, I’m dealing with this very personally in my own way with my brother and my sister, and there is 

no single manual that says if you find A, then you do B; and once 

B happens, then you turn to C. 

It is difficult to move through the systems. It’s difficult to understand what’s happening, not just as a daughter but for them to understand what’s happening. And so this has been an educational 

experience for me, so I really take to heart what everybody is going 

to tell us today and what you all as advocates in the audience do 

every single day to make sure that families have access to care. 

If you had a family that didn’t—I mean, if you had a senior that 

didn’t have a family, and the Senator alluded to this, it would just 

be tragically difficult for that senior to try to figure out on their 

own, or to even know where they are. I noticed there’s a registry 

for Alzheimer’s patients and folks that have been diagnosed. I’m 

guaranteeing you, it’s way underestimating what is really going on 

in this state and in this nation, because I can guarantee you neither one of my parents is probably on that registry. So we need to 

talk about that. 

But in any event, you can see it’s a very personal thing for me, 

so I’m very, very pleased to be here today. We have a lot of great 

resources both at the Federal and state level. We just need to make 

sure that we have the coordination, the awareness, the education, 
4 

because we have the dedication and the love and the caring that 

we need to move forward in this very difficult arena. 

So with that, thank you again for including me, and I look forward to hearing the witnesses. 

Senator MANCHIN. Thank you, Congresswoman. 

Before we start, I would like to reiterate what Congresswoman 

Capito said. Her parents, as they are needing some services, I can 

tell you my mother—I would like to know, if my mother did not 

have the family support, if my sister and my brother-in-law and my 

cousins and nephews weren’t taking care of her on a daily basis, 

what type of life would she have right now? I think that’s what I’m 

trying to find out, because I know other people aren’t as blessed as 

I am to have the family support that we have. 

And with that being said, that person still deserves that love and 

care no matter whether they have a family or not that can do it, 

and not everybody can do it. So that’s really the purpose of what 

we’re doing here today. 

So with that, our first witness today is Kathy Greenlee. Kathy 

is Assistant Secretary for Aging at the United States Department 

of Health and Human Services. Kathy Greenlee brings over a decade of experience advancing the health and independence of seniors 

and their families. Prior to becoming Assistant Secretary, Ms. 

Greenlee served as Secretary of Aging for the State of Kansas, as 

well as the Kansas State Long-Term Care Ombudsman. 

Ms. Greenlee, or better known as Kathy, thank you so much for 

being here, and we look forward to your remarks. 

STATEMENT OF KATHY GREENLEE, U.S. ASSISTANT SECRETARY FOR AGING, U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES, WASHINGTON, DC 

Ms. GREENLEE. Thank you, Senator. 

Do I need to turn this on? 

Senator MANCHIN. No. We have you loud and clear. 

Ms. GREENLEE. Very good. 

Senator MANCHIN. This is the state of the art. Kent Carper and 

the County Commissioner—— 

Ms. GREENLEE. The light is red. 

Senator MANCHIN. Oh, it stays red here. It stays red. 

[Laughter.] 

Ms. GREENLEE. Thank you, Senator. It’s a pleasure to be with 

you today for a special hearing of the Senate Special Committee on 

Aging; and thank you, Representative Capito, for also being here 

to participate. 

This has been a fabulous experience and tremendous honor to 

serve as United States Assistant Secretary for Aging, and this is 

the fourth time I’ve been able to attend a special committee hearing outside of Washington. I also travel the country, visit with seniors in all settings, from community services to long-term care settings, and what you are discussing today is happening all across 

the country, the number of seniors turning 65, the number of seniors who are now very old and very frail who need services and 

supports. 

In December, I had the opportunity to participate in the 50th anniversary celebration of the Senate Special Committee on Aging. In 
5 

addition to talking about seniors that day, there was something 

that became very, very clear, something that we all know and that 

is reflected by the two of you joining us today. This is not a partisan issue. Aging and aging services, and certainly the Older 

Americans Act, has a history of bicameral, bipartisan support. I 

think it’s a non-partisan issue and something that affects all of our 

families, all of our lives, and eventually ourselves. And so I just 

wanted to thank you for your leadership by being here to demonstrate that this is really about all of us and our families. 

As I work with the Older Americans Act and the aging services 

network, there are a number of significant values that I see that 

we share, helping older Americans and persons with disabilities 

maintain their health and their well-being so they are able to live 

independently with dignity for as long as possible. We have developed and implemented person-centered approaches. We’ve supported self-determination, respect, empowerment, and inclusion. 

The Older Americans Act helps protect the most vulnerable 

among us, and it helps provide basic respite care and support for 

families so that they are better able to help take care of their loved 

ones, which is what all Americans overwhelmingly prefer, that they 

have the support of their family and their friends and their communities as they age in place at home. 

Last year, the national aging services network served nearly 11 

million seniors and their caregivers, 11 million. And, Senator, that 

network is the one that you described. I oversee a very unusual 

Federal structure where we are very small at the Federal level. We 

send our money directly to the States, to the area agencies on 

aging, to tribal organizations, and through that network there are 

20,000 service providers who provide direct care; in addition to 

that, thousands and thousands of volunteers who do everything 

from deliver meals to provide long-term care ombudsman support. 

These are the backbone of the nation. These are the backbone services that provide care. 

Eighty percent of all long-term care in this country is still provided by families, and this is how we support this vital network. 

It’s also important to note that the key distinction of the Older 

Americans Act is that it complements medical and health care assistance. It does not duplicate those systems. And this assistance 

is critical in helping seniors remain independent. 

The flagship program that we have, the one that has always 

been the largest through the Older Americans Act has been the nutrition program. It’s 40 percent of the support that we provide to 

local communities and to States, whether it’s home-delivered meals 

or congregate meals. But often a meal is not enough. The people 

need other kinds of supports, the kinds of supports that you deliver 

here, transportation assistance and rides, bath assistance, in-home 

supports, caregiver supports. Seniors need a complex array of services. 

The first time I testified at a field hearing for the Senate Special 

Committee before Senator Kohl in Milwaukee, not surprising since 

he is the committee chair, and he had someone testify there who 

pointed out something that I had not really realized until that 

hearing, hearing from a consumer who pointed out that the Older 

Americans Act is the original home- and community-based service 
6 

system. It has been around for a very long time and is the core 

strength that we have, often supplemented by State dollars to help 

seniors stay independent. 

Here in West Virginia, in fiscal year 2010, nearly 50,000 persons 

over the age of 60 received supports through this aging services 

network. Of that 50,000, 30,000 lived in a rural part of the State. 

This is not a surprise to you as elected officials, that we must target the real parts of this State because often people are isolated 

and vulnerable and live alone in remote locations. 

We provide rides, home-delivered meals, and support senior centers. This assistance is well represented by the panel that you have 

following me, the long-term care ombudsman, the people who work 

for the financial exploitation task force, the people who are providing direct services through the area agency on aging. This is the 

core of our network, senior centers are where the services are ultimately delivered. 

I tremendously value the area agencies on aging, but I think the 

best place to visit is the senior center, because that’s where the 

seniors come for services, supported, of course, by the area agency 

on aging. This is important community assistance but is challenged 

by the number that you pointed out, Senator, the number of seniors turning 65 every single day. 

Fortunately, I believe we have some time to plan, not that we 

have time to waste, but most people do not need services at 65, but 

they need them by the time they’re in their late 70s or 80s, and 

this is a critical time that we support the services that we have. 

The Older Americans Act, which is the program that I’m responsible for, helps in three main ways. The Older Americans Act programs help Americans with severe disabilities remain independent 

and in the community. We can measure the frailty level of the people that we’re serving, and we have put together one of the measurements that’s called a nursing home predictor. Without these 

services, just as you said, Senator, what would happen to this individual, and we can tell over the course of the years that the people 

we serve through the Older Americans Act are more and more 

frail, more and more likely to need nursing home assistance without these vital community supports. 

Our programs are efficient. Our funding has stayed primarily 

flat. But because the money is leveraged at the local and community level, we have been able to serve more clients with the same 

amount of dollars. And because of this leveraging, the Older Americans Act services help build capacity in the network. It was never 

designed to be the whole show, but always an anchor around which 

you wrap State supports, community supports, private support, 

faith-based organizations. This is really, I see, the center beam 

around which we provide a variety of community services. It’s always meant to be and it’s always designed to be a grassroots system, as you have reflected here with you today. 

It is important that we continue to make advancements, that we 

take advantage of technology, that we have enough flexibility to try 

innovation. How can we use technology to help reach the remote 

seniors that you have in this State, as well as across the country? 

How can we be innovative in providing all of the services that we 

support and fund? 
7 

As you know, the Older Americans Act is up for reauthorization. 

It was actually up for reauthorization in 2011 and has not been reauthorized. Senator Sanders on the Senate HELP, Pension and 

Aging Subcommittee, who is in charge of reauthorization, is tremendously committed to reauthorizing the Older Americans Act, 

and we continue to work with the Senate very closely so that we 

can move this reauthorization. 

There are some fundamentals that I would like to talk about before I close about the Older Americans Act. When I first started, 

I spent most of the first year as Assistant Secretary traveling the 

country to get input from local providers, and here’s what I learned 

about the law. It’s working. It’s not broken. And this is an opportunity to talk about the future as we talk about the Older Americans Act. There’s nothing wrong with the law, and this is not a 

time when we need to go in and fix something but go into the law 

and figure out how it can continue to be improved. 

It is the glue that holds the entire national system of long-term 

support together. It is meeting the goals established by Congress. 

It meets the goals of targeting the people who are most vulnerable, 

people who are poor, people who have chronic diseases, people who 

have high risk for nursing home placement, people who are frail. 

It is meeting the objectives, and I always look forward to opportunities to figure out how we can do more, how we can find more 

partnerships. 

I will give you an example of one that’s not in my testimony. We 

have reinvigorated our relationship with the National Institute on 

Aging to find out what are the best evidences that they have on 

how they can help develop evidence-based programs that we can 

deliver through the aging network. We are ready to have good 

science behind the social services that we deliver, and the Older 

Americans Act and its network is as strong as ever. 

We are here to partner with you. We believe that the pending reauthorization could be passed, needs to be passed, and by doing so 

we can really look at the challenges of an aging population that are 

increasing, help individuals maintain their health and independence, and continue to be able to focus on the person. 

