U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

64–224 PDF 2011

S. HRG. 111–861 

STRENGTHENING OUR COMMITMENT TO 

MINNESOTA SENIORS: PROMOTING INDEPENDENT 

LIVING THROUGH THE OLDER AMERICANS ACT 

REAUTHORIZATION 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

MAPLE GROVE, MN 

SEPTEMBER 10, 2010 

Serial No. 111–25 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html 

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

BILL NELSON, Florida 

ROBERT P. CASEY, Jr., Pennsylvania 

CLAIRE McCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

MARK UDALL, Colorado 

KIRSTEN GILLIBRAND, New York 

MICHAEL BENNET, Colorado 

ARLEN SPECTER, Pennsylvania 

AL FRANKEN, Minnesota 

BOB CORKER, Tennessee 

RICHARD SHELBY, Alabama 

SUSAN COLLINS, Maine 

GEORGE LeMIEUX, FLORIDA 

ORRIN HATCH, Utah 

SAM BROWNBACK, Kansas 

LINDSEY GRAHAM, South Carolina 

SAXBY CHAMBLISS, Georgia 

DEBRA WHITMAN, Majority Staff Director 

MICHAEL BASSETT, Ranking Member Staff Director 

(II) 

C O N T E N T S 

Page 

Opening Statement of Senator Al Franken ........................................................... 1 

PANEL I 

Jim Varpness, Regional Administration for the United States Department 

of Health and Human Services Administration on Aging ................................ 4 

PANEL II 

Statement of Sherilyn Moe, Office of Ombudsman for Long-Term Care, St. 

Paul, MN ............................................................................................................... 18 

Statement of Kathleen Harrington, Chair, Minnesota Board on Aging, St. 

Paul, MN ............................................................................................................... 24 

Statement of Jan Ferrier, Anoka, Minnesota Resident, User of Older Americans Act Services, Coon Rapids, MN .................................................................. 34 

Statement of Iris C. Freeman, Associate Director, Center for Elder Justice 

and Policy, William Mitchell College of Law ..................................................... 37 

Statement of Neil Johnson, Executive Director of The Minnesota Homecare 

Association, St. Paul, MN .................................................................................... 43 

APPENDIX 

Testimony submitted by Minnesota Association of Area Agencies on Aging ..... 55 

Testimony submitted by Minnesota Adult Day Services Association ................. 57 

Statement submitted by National Alliance on Mental Illness of Minnesota ...... 60 

Statement submitted by Minnesota AARP ............................................................ 64 

Statement submitted by Minnesota Leadership Council on Aging ..................... 74 

Statement submitted by Volunteers of America of Minnesota ............................ 76 

Testimony submitted by Minnesota Women’s Consortium .................................. 82 

Testimony submitted by Experience Works, Inc. .................................................. 84 

Statement submitted by Lutheran Social Services of Minnesota ........................ 87 

Statement submitted by Senior Community Services .......................................... 89 

Statement submitted by DARTS, West St. Paul, MN .......................................... 90 

Statement submitted by Living at Home Network ............................................... 94 

Testimony submitted by Mary Jo Schifsky, Executive Director, Store to Door . 96 

Statement submitted by Minnesota Association of Senior Nutrition Services ... 97 

Statement submitted by Dr. Robert Kane, Minnesota Chair in Long-Term 

Care and Aging, University of Minnesota School of Public Health ................. 99 

Testimony submitted by Gayle Kvenvold, President and CEO, Aging Services 

of Minnesota ......................................................................................................... 101 

Statement submitted by Steve Hennes, Whitney Senior Center ......................... 103 

Statement submitted by Krista O’Connor, Administrator, Eldercare Partners, 

West St. Paul, MN ............................................................................................... 104 

Statement submitted by Janice Sinna, Program Coordinator, Minnesota Network on Abuse in Later Life ............................................................................... 107 

Testimony submitted by National Association of Area Agencies on Aging 

(n4a’s) .................................................................................................................... 109

(III) 

(1) 

STRENGTHENING OUR COMMITMENT TO 

MINNESOTA SENIORS: PROMOTING 

INDEPENDENT LIVING THROUGH THE OLDER 

AMERICANS ACT REAUTHORIZATION 

FRIDAY, SEPTEMBER 10, 2010 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Maple Grove, MN. 

The Committee met, pursuant to notice, at 1:30 p.m., in the 

Maple Grove Community Center, Hon. Al Franken, presiding. 

Present: Senator Franken [presiding]. 

Index: Senator Franken. 

OPENING STATEMENT OF SENATOR AL FRANKEN 

Senator FRANKEN. I now call the Special Committee on Aging 

Hearing on the Reauthorization of the Old Americans Act to order. 

Thank you all for turning out. Thank you to the Maple Grove Community Center for hosting this event. This is an official hearing of 

the Senate Special Committee on Aging, and we’ll be hearing from 

a number of key experts on aging. 

I’m pleased that additional experts have submitted testimony for 

the record. I welcome everyone in attendance also to submit any 

comments you have about today’s hearing to my office using the 

form that you received when you came in. 

I’m pleased to have the opportunity to discuss this important law 

and to hear your recommendations for improving it. I’m proud to 

sit on two key Senate committees that oversee senior services and 

I want to make sure that we’re doing all that we can so that Minnesota seniors remain independent and healthy for as long as possible. 

So, thank you all for being here to be part of the Reauthorization 

of the Older Americans Act, and to share your expertise on seniors 

issues in Minnesota and across the nation. 

The Older Americans Act funds many crucial programs for our 

seniors, Meals on Wheels, caregiver support, health promotion, 

elder abuse prevention, and much, much more. These programs are 

cost effective with a high return on investment. In Minnesota we 

spend an average of $4,900 per month for a resident in a care center, as compared to $2,700 for those seniors we support to stay at 

home. That’s real savings, and that’s why it’s important that we’re 

not pennywise and pound foolish by underfunding these programs 

2 

that help people stay in their homes. Keeping people out of nursing 

homes saves money and it’s what seniors want; it’s win/win. 

The Older Americans Act became