This is where I’d like to conclude, that the beauty of having this 

particular law is that it’s able to do as you talked about, Representative Capito, come in and evaluate one person at a time regardless 

of their race or income or geographic location, regardless of their 

situation in life, to determine what do they need, what are their 

frailties, how can we provide assistance, and if those change next 

year, we’ll provide different additional ones. 

This is the beauty of how this law has always been developed, 

that it is person-centered, that it reflects the very unique needs of 

each individual senior as they age in this country. Thank you very 

much. 

[The prepared statement of Kathy Greenlee appears in the Appendix on page 38.] 

Senator MANCHIN. Secretary Greenlee, thank you so much for 

your remarks. 

Let me preface. I have about three quick points to make, and 

then I’d like to hear your response. 
8 

Before I do that, the most sobering moment I’ve had as a senator 

was when I sat in the Armed Services Committee and I asked at 

that time Admiral Mullen, who was then chairman of the Joint 

Chiefs of Staff—this is the entire Department of Defense, military, 

everything that protects us in who we are as a country—and I 

asked him, I said what’s the greatest threat the United States of 

America has right today? This was maybe three or four months 

ago. 

Now, there’s a lot of things I was expecting, an array of answers. 

Was it Al Qaeda? Afghanistan? Iraq? Was it Iran? North Africa? 

Or was it Russia? Or was it China building up their military? I 

could have gotten an array of answers. 

He didn’t even flinch. You know what he said? The deficit and 

debt of this nation is the greatest security risk we have as a nation. 

He didn’t think there was an army that would pose that much of 

a threat. He didn’t think that there was any foreign element that 

would pose a threat to us as a nation. 

But our debt and what we’re carrying right now, the financial 

burden—and we’ve talked about this—if we don’t fix it—we’re now, 

our debt ceiling is able to go to $16.4 trillion. If we don’t bring this 

under control—so I’m prefacing it by saying what our challenges 

are and why we have to be so much better and smarter. 

We will be the first generation to turn over the keys to our children in worse shape than our parents gave it to us. We’ll be the 

first. All of us will be guilty to be the first to let that happen if 

we don’t stand up. 

With that being said, that’s more to the point of what I’m going 

to be asking. We brought all the different people who are on the 

front lines in West Virginia, and you’ll hear from them in a second 

panel. 

Can you tell me more, Secretary, about how you’re building collaborative partnerships with Federal and state community, how 

you’re looking for that efficiency, and basically the point of service 

where it gets the most traction, if you will, the most good to the 

people? 

Ms. GREENLEE. Let me answer your question in two parts and 

first talk about the debt part, the financing part that you prefaced. 

What we know, those of us who provide services through the 

Older Americans Act systems, the people behind me who provide 

these services, is that if these services were not in place, many, 

many people would then become reliant more quickly or eventually 

on public programs; that it’s very important that we help—Older 

Americans Act services are cost effective, they’re fairly inexpensive, 

and they can help someone stay in their community for as long as 

possible. 

Once someone has to leave and go to a nursing home that type 

of care in that setting is tremendously expensive, and many people 

who get to the nursing home spend down within the first year and 

become eligible for Medicaid. So from both good people policy and 

good fiscal policy, community services are much more cost effective, 

and I think that’s the real value that we have in providing Older 

Americans Act services. 

But the world has become increasingly more complex for seniors 

to navigate between the VA and Medicare and Medicaid and these 
9 

local services. The way the Administration on Aging has been addressing this was first realized in the mid-2000s. In the 2006 reauthorization of the Older Americans Act, we implemented for the 

first time aging and disability resource centers. All of your area 

agencies on aging here in West Virginia participate as aging and 

disability resource centers. 

And the best way for me to describe to you what that is, it’s a 

capability or a quality that the people in that resource center can 

help someone access everything they need in the community, 

whether its community supports from the government, whether it’s 

social service supports in the community. What we have known in 

the aging services network for decades is that our best asset is 

sometimes not the services we deliver but the knowledge in our 

brains about how we put together services and supports, formal 

services, informal services. 

What the aging and disability resource centers do is the piece 

that you’re recommending. How do we have a one-stop shop, someplace where there’s one person who an individual can call so you 

can say, oh my goodness, I don’t know where to even begin. Where 

there’s someone who can do an assessment of the loved one if they 

need it or help provide support for the family caregiver, or help figure out if there are other government services or other kinds of assistance that the senior may need? 

It is an extremely complicated system, and often people will—I 

think people arrive at that system one of two ways, in a crisis 

where mom falls and breaks a hip and the mom is at the hospital, 

or with a family who has a senior who continues to age and need 

more and more care at home. We can provide assistance for all 

those scenarios. 

Senator MANCHIN. Certainly with the budget crisis that we’re 

facing in Washington, we’ve been blessed in West Virginia and we 

have our house in pretty good order, if you will, and they’re working on making it even better, but the challenges are still there. But 

in Washington, knowing that we’re going to be facing some—every 

agency is going to be asked—every agency is going to say, yes, but 

we’re much more important, so we want you to protect us; if anything, increase our funding. We’re going to have to make the hard 

realization that everybody can work better and more efficiently. 

Where do you see the efficiencies that you could, in your crystal 

ball, looking at where you’re seeing it from 40,000 feet now being 

in Washington, looking down at what every agency is facing, how 

can we provide more services to more seniors probably more efficiently, cut out the waste, fraud and abuse? The GAO last year 

said $125—we knew that $125 billion was misspent on most of our 

social services. When I say that, the abuse, fraud, and waste that 

went into it. And when I went to Washington, the first time I was 

there, they were going to cut Head Start, the poorest of our children. They were going to cut Social Security. They were going to 

cut Medicare and Medicaid. I think who else is left to throw under 

the bus? 

But if we could run it more effectively and more efficiently, can 

we get better services and still have the responsibility of our budget crisis that we’re having? How would you recommend and where 

do you see we can go? 
10 

Ms. GREENLEE. Senator, I am a long-time public servant as well, 

two decades in public service at the state level and the Federal 

level. I agree with you but also would like to, point out one key fact 

with regard to the programs that I run. 

The Older Americans Act at the Federal level is a relatively 

small investment. My budget on an annual basis will sound big in 

West Virginia dollars, are real dollars, $1.6 billion. That’s my annual budget. That’s roughly what Medicare pays each and every 

business day in this country every year. So it is very small, and 

I always am concerned and responsive when people talk about 

fraud and abuse. 

We have program integrity measures. Every couple of years there 

will be a provider in our network that runs off with some money. 

But this is not a network that’s replete with fraud and abuse. It’s 

not a network that drives significant enough dollars to attract 

criminals. It’s just really small. 

I think the best way that we leverage the resources is to partner 

with our bigger Federal partners. I believe there’s a relationship, 

or there needs to be improved relationships between community 

services and medical services, for example, that the doctors and the 

hospitals provide something as basic as care transition to their 

home so people discharged from a hospital know about these local 

services and the need to help support the local services. 

We have built silos of care, whether it’s acute medical care or 

long-term care or community services, and the most holistic approach is to stitch them together so you’ve got one person who 

needs a little bit of community services, who needs a little bit of 

long-term care support, and they occasionally need to see the doctor or go to the hospital. 

The opportunities in the Affordable Care Act that I see are for 

us to be innovative. I also think we have to look in other directions. 

I spend a great deal of time talking to my colleagues at the Health 

Resources Services Administration. There are Federally-qualified 

health clinics all around this country, and I have found since I 

came to Washington something that concerns me, which is there 

are parts of the country where the Federally-qualified health clinic 

doesn’t know the area agency on aging, and they’re all providing 

services to seniors. 

So we have to do an increasingly better job of outreach both at 

the Federal level and at the community level to make sure that we 

can help seniors navigate all of these systems, because of the Federal budget and the strain on the State budgets, our budgets are 

not growing. They’re remaining relatively flat, and we have more 

need. 

Senator MANCHIN. A final one before I turn it over to my colleague. As you know, West Virginia is a small state, and we have 

about 15 percent of our population over 65 years of age, which 

makes us the second most aged state in the nation on a percentage 

basis. 

With that, under the Older Americans Act, the funding is done 

based on size and not specifically on need, mostly in the nutrition. 

I’ll tell you where I’m coming from. In nutritional services, Florida 

receives 10 times more dollars than we do but only serves four 

times more meals than we do, and that just seems inherently un-
11 

fair, and that’s what we’re seeing based on need. And we’re doing 

a heck of a job, but we have an awful lot of people in a rural area 

that depends on us. 

So we’re out there working and going out and being able to provide these services. So we’re saying can fairness be brought to that 

system? Funding solutions and what you’re saying, the story you 

just told us about efficiencies that you have, you need to tell that 

story more. When you start saying that we spend every day $1.6 

billion in Medicare, and your total annual budget to help all 50 

states and the territories is only $1.6 billion, it pretty much sends 

a message. 

With that, we all still have to look for our efficiencies if we can 

do something better. But with what I just pointed out to you, the 

inequity in the system, the way the monies are spent, taking into 

consideration—I don’t think they do—the rural state, the Older 

Americans Act—the ruralness of our state, the amount of people 

we’re serving, and the dependency that people have, how would you 

approach that? 

Ms. GREENLEE. Senator, the money that we have through the nutrition program, both on the congregate side and in the home-delivered program, is administered through an interstate funding formula to every State based on the number of people in the State 

over the age of 60. So it is a demographic distribution based on the 

people over the age of 60. 

But to respond to the point that you made, which is what if we’re 

serving more meals, we also have a smaller nutrition program 

that’s not as well known, which is the Nutrition Services Incentive 

Program, which follows along afterward to help provide incentives 

and reward people who do the most with the money that they get, 

who serve more people with that money. 

You are a particularly rural State. The Older Americans Act requires that the State and the area agencies target certain populations, and in West Virginia you would automatically target rural. 

In Florida, they have larger numbers of people of color and minorities. They’re also listed as a high-profile State. There are States 

that have people who are also remote. I could talk to my friends 

in Alaska who also have tremendous transportation challenges. 

So we do a base funding, and then we follow along to reward incentive because each State has kind of a slightly different highneeds area that they’re serving. 

Senator MANCHIN. Thank you so much, Kathy. 

And now for Congresswoman Capito’s questions. 

Representative CAPITO. Thank you. I’m just going to follow briefly up on what the Senator said. With the $1.6 billion, if you could 

just kind of walk me through, that’s the Older Americans Act appropriation for annual appropriation. 

Ms. GREENLEE. Yes. 

Representative CAPITO. So then parts of that is nutrition? How 

does that fold out, just really briefly? How does that fold down to 

the state? Because you said mostly it is then just pushed out to the 

states. So we’re different pockets. Obviously nutrition is, what, 

about 40 percent of your budget? 

Ms. GREENLEE. It’s about 40 percent of our program dollars. 

Most of the money that we have is distributed based on a formula. 
12 

So we have some competitive grants. We’ve done a lot, for example, 

in the field of Alzheimer’s and some other evidence-based programs. Almost all of the money is sent to the states based on the 

Census. 

Representative CAPITO. So there’s nutrition. And then what 

would your other pockets be? 

Ms. GREENLEE. Then we have in-home supports. 

Representative CAPITO. Okay. 

Ms. GREENLEE. We have nutrition. We have the family caregiver 

program. We have some smaller parts. It’s probably the smallest 

one we have, for health promotion, where we’re doing a lot of 

chronic disease management, preventive services, as well as in 

Title VII, the Elder Rights Program, where we have some targeted 

efforts for elder abuse, long-term care ombudsman, and legal services. Those are divided out per State, per capita, based on the population of 60 or older, which is the age of eligibility. 

We also have some smaller programs that are directed specifically to Native American programs, Alaska Natives, Hawaiian Natives. There’s a nutrition program, a family caregiver program, 

and, of course, we have a direct government-to-government relationship with the tribal organizations. 

Representative CAPITO. One of the questions when we were 

speaking with the media before we began was do you just need 

more money? I mean, we’re talking about the constraints that we 

have. You mentioned them, too, and where we are for our future. 

So we know that that’s the big conversation in Washington now. 

And certainly if you had your wish list of everything you could 

have, more money would probably be at the top of everybody, 

whether it’s education, military, whatever the government is involved in. 

But it seems like you’ve accomplished a lot of efficiencies with 

the money that you have. So I guess the message I’m receiving is 

while certainly more money would be great, you can still achieve 

great efficiencies with the $1.6 billion that is then granted down 

to the states. Is that a fair statement? 

Ms. GREENLEE. May I address the money first and just point out 

that I was very pleased in FY 2011, Federal fiscal years 2011 and 

2012. The President recommended that the Older Americans Act 

receive an additional $100 million in funding, and that was packaged together as a caregiver initiative. Roughly half of that money 

would have gone to provide support to family caregivers and half 

that money to the care recipient. 

Those historic increases, we’ve not seen that sort of a recommendation for a decade for the Administration on Aging. Those 

increases were not realized, that our budgets have been flat funded. 

Representative CAPITO. Do you know what he’s doing in—he’s 

putting his budget out today, I guess. 

Ms. GREENLEE. Yes, but one rule is I don’t want to get ahead of 

him. He’s announcing his budget in a couple of hours. But I will 

say that these are tough times, and we have seen support from 

both the Secretary and the President regarding the value of these 

particular programs. They don’t duplicate other programs. They’re 

critical infrastructure. They complement other community services. 
13 

Yes, I think there’s tremendous unmet need, and we do the most 

that we can to spend these dollars wisely and to partner with local 

communities as well. 

Representative CAPITO. The other thing I just would reinforce, 

and we talked about this earlier too, is particularly in terms of the 

VA. Just in the brief comments that we had before when we were 

talking earlier and from my own personal experience, there’s a disconnect between trying to figure out how to weave the VA and the 

Medicare and all the other services, whether you have your own 

private-pay personal care situation or hospice or all the different 

pockets of Federal. 

I would encourage you, and you’ve said this in your remarks, 

that you’re coordinating with the VA, because the VA has sort of 

opened up this area as an area of emphasis for them. When you 

look at—I mean, we’re losing our World War II veterans, but we’re 

going to have our Vietnam veterans, and then certainly we want 

to plan for the folks who are coming out now so that when in 40 

or 50 years, or 30 and 40 years from now, when they are trying 

to access these systems, the VA has—and I know the VA is not 

your bailiwick, but the VA has morphed into an area that—and I 

think they are trying to change where they can meet those areas. 

So I would just encourage that. 

And the other thing is I see Chuck back there from Roane County, and another thing I’d like to reinforce, because he does this at 

his senior center, is I like the way he has coordinated not just seniors in a building, but he has young people in the building, he has 

small businesses that are—he has a rather large building, but he 

has entrepreneurs who are coming in and trying to do building 

start-ups. He has after-school care in the building. So it really does 

reflect more for the senior who is getting the care more a community, because seniors don’t live in a—I don’t live in a community 

of 56—I’m going on 58. 

[Laughter.] 

of 58-year-olds. 

Senator MANCHIN. I didn’t want to remind you. 

[Laughter.] 

Representative CAPITO. Yes. Well, I am younger than you. 

[Laughter.] 

And, you know, seniors don’t—the joy that I see, that most seniors see when they see a baby or a young child, or even an animal, 

a dog or a cat or a pet or something like that, I just think that 

those kinds of coordinations outside of the umbrella of senior care 

is something that we really ought to look at, and I know you all 

are looking at it, but it’s something that maybe we ought to put 

more emphasis on as a nation and create communities that are 

more reflective of the general population, which then would lead to 

general better health, better mental health. 

So with that, if you want to comment on that—— 

Ms. GREENLEE. Just briefly about both. With regard to the VA, 

I completely agree with you. I believe in this network, and we do 

the right thing even when we don’t get paid for doing the right 

thing. In 2008, the Administration on Aging began to partner with 

the Department of Veterans Affairs (VA) because we had soldiers 

coming home from the two wars at that point who didn’t have re-
14 

sources in the community, that the VA had not built a home and 

community-based infrastructure. 

So, because we saw the value of the network, what we could provide given our skill set, VA began a brokerage arrangement where 

we said VA, let’s introduce you to our network so that they can bill 

directly for their services to the VA. The VA is completely committed to this program. It is growing. Every year they provide more 

resources, and they’re moving to take this nationwide, to use that 

infrastructure. 

And then on your second point, I never talked about this in a 

hearing before, but I will tell you there are occupational hazards 

in this job, that sometimes it makes you cry. It just does, and the 

people who do this work will tell you, and you’ll probably start crying for different reasons, so I’ll tell you about one where I did, and 

that was December, not last year but the year before, when I visited an Alzheimer’s program in Washington, D.C. 

Right after I began, I started to tour and look at the programs 

in Washington so I would be familiar with what we were providing, 

and we were providing services or are providing support to an Alzheimer’s program. In that December, they brought the children in 

that were about age 4 to sing, and really, you just had to cry. When 

you see seniors and young people together, especially seniors in a 

nursing home or people with dementia, it’s just special and very 

magical, and there are many places around the country that also 

see that, that bring together kind of the whole family, the whole 

community because it’s valuable to both. 

I think it’s helpful to seniors, but I must tell you I think it’s also 

helpful to children so that they continue to see a positive view of 

aging and learn all the things we would hope that they would learn 

about their elders. So there are wonderful things that we’re doing. 

Senator MANCHIN. Thank you, and thank you, Congresswoman, 

for your questions. 

I want to thank you for your testimony. If you would, you’re 

more than welcome to stay right there. 

Ms. GREENLEE. Okay, I will. 

Senator MANCHIN. And then we’ll bring the others. I think we 

have enough seats, because I was going to bring you back anyway. 

So rather than sending you back and then bringing you back, you 

just stay right where you are. 

Ms. GREENLEE. Okay. 

Senator MANCHIN. Let me just say, first of all, I want to welcome 

Senator Ron Stallings, Dr. Ron Stallings for being with us. 

Ron, if you’d stand up. 

Ron does a great job. 

[Applause.] 

Ron is chairman of the Senate Health Committee. He’s a practicing physician. He brings a world of practical experience to that 

committee, and I just enjoy working with him. 

Thank you so much, Ron. 

The first witness on the second panel is going to be Suzanne 

Messenger, and I would like for all of our panelists to come forward, and I’m going to read a little bio on all of you, and then we’ll 

start right down, if you will. We have Brenda here, Janie, Helen, 

and James. 
15 

The first witness on the second panel will be Suzanne Messenger, and Suzanne is a West Virginia state long-term care ombudsman. I’m sure she’ll explain her duties when she starts speaking. Her job is to empower seniors and their family members to 

make informed, long-term care decisions. 

Then we will hear from Brenda Landers. Brenda is the Director 

of the Metro Area Agency on Aging, one of West Virginia’s four regional Area Agencies on Aging. Her agency oversees programs delivery in southwestern West Virginia and contracts with local senior centers to provide meals, transportation, and other services. 

After Brenda we’ll be hearing from Janie Hamilton. Janie is the 

Executive Director of the Kanawha Valley Senior Services in 

Charleston. Her organization provides critical programs like inhome care, transportation and nutrition services to seniors of the 

Kanawha Valley. Janie is also an only child and caregiver of her 

83-year-old mother that lives with her at her home. So she has the 

real hands-on experience. 

We’ll then hear from Helen Matheny. Helen is the Director of the 

Alzheimer’s Disease Outreach Program at the Blanchette Rockefeller Neurosciences Institute at West Virginia University. The aim 

for her program is to provide physicians with training and tools to 

improve screening, diagnosis, treatment and care of patients with 

Alzheimer’s disease and related dementias. Ms. Matheny also 

serves as a member of the National Advisory Council on Alzheimer’s Research, Care and Services. 

And finally we’ll be hearing from James Clagg on behalf of himself and his wife, Ellen. James and Ellen volunteer at the Milton 

Senior Center. Ellen serves as assistant treasurer of the Center 

and works with the Center’s kitchen. James calls bingo every Tuesday and drives the bus on Center trips. James and Ellen have been 

married for 23 years and have lived in West Virginia all of their 

lives. 

So I want to thank each and every one of you for coming and taking time to be with us. 

And with that, Suzanne, we’ll call on you. 

STATEMENT OF SUZANNE MESSENGER, STATE LONG-TERM 

CARE OMBUDSMAN, WEST VIRGINIA BUREAU OF SENIOR 

SERVICES, CHARLESTON, WV 

Ms. MESSENGER. Thank you, Senator Manchin and Congresswoman Capito, for the opportunity to testify here today. 

As state long-term care ombudsman, I advocate for the rights of 

long-term care residents with the goal of enhancing their quality 

of life—a lot of living goes on in long-term care facilities—and promoting self-determination. 

By devoting our time and resources to the areas of preventing financial abuse and ensuring a robust long-term care ombudsman 

program, I believe we can improve the effectiveness and efficiency 

of our aging network and continue our mission of person-centered 

services. 

Although there are many legal definitions of financial exploitation, it’s basically stealing. It can be the simple unauthorized use 

of a credit card or it can be a really complicated fraud scheme. 
16 

In 2010, a MetLife study estimated that the annual financial loss suffered by seniors through financial exploitation was $2.9 billion. 

Remember, that’s almost twice the budget of the Administration on 

Aging, $1.6 billion, $2.9 billion stolen from our seniors. 

Exploiters are criminals, but sadly they’re often friends and family members or others that the seniors thought they could trust. It 

can be even more complicated when the person is stealing through 

legal means, which sometimes happens through a durable power of 

attorney, a legal document that provides them access to the senior’s 

money. These cases often come to the ombudsman’s attention when 

residents are issued discharge notices. 

The perpetrators spend the money. They don’t save it. Many 

times the seniors are unaware that it’s even happening, and they’re 

reluctant to come forward because it’s their family. They’re also 

under the misunderstanding that this power-of-attorney representative holds some magic power over them and that somehow they 

can punish them or do something wrong to them if they challenge 

them, when really the reverse is true. 

In order to stay this exploitation, we need better laws, and right 

now our legislature is considering reforming West Virginia’s powerof-attorney law and enacting the Uniform Power of Attorney Act 

through Senate bill 449 or House bill 4390. This will provide some 

important protections for our seniors and agents, and even third 

parties who rely on that. 

But we also need better education, and Older Americans Act programs are great at providing that kind of education, education to 

seniors that they’re really the ones in charge here. They’re the 

boss, not the agent, and that’s sort of different from how many of 

them understand it now. And unfortunately, people in the community are under that same misconception, and even many attorneys. 

So we need better education to address financial exploitation. 

If we can empower our seniors to take control over their money and prevent that, just think the good that we can do with $2.9 billion extra in our economy. 

Another way to empower our seniors is by ensuring a robust ombudsman program. The long-term care ombudsman program is the 

only Older Americans Act program that’s specifically designed to 

serve residents in residential care facilities. Through complaint investigation and consultation and information, our ombudsman supported residents in exercising their rights, staying free from abuse, 

receiving quality services, and enhancing their dignity. 

When one administrator was asked what would be the situation 

if there was no ombudsman program—and this was a facility administrator—he said residents would lose a channel of communication and support that helps them exercise their rights and freedoms. 

Reauthorization and adequate appropriation of the Older Americans Act is one way to provide a solid basis for ombudsman services. Fully funding the Elder Justice Act, which is a complementary 

act that can provide a strong safety net for the ombudsman program and many of its partner agencies, is another way to strengthen this. Enabling residents to solve problems before they escalate 

into major issues, helps assure that residents have the best quality 

of life and quality of care that they can. 
17 

Preventing financial exploitation and power-of-attorney abuse not 

only protects our vulnerable adults but it also allows for a more efficient system based on choice and autonomy rather than dependence and fear. Ensuring a robust ombudsman program empowers 

our residents and helps assure quality of life and quality of care, 

which are the hallmarks of an effective and efficient senior aging 

network. 

Thank you for the opportunity. 

[The prepared statement of Suzanne Messenger appears in the 

Appendix on page 49.] 

Senator MANCHIN. Thank you. 

We’ll go down through the witnesses and then we’ll go to questions, okay? 

Brenda, if you would? 

STATEMENT OF BRENDA LANDERS, DIRECTOR, METRO AREA 

AGENCY ON AGING, DUNBAR, WV 

Ms. LANDERS. Good morning, Senator Manchin, Congresswoman 

Capito, Assistant Secretary Greenlee, and other distinguished 

members of the committee. Again, I’m Brenda Landers, the Director of Region 2 Metro Area Agency on Aging, located in Dunbar, 

West Virginia. Again, thank you for the opportunity to testify on 

behalf of the West Virginia Area Agency on Aging. I will attempt 

to explore the history of the AAAs, identify and address future 

challenges facing West Virginia’s aging population, and provide recommendations for the reauthorization of the Older Americans Act. 

West Virginia’s AAAs assisted in establishing many non-profit 

organizations in the early 1970s. These organizations became the 

county aging programs, offering services such as nutrition, transportation, and social services which have become very visible and 

much-needed services in West Virginia. 

The West Virginia Bureau of Senior Services, BOSS, is the state 

unit on aging designated to receive Federal and state funds for senior programs. BOSS contracts with the four regional AAAs to administer funds from the Older Americans Act and the West Virginia Bureau of Senior Services. 

The AAAs develop or enhance comprehensive, coordinated community-based systems that serve all 55 counties through four regional offices located in Wheeling, Dunbar, Petersburg and Princeton, West Virginia. The AAAs contract with aging county providers 

for the provision of meals, transportation, and in-home services. 

The AAAs also have a monitoring system in place to address waste, 

fraud, and abuse. 

It’s the AAAs responsibility to provide assistance to the service 

providers, as well as to manage and monitor the responsible use of 

Federal funds utilized for specific programs. Each AAA employs a 

monitor and has a monitoring review process to determine compliance with the requirements of state and Federal funding entities, 

applicable laws and regulations, and stated outcomes. AAA monitoring activities include desk audits, review of reports submitted by 

the providers, site visits to review financial and programmatic 

records, and observation of daily operations. 

Regarding the reauthorization of the Older Americans Act, on behalf of the West Virginia Area Agencies on Aging, I respectfully 
18 

submit the following recommendations: consolidate funding for congregate meals and home-delivered meals to allow flexibility and 

meeting the demands of the affected communities; expand the 

range of Title III services for which cost sharing is permitted; and 

require states to request a waiver for cost sharing for nutrition and 

case management. Also, provide additional funds to states as an incentive for high performance and achieving program goals. In addition, our West Virginia AAAs would recommend an increase in the 

monies for the core Titles of the Older Americans Act; and also new 

use of Federal monies to augment existing state funds for ADRCs. 

West Virginia remains one of the oldest states in the nation. 

Planning for the future will make sure the needs of senior West 

Virginians and their families are met. The National Area Agency 

on Aging recommends establishing new provisions with dedicated 

funding, authorizing the AAAs to assist county and city governments in preparation for aging in their communities. These provisions would authorize funding and outline the roles and activities 

to be performed by full-time planner/community organizer position. 

The new position would take the lead role in working with other 

agencies and stakeholder organizations in the development of a 

comprehensive livability plan and implementation strategy. 

West Virginia communities will need to provide an array of services, including facilitation of more accessible housing, preventive 

health care, including health and lifestyle education, and immunizations and screenings to reduce injuries and the onset of chronic 

diseases, and a range of in-home health assistance to keep people 

in their homes longer. The four West Virginia AAAs received a $488,000 grant for 

Money Follows the Person or Take Me Home West Virginia program. This program will assist West Virginians as they move from 

a nursing facility or a hospital to a residential setting in a community. The West Virginia AAAs recently applied for the CMS’ Health 

Care Innovation Challenge in the amount of $7 million. The intent 

of this program is to develop and utilize strategies to decrease the 

behavioral health risks for preventable chronic diseases in West 

Virginia’s senior population. 

The AAAs proactively carry out, under the leadership of the West 

Virginia Bureau of Senior Services, a wide range of functions related to advocacy, funding, planning, coordination, inter-agency 

linkage, information sharing, brokering, monitoring, and evaluations. West Virginia Aging and Disability Resource Center plays an 

integral part in meeting the needs of seniors and persons with disabilities. The ADRCs strive to reduce consumer confusion and build 

trust and respect by enhancing individual choice and informed decision-making. 

It’s important that the ADRCs remain independent since they 

are the first place to get accurate, unbiased information on all aspects of life related to aging and living with a disability. ADRCs 

are reaching many consumers who do not frequent the county senior centers. There’s a great need for Federal dollars to accompany 

state monies to continue the ADRCs’ mission. 

It’s very important that we view seniors and the aging Baby 

Boomer population as community assets, not simply the focus of 

burgeoning cost. West Virginians need to devote more efforts to fos-
19 

ter job creation and create incentives for employers to hire this 

population. The modern focus of aging no longer remains on increasing the quantity of years but rather on enhancing the quality 

of years lived through a balance of physical, mental, and social 

healthful behaviors. 

As West Virginia’s 65 and older population increases, it’s important that individuals have access to an array of services that promote physical activity, mental fitness, social health, and overall 

health and wellness support. The provision of health promotion and 

disease prevention programs are essential for effectively enhancing 

the health of our senior population while reducing the burden of 

their health care costs. 

In conclusion, thank you for the opportunity to share with you 

the history and the goals of the West Virginia AAAs and their 

plans to address future challenges to our aging population. 

[The prepared statement of Brenda Landers appears in the Appendix on page 56.] 

Senator MANCHIN. Thank you so much, Brenda. 

Janie. 

STATEMENT OF JANIE HAMILTON, DIRECTOR, KANAWHA 

VALLEY SENIOR SERVICES, CHARLESTON, WV 

Ms. HAMILTON. Senator Manchin, Congresswoman Capito, I’d 

like to thank you and your committee for the vision to come and 

look and hear from us who are advocating for the seniors of our 

country, and especially the State of West Virginia. 

My agency, Kanawha Valley Senior Services, is the county-level 

agency that provides social services, in-home personal care and assistance through Waiver Medicaid Personal Care, Lighthouse, the 

FAIR program, the VA Homemaker Program, Creative Care, which 

is what we call our private-pay, in-home care program, the Family 

Caregiver Respite and Daycare—we have the social model located 

at the Tiskelwah Center in Charleston—and there is also a center, 

as you well know, at the Hansford Senior Center in St. Albans. 

There are health and wellness opportunities, computer literacy, 

transportation and support for 12 nutrition sites in Kanawha 

County. 

As a local provider, my issue is to absolutely encourage you to 

reauthorize the Older Americans Act. And as Secretary Greenlee 

said, we have a flat funding for the last 10 years, and as the Baby 

Boomers are coming into this area of need, we are going to have 

to look at ways to increase funding. As she stated, her budget is 

very low for the amount of services we provide. 

The oldest Americans are the fastest growing segment of our 

population, and that’s going to continue for the next 20 years. So 

we really need to look at ways to increase the funding, as well as 

be efficient. We need to allow the cost sharing in the in-home care 

services, as has been already reported. We need to add more prevention and health education in all of the three program titles of 

BCMD, as well as Title 8. 

We need to reduce and/or relax the excessive regulations and redundant regulations. Sometimes our reporting causes us to lose 

more time and money than we can be reimbursed for, and that 
20 

means every dollar we spend administering programs is a dollar 

less we have in providing service to the seniors themselves. 

We definitely need more flexibility in the funding of the state 

units on aging, and we need a mechanism for the modernization of 

senior centers, perhaps adding an incentive for Federal community 

block grants to allocate money to senior center modernization. 

You know, 30 years ago, when economies were in much better 

shape, the City of St. Albans reached out and funded their own 

senior center. No other community does that in our state. That 

should have been done. The original intent of the Older Americans 

Act was that the local level would embrace their seniors and fund 

their centers, and that isn’t being done, and it can’t be done now. 

There’s no way we can go back to communities and municipalities 

and say you need to start funding your senior center at some level. 

The levels are very low, if any at all. So our senior centers are 

going to fall into disrepair because of the lack of funding because 

we’re trying to just provide services. 

At the county level, we don’t really have the money to help them 

write their own grants and get monies from other sources. 

As a county agent provider, my mission is to assist our aging 

population in attaining or maintaining a good quality of life for 

their remaining years using the resources available effectively. As 

economic problems prevail, the competition for available funds and 

other resources increase, making that part of my job a time-consuming endeavor. I spend way too much time seeking out funding 

instead of managing the programs. 

With the surging boom in our aging adults just beginning to skyrocket, as you both alluded to, we are in the early stages of a challenge our country has never, ever seen before. 

Another point I would like to make is there’s a remarkable increase in Boomer generation grandparents raising their grandchildren. This is at the same time trying to assist their own aging 

parents. The number of grandparents raising grandchildren is increasing, currently 5.8 million children in the US. This adds a 

whole other dimension of need to the aging seniors. 

Mental health services is another area of need. We are lacking 

severely in mental health services across the board, and right now 

I meet with 50- to 70-year-old adults whose parents are still living 

but suffering with some type of a mental health problem. The aging 

child doesn’t know what to do for their parents, and they really 

don’t have the time or energy to assist their parents, or even hook 

them up with what may be available for them. They’re unprepared 

to cope, have no idea where to turn, and agencies like ours don’t 

have advertising dollars. So that’s where some of the flexibility 

needs to come in. 

There are seniors facing addicted, mentally unstable adult children who are exploiting them, literally stealing their life savings 

out from under them, and they often have their medication stolen 

by family members who are addicted, or perhaps they’re selling 

them on the street just for the money. Perhaps some funding for 

policing these things, educating the seniors about these things. 

We’ve had some movement in that area, but it definitely needs to 

be expanded upon. 
21 

We spend a lot of time in my agency showing proof of services. 

Extreme amounts of time is spent and not always reimbursed, 

again, for those hours. We have the layered challenge of complicated reporting requirements and excessive hoops to jump 

through to prove services. It causes us to spend money that we 

can’t put toward assisting seniors. 

As an example, the local VA has a slow reimbursement turnaround to the point where they’re actually paying us interest because of their lateness in payments. VA cases are randomly assigned. So some more collaboration with the aging network and the 

VA definitely needs to be done so that we can bridge these services 

and work together to serve our senior veterans. 

We need more flexibility in all of this. When Senator Manchin 

was our governor the Lighthouse program was developed. Right 

now, it is the most user-friendly service we have available. It allows for those who qualify to receive all that they need and not limited to personal care only. This is funded entirely by the State of 

West Virginia. There is a waiting list, but this model needs to be 

looked at at the Federal level for funding services. 

The Family Caregiver Program is a wonderful program. Challenges by family member include availability of time, lack of training, their lack of health literacy, personal, physical, mental and financial issues, all that causes that adult family caregiver a lot of 

stress and then puts their health at risk. The success of the Alzheimer’s Family Caregiver Respite programs is high, but we definitely need many, many more, as I’m sure Helen will attest to in 

the next few minutes. 

We need to learn best practices and imitate them in all communities, and keep funding, if not increase it. 

Community awareness of the symptoms of Alzheimer’s is another 

thing, and elder abuse and exploitation, both in the urban and 

rural settings, must increase with some sort of maybe anonymous 

call-in line or a website where reporting can be done. We need to 

train local law enforcement, case management and social workers. 

EMTs and clergy all need to be included in awareness trainings 

that assist in detecting the symptoms at the earliest time so that 

plans for their care can be made by the individual before they become incompetent. A lot of times, family members don’t realize that 

their parents are deteriorating mentally, and therefore they don’t 

say ‘‘You need to make those plans for your future care before it’s 

too late.’’, and then a family member is left to try to guess. 

Transportation is definitely an issue, as you know, in a rural setting. We have a hard time providing all that’s needed, and one 

thing that would be very helpful is routing software. If we had the 

funding, if there was specific funding or some collaboration with 

companies that provide this type of software, we could be much 

more efficient in our transportation efforts. 

As a family caregiver and a sandwich generation participant, I’m 

the only child to my 84-year-old mother. She shares my home, and 

we have taken the steps to make her care needs as smooth as possible as they arise. I depend currently on the transportation services that my agency provides to get her to and from all her medical 

appointments. 
22 

We live in St. Albans. I work in Charleston now. It is much easier for me to meet her at her appointment. I’m her health advocate. 

But if I didn’t have those transportation opportunities to get her 

up there, I would really, really be in a fix because I do need to 

work. I have a 20-year-old. That’s the youngest of four children. 

And as you kind of mentioned, Shelley, kids don’t just quit needing 

you just because they become of legal age. And so we’re still sandwiched even though we don’t have grade-school children at home 

or high-school children at home. We’re still sandwiched between 

those two needs of our family members. 

My mother enjoys the socialization opportunities available at the 

Hansford Senior Center in St. Albans, and I believe that these 

things have added to her quality of life, and she agrees. I couldn’t 

work full time and help raise my children without this aging network that is in place, and I cannot imagine trying to do this in a 

rural area of our state. 

So again, I will ask that you look at making sure that the Older 

Americans Act is reauthorized; if not, some funding increases put 

in place, and look at allowing cost-sharing for the in-home care programs. We need some support for the modernization of our senior 

centers, which you very well know is a very, very local level of 

quality of life for seniors in the area. 

Our future is sure to test our country’s ability to rise to the occasion and look to the good of those who are in need of protection 

rather than those who are capable of working towards their own 

support. We have had such a rich life here in our country. Those 

who have made this country great are living longer in larger numbers than ever before. We owe them all a debt of gratitude and all 

the support they need to spend their final years in peace and comfort. Don’t forget, our children are watching. 

Thank you so much for this opportunity. 

[The prepared statement of Janie Hamilton appears in the Appendix on page 64.] 

Senator MANCHIN. Thank you, Janie. 

Helen. 

STATEMENT OF HELEN MATHENY, DIRECTOR, ALZHEIMER’S 

OUTREACH AND REGISTRY PROGRAM, BLANCHETTE ROCKEFELLER NEUROSCIENCES INSTITUTE, MORGANTOWN, WV 

Ms. MATHENY. Senator Manchin and Congresswoman Capito, 

thank you very much for this opportunity to testify on strengthening the aging network. Senator, as you mentioned, I serve as the 

Director of the Alzheimer’s Outreach and Registry program at the 

Blanchette Rockefeller Neurosciences Institute. The institute is a 

unique, non-profit medical research institute dedicated to the study 

of memory and memory disorders, with its focus on Alzheimer’s disease and related dementias. BRNI is operated in alliance with 

West Virginia University, as well as in collaboration with other 

academic institutions. 

The Institute’s Alzheimer’s Outreach and Registry Program, the 

only one of its kind in the country, provides physicians with education and tools to improve screening, diagnosis, treatment and 

care of patients with Alzheimer’s disease and related dementias. 

The continuing education sessions help connect the medical com-
23 

munity with local resources to better link patient treatment and 

care, as well as to support caregivers through the disease progression. 

The program also maintains the West Virginia Alzheimer’s Disease Registry. The registry is a secure database that compiles demographic, diagnostic, and medical treatment conditions information about patients who have been diagnosed with Alzheimer’s disease or a related dementia. 

As I begin my discussion today, I would like for you to keep in 

mind a few key facts about Alzheimer’s disease in West Virginia. 

I know you’re well aware that, according to the Alzheimer’s Association, 44,000 West Virginians age 65 and older have been diagnosed with Alzheimer’s disease. Also, Alzheimer’s shares similar 

risk factors as stroke and cardiovascular illnesses, including smoking, high cholesterol, obesity and diabetes. 

Efforts to address this devastating disease must be bold. Until 

we find a cure for this disease, I strongly believe we need to develop a system of quality care for individuals with Alzheimer’s disease and related dementias. This system would include four key 

components. 

The first area is detection. It is important to distinguish dementia from temporary reversible conditions that may cause loss of cognitive functioning. Despite the availability of assessment tools, 

structured assessments for dementia have not routinely been incorporated into practice. One solution to this challenge is to utilize the 

Medicare annual wellness visit. It requires that detection of possible cognitive impairment be included in each visit, potentially resulting in earlier detection of dementia. 

The next component is diagnosis and care planning. In primary 

care settings, physicians report insufficient time and reimbursement as important causes of misdiagnosis of care. Many times physicians will focus on the issue that brought the patient in that day. 

I recommend that Congress pass legislation to create Medicare coverage for a package of services that covers a clinical diagnosis of 

Alzheimer’s disease, as well as care, planning, and coordination for 

the individual and their caregivers. 

Next I suggest we build upon the medical home model and utilize 

technology to enhance quality and care coordination. An electronic 

medical record template could be standardized to include screening 

and diagnostic tools, educational information for the patient and 

caregivers, and links to resources. Finally, the system could include 

tools for advanced care planning such as advance directive and 

medical power-of-attorney forms. 

The third area of the system is caregiver support. Approximately 

70 percent of individuals with Alzheimer’s disease and related dementia live at home and receive care from family and friends. In 

2010, more than 105,000 Alzheimer’s caregivers in West Virginia 

provided more than $120 million of unpaid care. I’m sorry, 120 million hours of unpaid care. West Virginia is fortunate to have the 

Family Alzheimer’s In-Home Respite or FAIR program that can 

serve as a national model of care. I encourage expansion of quality, 

affordable home- and community-based services for individuals 

with Alzheimer’s disease and their caregivers by increased funding 

for programs such as our FAIR program. 
24 

Another great resource for seniors is the new WVSeniorCare.com 

website that provides information about medical and social services, as well as health care facilities. 

Finally, the fourth component of the system is workforce development. This is a critical piece that we must address the shortage of 

physicians, nurses, and other health care professionals to improve 

care for an aging population. Congress should explore the increased 

use of available tools such as tuition assistance, loan forgiveness, 

housing subsidies, and stipends that encourage health care professionals to pursue specializations in primary care and geriatrics, 

particularly providers who make a commitment to work in underserved communities. 

The reality is that there are many West Virginians just like the 

Smiths. Mrs. Smith is 93 years old and is nearly blind. She’s a diabetic, has congestive heart failure, and is in and out of the hospital 

numerous times a year. Her husband has hearing problems, and 

his vision is impaired due to a stroke. The Smiths live in their own 

home. Because of their illnesses, they’re on multiple medications 

and they face high deductibles and medical co-payments. The 

Smiths, like many seniors, want and need high-touch, not necessarily high-tech, care. They need assistance with chores around 

the home and medication management. The Smiths need and deserve a quality system of care. 

In conclusion, I applaud your interest in identifying ways we can 

improve the efficiency and the effectiveness of the aging network. 

I want to thank you, Senator Manchin and Congresswoman Capito, 

for the opportunity to share with you suggestions about developing 

a system of quality care. I look forward to continuing to work with 

you on these issues, and I’ll be glad to answer any questions. 

[The prepared statement of Helen Matheny appears in the Appendix on page 69.] 

Senator MANCHIN. Thank you, Helen. 

James. 

STATEMENT OF JAMES CLAGG, VOLUNTEER, MILTON SENIOR 

CENTER, MILTON, WV 

Mr. CLAGG. Mr. Chairman and members of the committee, thank 

you for the opportunity to testify before the Senate Special Committee on Aging. We are James and Ellen Clagg. We represent the 

Milton Senior Center and the Cabell County Community Service 

Organization. 

‘‘Why don’t you go to the center with me today? We have a lot 

of fun over there.’’ 

This is how I was introduced to the Milton Senior Center. My 

wife had been attending for about a year, and she enjoyed it very 

much. 

My first thought was, ‘‘How can a bunch of old people have fun?’’ 

[Laughter.] 

‘‘What could they possibly be doing?’’ 

When I started attending the center, the people I met were ordinary folks just like us. Some are still living in their own homes, 

but others are living below levels that they would prefer. Others 

are living alone in subsidized apartments, some in trailer parks. 

Most are failing in health and have limited income. 
25 

Where or how can they have fun? 

At the senior center, they have a place to become part of another 

family. 

I’m sorry. 

The members may not be blood related. However, each one, in 

time, becomes a brother or a sister within the family. 

We participate in a variety of games, bingo the favorite. We work 

table puzzles, exercising on our machines, have crafts to work on, 

sew, and make lap quilts for the shut-ins. 

The Cabell County Community Service Organization, or CCCSO, 

as we know them, provides a warm meal daily. At this meal, we 

talk and exchange thoughts on any subject that might come to 

mind, a home atmosphere with family members. 

The center provides a number of presentations by locals, as well 

as professionals. Senator Manchin visited us this past month and 

asked for our opinions and shared with us his on different subjects 

currently before Congress. 

We have health screenings at least once a month where blood 

pressure and blood sugar levels are tested at no cost. 

We also have monthly dinners where singers delight us with 

their music. Schoolchildren at Christmas have a wonderful program for our enjoyment. 

Fun? You bet. But more than fun. A place where, for a few hours, 

we become a member of our family, members who will listen to our 

gripes, comfort each other in times of sorrow, and share in our joys. 

The center has become a major part of our lives. 

In conclusion, we are grateful for the Milton Senior Center and 

CCCSO for all the help they provide the aging residents of Milton 

and Cabell County. We strongly urge you to support all senior citizen programs no matter what the organization may be called or 

what state they represent. 

We are one family, all created by God, depending on him and 

each other. As our senator, we need your continued help and support. 

Thank you for allowing us this brief time to testify before the 

committee. 

[The prepared statement of James and Ellen Clagg appears in 

the Appendix on page 75.] 

Senator MANCHIN. Thank you, James, to all of you. 

Before we start our questions, again I want to recognize Mrs. 

Rocky Goodwin, representing Senator Jay Rockefeller here, who 

has been very involved in these issues also. 

Rocky, would you have anything that you want to say? 

Mrs. GOODWIN. The Senator apologizes that he couldn’t be here 

today. He’s been working diligently over the weekend on the surface transportation bill. But thanks, Senator Manchin, for convening this hearing today, and Congresswoman Capito for being 

here. He asked me to bring back all of the wisdom and recommendations of our stellar panel today. 

Senator Rockefeller has a long history with supporting issues related to seniors. You may know that under his term as governor, 

we instituted all of the senior programs in every county, and he is 

proud that that has continued. 
26 

Certainly, from hearing from the ombudsman programs about 

the needs that you’ve expressed here today to the more detailed implementation of local programs from the Area Agencies on Aging 

and the county programs, and as you say, it’s a family program, it’s 

not just a county program in Milton, but also across the state, and 

has worked hard with obviously the Blanchette Rockefeller Neurosciences Institute on identifying need. 

So the Senator has a staff in Washington, D.C. of legislative folks 

who deal with all of the issues that we’ve discussed today, legal 

help, the funding issues, and also has a number of case workers in 

the state, and you probably have dealt with his folks. 

Please know that the door is always open to receive those recommendations that you have, as you here today on the front lines 

have the best information on policy moving forward. So, thank you. 

Senator MANCHIN. Thank you, Rocky, appreciate it. 

Let me start with our questioning now, and I’m going to go to 

each one of you, and I want to thank you again. Then Congresswoman Capito can proceed with hers. 

First of all, to Suzanne Messenger, I know you talked about the 

exploitation—and I think, Jane, you did, too—of our seniors. Let 

me tell you how this came to light to me. One of my first Aging 

Committee meetings, Mickey Rooney came, and I don’t know if you 

all read about that or heard about that, but having a high-profile 

person like Mickey Rooney that we grew up watching every one of 

his movies and just as a person you think, well, they’re untouchable, they’ll never fall into that trap, and when he tells you his 

story about what happened to him by a family member that just 

about literally wiped him out, I think it brought home to me. And 

I would never think of that because, you know, you think your family will take care and you don’t have to worry about that in your 

family, but it can happen in any family. 

How do you think that the best way to prevent that or educate 

residents and our caregivers? Is it the punishment, the laws? Is it 

the ombudsman overseeing? They don’t want to talk. I mean, he 

even told us, he says I didn’t want to believe it. He said I knew 

something was going on, and I knew my money was gone, but I 

didn’t want to think it was my own flesh and blood or someone 

very close to me that I raised. 

How do we do this? 

Ms. MESSENGER. I think it has to be a multifaceted approach, 

Senator Manchin, and certainly good laws are a place to start. Our 

legislature is working on—— 

Senator MANCHIN. I guess, Suzanne, what I’m asking, do you see 

a lack? Have we missed laws that should be there? Is the punishment not severe enough for the crime they’re committing in exploiting their own family? 

Ms. MESSENGER. That’s a good question, Senator Manchin, and 

I suspect that’s a piece of it. Another piece of it is many of us don’t 

realize—the awareness simply isn’t there. I think Mickey Rooney, 

one of the best things he did was make it okay to talk about these 

sorts of things and not to think, well, I should have known better, 

that shouldn’t have happened to me, I did something wrong because now this person has all my money, to reach out and ask for 
27 

help, to get better education among the people that help our seniors. 

As I said earlier, many people think that a power of attorney 

gives me some magic power over somebody, and it works just the 

opposite. You have power under the person you’re supposed to be 

helping, and I think many of our seniors and many of us in this 

room maybe don’t have as good an understanding about that. 

It’s okay to ask questions, to do better education about what happens, and then we absolutely have to have prosecution. We have 

to enable our prosecutors and law enforcement. These are complicated cases. They’re paper-specific. They take lots of bank 

records. The people that are involved are sick people who get sicker 

and may even pass away before this works its way through the 

court system. So maybe we need to think about having an expedited process to address financial exploitation. 

Senator MANCHIN. The final on that to follow up is that basically 

you talked about drug abuse. 

Ms. MESSENGER. I don’t think that was me. 

Senator MANCHIN. Okay. I’m sorry. 

Ms. MESSENGER. I could talk about drug abuse if you’d like. 

Senator MANCHIN. First of all, it’s an epidemic in this nation, not 

just in West Virginia, not just in your county, or not someone in 

your family, because I don’t think there’s a person in this room 

right now, and I’m one of those people, that doesn’t know someone 

in their immediate family or extended family, very close, that has 

not been affected by this. Most of it is legal prescription, and I did 

not realize how many family members are taking from their own 

family, especially their grandparents. I just did not realize the severity of this problem. 

I don’t know what we do on that except I’m thinking of this, and 

you chime in and help me on this, Janie. Let’s say my mother is 

on prescription, whatever it may be, probably pain relief, a painkiller, and she has to go back because they’re missing, and she 

doesn’t know if she took too many or what happened to them. So 

she has to go back at more frequent times, more frequencies to 

make sure she has her medication. Now, something has happened. 

A pharmacist right then should be able to flag that and know, wait 

a minute now. 

You see, I don’t know what we’re lacking. Is there some type of 

reporting, Good Samaritan reporting? Everything doesn’t have to 

be criminal, but I know that family members don’t want to tell on 

their grandkids or their children that’s taking the drugs and using 

them not for the purpose they were prescribed to me for. But there 

has to be somebody that can get us on the trail of that to stop that. 

Do you have any recommendations on that? 

Ms. HAMILTON. Well, there’s a lock box program in place that has 

been funded through some small grants that can be effective. But 

again, you’ve got a senior that has trouble with a medicine bottle, 

and you have a lock box with a combination of some sort, it’s good 

for the storage of the medications maybe you don’t take very often. 

There does need to be a system in place whereby a responsible 

caregiver can oversee. 

Oftentimes, pain medication is only taken as needed. So if the 

person has a 30-day supply and they haven’t taken but 5 or 6 
28 

throughout the 30 days, if the rest of them are gone and they go 

back for a refill, the pharmacist isn’t going to catch that. He would 

assume that person has taken it every day. 

Now, if the pharmacist could stop and say, ‘‘Well, Mrs. Smith, I 

see you’ve taken 30 of these in the last 30 days. Does that mean 

your pain has increased? Do you need to talk to your doctor?’’ And 

get a conversation going. But again, that’s going to be up to the 

pharmacist. 

Senator MANCHIN. Do you all have any conferences with—I think 

we have a tremendous network of pharmacists that do a wonderful 

job. But if they don’t communicate and don’t know what to look for, 

are you doing that? Could we help facilitate that on a state level? 

Ms. HAMILTON. We should. 

Senator MANCHIN. Okay. 

Ms. HAMILTON. That’s another person on our list of people who 

need to have this awareness. 

Senator MANCHIN. I got you. 

Ms. MATHENY. Senator, there are a lot of items that are being 

talked about right now in that regard. A lot of that responsibility 

falls on the primary care physician or the physician who wrote that 

original prescription. If they go back for a refill, that individual 

should probe and ask questions, what happened to the medication. 

The other thing is the database now that we have, the pharmacy 

database, that will be an effective tool in that toolbox too, that you 

can track and see what medications are being prescribed. 

Senator MANCHIN. Brenda, if you will, I know we talked about 

the consolidation of programs and things of this sort, and maybe 

you can tell us a little more about what it would mean to your organization if we were able to do some of this, how much better 

services could you do if you could consolidate some of them? 

Ms. LANDERS. Consolidate nutrition? Right now, when we send 

out nutrition funding, they divide it between C1 and C2, which is 

a home-delivered meal or a congregate-setting meal. And at that 

point, if they go over in one, then they have to come back to the 

AAA and say I need to transfer funds. So I think it would be easier 

if the county had that liberty or that flexibility to be able just to 

serve the meals that they need, whether it be C1 or C2, because 

as we’ve often stated, every county is different. I may have a county that has more rural; they’re going to need more C2. It would just 

give them the flexibility of being able to serve either a C1 or a C2 

without coming back to the AAA and saying I need to transfer 

funds. Just give them that liberty to serve all the C1 or C2 that 

they need, and then they can bill us. And at the end of that grant 

period, then we can say this amount was served. So it would just 

give them some flexibility. 

They have that ability to somewhat do that now, but then they 

have to come back to the AAA and say, you know, I need to transfer funds or I’m going to over-serve in one, and I think that time 

given is at the end of May they lose that opportunity to transfer 

funds. So it would just give them some flexibility to be able to serve 

what they need and not have to designate that we want to serve 

15,000 C1 and 16,000 C2. If we could just give them a little more 

flexibility, to serve as needed in their communities. 
29 

Senator MANCHIN. Helen, if you could, explain the FAIR program. I think you’re familiar with the FAIR program. And, Kathy, 

I think that you’ve heard from everybody about this program we 

started in West Virginia because of the need we have and how well 

it has worked. If you could explain a little bit, Helen, about how 

you think that could be looked upon on a larger scale, if you will? 

Ms. MATHENY. Well, sure. From what I understand, it is a huge 

success, and it’s available in every county in the state, the Family 

In-Home Respite Care program, and it just provides families that 

needed break with trained, screened people to come into the homes 

and to help provide some chores, some personal assistant bathing 

and those types of things. But it’s a really valuable resource. The 

legislature increased funding last year by $1 million for it. There’s 

still a waiting list. But again, I think it could be a national model, 

something to take a look at. 

Senator MANCHIN. I will say this, Secretary. Our purpose for that 

was to reduce our cost but to give quality care and to have people 

have respect and dignity. We were wearing the family members 

out, and both of us, the Congresswoman and I both understand 

how much care it takes, and we have to have competent people. 

But let’s just say the family members were trying. They wear out 

and they give up, and they say I can’t do it any longer. Well, you 

know what happens then, and you know where the costs go. You 

just mentioned about the accelerated cost that’s involved when they 

come into a nursing home. 

That was the whole purpose, and it has I think worked extremely 

well and been extremely successful. We think it’s the best, and 

Sandy Vanin, who was my commissioner at that time, really got it 

going, and we’d be happy to work with you to really show you the 

ins and outs and the things we think are great, the mistakes we 

made, how we could better improve upon it. 

Sandy, if you would be helpful if the Secretary would need anything, I would appreciate that. 

And finally, James, I want to thank you. I’m going to ask you a 

question. But first of all, you basically said everything, and the way 

you said it is why we’re here. It’s family. Whether you have your 

blood family with you or not you become family. Tell me how you 

and your lovely wife got into the whole volunteering. I guess she 

kind of brought you along. It was contagious, right? 

Mr. CLAGG. Right. 

Senator MANCHIN. How did she get involved? What made her—— 

Mr. CLAGG. She had retired recently, I think, and her sister and 

her are pretty close and they wanted to get out and find other activities now that they were retired, and they started going over to 

the senior center. And like I said, they came home and told me 

they had a lot of fun. I couldn’t understand it, because I was still 

working at the time. 

[Laughter.] 

Mr. CLAGG. I just couldn’t understand what was going on. But 

now I see much clearer now. 

Senator MANCHIN. And you see the quality of life, right? It has 

improved the quality. I mean, people live for that, right? That’s 

their family. 
30 

Mr. CLAGG. Exactly. They look forward to it every day to go to 

the senior center. 

Senator MANCHIN. How many of you think that’s the only nutritional meal they get? Just percentage wise, half of them, 10 percent, or a majority? 

Mr. CLAGG. Well, basically let’s say, go with 25 attending, I know 

3 of the 25 —— 

Senator MANCHIN. That’s it. 

Mr. CLAGG [continuing]. That’s probably the only meal they get. 

Senator MANCHIN. I know how true that is. And you know how 

hard it is to cook for one person. As you grow older, it’s not worth 

the effort. 

Yes, Janie? 

Ms. HAMILTON. At the senior center in St. Albans, where 50, 60, 

70 people a day would be a regular number, in the past I’ve seen 

them, the ones that are alone, take half their lunch and package 

it up to take home to have for dinner. They’re there every day. So, 

you know, there’s quite a few in that department. 

And then the men who are widowed, in that generation the wife 

did the cooking. People go home and don’t eat well, if at all, because of the fact there’s no one there to fix his dinner. 

And I know of a veteran who lived alone who is a widower who 

would walk with his walker from his home every evening or early 

afternoon, late afternoon to the Tudor’s to get the beans and corn 

bread because that was cheap, and he would eat and go back home 

on the walker, because he wouldn’t even call us for a ride because 

of his pride and not wanting to take something that he had not 

paid for. So you have every area of need being met at the senior 

centers. 

Senator MANCHIN. I would like to have one more, and then I’m 

going to turn to the Congresswoman. 

Secretary Greenlee, if you would, I know Brenda brought up the 

issue of older workers, and we’ve been blessed with some health. 

When we grow older, we still want to be contributing. I think it’s 

very important for us to be productive for as long as we possibly 

can, and think that we’ve paid our way. 

What are you all doing, or the Administration on Aging doing, 

that can help seniors who really want to work find work? Do we 

have a centralized—in West Virginia, are we networking to where 

a person that’s looking for a more experienced—I hate the word 

‘‘senior’’—a more experienced person who has had a lot of life experience, can we match them up? Someone who says I need this type 

of person who has had 40 years’ experience, they might be 65 or 

70 years of age, is there anything that you know that we link them 

up in the state, or anything on the Federal that could be done? 

Ms. GREENLEE. There is one section of the Older Americans Act 

that is not administered by the Administration on Aging, the Senior Community Services Employment Program. It’s Title V of the 

Older Americans Act, and it’s meant to provide support to low-income seniors so that they can continue working in the workplace. 

It’s often administered at the State level by the Department of 

Labor. That’s where it’s administered Federally. But when it gets 

to the local organizations, many of them will run the Title V program. I took a trip to Los Angeles and met many of the people who 
31 

are getting this support, where seniors really need some extra income, to work. 

One of the requirements for the staff who are working to help 

the seniors, the staff in the Title V program, is to also work with 

the one-stop shops from the Department of Labor. So if there are 

seniors who have more resources than the low-income seniors, you 

can also get them connected to the one-stop system. That’s where, 

in the whole employment universe, they are a whole other world 

in terms of one-stop information assistance and employment. You 

want to make sure that the senior programs can address the highrisk populations, but then also get to the more mainstream or traditional Department of Labor supports for other people who want 

to stay working. 

We all know, anecdotally and through data, the number of seniors, who because of the economy, have had to postpone retirement 

or need to go back to work in order to make ends meet. 

Senator MANCHIN. Thank you all. 

Congresswoman Capito? I’m sorry. 

Representative CAPITO. Thank you. No, thank you. This has been 

great. I want to thank all of you all who have testified. 

James, I’m going to start with you. Your comments I think 

touched everybody in this room, and obviously you give a lot, but 

you get a lot in return, and I think that’s great. 

I will say, as someone who has traveled, I don’t go to Milton because that’s over in Cabell. That’s the next county over from my 

district. But when I go to Hansford and others, I gain a lot of wisdom that is at the senior center. So when you said you sit down 

for lunch and you saw problems, you could probably solve this debt 

problem for us right off the bat. So keep that up. I know that keeps 

you going, and bring all your comments to the senators and your 

congressmen because we appreciate that wisdom. 

You mentioned that there might be 25 people at lunch, and I 

know the Hansford Center has 7. It’s probably one of the largest 

ones, certainly. But there are a lot more seniors out there that, if 

they knew or if they maybe could get over the fact, like you had 

in the beginning, what could I really want to go to a senior center 

for, and it was mentioned that there was no dollars for advertising 

the senior center, how do you think we get more seniors to the senior center to realize all the good things that are going on? 

I mean, obviously, transportation is an issue. But let’s say that 

person didn’t have a transportation issue. They had a family member or something. How would you reach out to those folks? Do you 

have any suggestions for that? 

Mr. CLAGG. It would have to be a more one-on-one thing. 

Representative CAPITO. Word of mouth kind of thing? 

Mr. CLAGG. Word of mouth, or members that are already there 

participating spreading the word to others, because when you get 

to my age, and you’re soon to be—— 

[Laughter.] 

You do not care much about pamphlets being handed out to you. 

Representative CAPITO. Right. 

Mr. CLAGG. That’s just something you don’t understand to start 

with, and it’s a waste of time. So there it goes, in a bookshelf or 

something. 
32 

So we need some kind of a one-on-one thing, or just like the programs you were talking about, the one-stop shop place, that’s a terrific idea, terrific. 

Representative CAPITO. Well, I don’t know. I’m just sitting here 

sort of brainstorming and thinking if you had a volunteer corps, or 

I don’t know. The press remembers—or the folks that are your frequent flyers, to go out and talk to other people, because you obviously know well. You can’t advertise on the Internet because a lot 

of seniors aren’t on the Internet, and you can’t say how great it is. 

There aren’t blogs around talking about what a great time we’re 

having down at the senior center. I mean, that is just a 

generational thing. 

But I will say in terms of technology, one thing that—I keep alluding to my own personal situation here. But one thing that I 

found that is a really neat tool for the future are iPads for seniors, 

same as they are for children. I mean, I can get my iPad out and 

show the family pictures, and it is a really great way to spend a 

day. So, anyway, I’ll just put that little nugget out there. Maybe 

that’s a good Federal-funded technology initiative. 

[Laughter.] 

I mean, I know you’ve got the computers, but there are even 

easier methods now. 

I wanted to ask Suzanne Messenger about the ombudsman. Is 

your program state or federally funded? 

Ms. MESSENGER. It’s a blended program. I’m the state ombudsman, and I work for the Bureau of Senior Services. I’m a state employee. We get Federal dollars, and we also get some matching 

state dollars. I oversee the contract that the Bureau has with Legal 

Aid of West Virginia. 

Representative CAPITO. Okay. 

Ms. MESSENGER. That’s the regional office. 

Representative CAPITO. That’s what I was going to ask you. What 

kind of coordination do you have with Legal Aid? Because I’m sure 

your resources are really slim, and to get to this, how do you network out from where you are? Through the legal community, or 

does the bar, the West Virginia Bar Association help you, or the 

law school? 

Ms. MESSENGER. With ombudsman services? 

Representative CAPITO. Well, just—yeah. 

Ms. MESSENGER. Not so much with ombudsman services. We 

have a good partnership with our aging and disability resource centers. That kind of seems like a natural partnership. The aging and 

disability resource centers, as you’ve heard many times today, are 

that one stop, sort of that single entry point for long-term care. 

Representative CAPITO. Right. 

Ms. MESSENGER. And then if there are problems in residential 

care facilities, the ombudsman provides a good support. 

Representative CAPITO. Right, right. And then, Brenda, staffing, 

there’s a huge problem. I mean, traditionally low paying jobs for 

caregivers. As soon as they—many times, we have the issues with 

the abuse. If you pick somebody up that maybe is not bonded or 

with an agency, I think you have some safety issues and legal 

issues. Unless you have somebody right there—and even if you do, 

I guess like Mr. Rooney did, it still doesn’t matter. 
33 

What are you doing to—are you looking—what kind of workforce 

development things are going on right now that are going to be 

able to meet this huge need? 

Ms. LANDERS. As far as caregivers? 

Representative CAPITO. Yeah. 

Ms. LANDERS. We are working on a statewide registry for inhome workers to know that they’ve been through proper training, 

that they have looked at background searches and things, and 

that’s one thing that we are working on. 

Also, I think it would help with what we talked about, the drug 

abuse, that we have caregivers in the home that we know have 

passed background searches, that they’re not stealing medications. 

Representative CAPITO. You know, an individual family can’t do 

a background check. 

Ms. LANDERS. No, but we were working on a state registry so 

that these workers would go through the registry that we have 

somewhat for nurses. Now we have in-home workers that would be 

on this registry that you could go and pick a home worker and 

know that they’re qualified and they have all of this, so families 

can pick up the phone and say I need a worker, and we have our 

ADRCs or our aged and disabled resource center that could go into 

this registry and be able to supply a worker. 

Representative CAPITO. Is there a shortage right now? 

Ms. LANDERS. Of workers? Yes, because of, as you say, because 

of income. I mean, the wages are just so —— 

Representative CAPITO. And it’s hard work. 

Ms. LANDERS. It is hard work, and there’s lifting and there’s tugging. We just don’t have enough money, but we’re dealing with it. 

Representative CAPITO. Then I want to go over to Helen, Ms. 

Matheny, on the medical professionals, because I think one thing 

that—while the primary caregiver has an experience in a myriad 

of different physical and mental issues, because that’s why they’re 

a general practitioner mostly, but there are certain specialized 

areas that a gerontologist, or in the area of gerontology 

Are younger students going into this, medical students, to face 

this challenge? I mean, when you look around the state and try to 

find somebody who is an M.D. that has a specialization here, it’s 

scarce. 

Ms. MATHENY. Absolutely. 

Representative CAPITO. Is it getting any better? 

Ms. MATHENY. It’s not getting any better. The number of boardcertified geriatricians is very small in the state. And so that’s why 

I’m encouraging Congress to help to continue to incentivize for 

that. And in the meantime, that’s what we’re trying to do with our 

continuing education classes, is to get out there to the primary care 

physicians to provide additional training with geriatrics to help 

them help their patients. 

Representative CAPITO. I think you mentioned that some reimbursement services for these kinds of—when you talk about pharmacists, I know this has come up from time to time. Is the pharmacist going to get paid for the 15 minutes that they’re going to 

work with the senior to find out if they have conflicting medicines 

or do they understand when to take it? 
34 

We went through this with the prescription drug bill when it was 

created in 2003, and I don’t think we’ve solved this issue, because 

in a business that’s made on the bottom line, time is money, and 

if you’re getting paid to talk—are you getting paid to talk and to 

understand? And a lot of times, the first time you say it, you’ve got 

to say it more than once and in different ways. 

Is this an issue? I mean, Janie, obviously—— 

Ms. HAMILTON. I have a health background as well, and there 

are a lot of health literacy issues. If I wasn’t there to advocate for 

my mother, she wouldn’t understand or remember half of what she 

was told, and she’s not an ignorant person. She’s fairly savvy, but 

the generational thing, the lack of health literacy—I mean, there 

are people across the board, all ages that have very low health literacy. 

There’s a movement in our state to eliminate that, but we have 

to start not only from the top down but from the bottom up. 

Representative CAPITO. Well, you’ve asked for flexibility. Is this 

something that you think more flexibility in the Federal standards, 

and state, or either/or—— 

Ms. HAMILTON. Health care advocacy could be part of the aging 

network if we had the health field and the aging programs come 

together and fund, allow funding for a health care advocate for 

maybe each senior center, at the very least, to help do nothing but 

assist seniors with their communication skills with their physician, 

teach them how to take charge of their own health, help them understand what things mean, them and/or their family members 

that are maybe their advocates. A lot of times the family member 

is their advocate, but they don’t understand it either. 

Representative CAPITO. Is that different than the SCHIP? Because the SCHIP is mostly with the insurance? 

Ms. HAMILTON. Yes. That’s just assisting the seniors. You know, 

Medicare Part D, my goodness, that’s a thing in itself that has 

been—so many seniors are completely just at the mercy of whomever they can get to help them make decisions. And a lot of times, 

when they get the letter for open enrollment in the mail, they just 

keep what they’ve got, and it may not be the best thing for them. 

They don’t even understand that they have an option. The fact is 

they have to go through the process of getting the counseling 

through the SCHIP program in order to help them find that. There 

are a lot of complicated things that older adults don’t understand 

and need that support to make better decisions for themselves. 

Representative CAPITO. Well, I think this has been a very interesting, enlightening panel. One of my colleagues came to me last 

week. She’s probably—I don’t want to say how old she is, 68 or 70 

maybe. She looks at me and she goes, ‘‘Guess what?’’ I said, 

‘‘What?’’ She goes, ‘‘I’m going to live until I’m 100.’’ And I said, 

‘‘What do you mean?’’ And she goes, ‘‘Well, the statistics are that 

if you get to a certain age, that you’re going to live to 100.’’ And 

I’m thinking to myself, is that a good thing? 

[Laughter.] 

She says, ‘‘No, it’s not a good thing.’’ But when you look at what 

Alzheimer’s is doing to not only young people but more increasingly 

as people get older, dementia just creeps in no matter what, and 

then to certain degrees we’re just going to have all kinds of issues, 
35 

especially if we are living to 100. Maybe our bodies are taking us 

to 100, but our minds have left us at 88. 

So it’s a challenge, and I think you all have been great demonstrators that it can’t be solved as a Federal issue no matter how 

aggressive and well funded and good intentioned. You’ve got to 

have James and Ellen at the senior center willing to dedicate their 

time and energy, and the family members that do that, too. 

So I appreciate everything I’ve learned today, and I appreciate 

all of you all working in this field. I know it’s rewarding, but it’s 

very tough. So thank you for what you do. 

Thank you, Senator, for including me. 

Senator MANCHIN. Thank you for being here, Congresswoman. 

And speaking of that, someone told me that if I start taking the 

fish oil pills, that it would help my memory. The only thing it’s 

done is give me an urge to go swimming. 

[Laughter.] 

With that, let me just say this. Gaylene Miller, thank you so 

much. AARP, I know you do a great job, and Angela and all of you. 

And I hope this has been beneficial for you, too, because we interact so closely with you and your organization. If you could keep in 

touch with us, and also with Secretary Greenlee here. That’s great. 

And let me just say this to all of you. All of you have done a 

great job, and I appreciate it. The Secretary has been so accommodating, and I thank her for her graciousness and giving us her 

time. 

But I don’t want her to go back to Washington without at least 

each one of you giving her one recommendation of what needs to 

be fixed in your world, of what you’re seeing. Something can make 

it better, and let her evaluate that, because if it works here, it will 

work anywhere. We have more challenging demographics, and our 

topography also, and I think I’ve said that. If you ever are looking 

for that pilot project, you have a theory, you don’t have to throw 

money at us, and if we say give us a little flexibility, give us some 

maneuverability and we’ll tell you if it works or not, that’s what 

we’re asking for, Kathy. And I just appreciate so much you being 

here, I really do. 

So on behalf of all of us and all of you who have come, I hope 

it’s been enlightening to a lot of you. And you’re going to be 

around, I understand, and spend some time, and I would challenge 

you all to please share that with the Secretary because she’s on the 

front line. She’s going to be the one very much involved in the 

Older Americans Act and how we do this and how we go forth, and 

really basically lobbying for what needs to be done for all of us as 

we grow a little bit older. 

Thank you, and that concludes our hearing. 

[Whereupon, at 11:37 a.m., the hearing was adjourned.] 

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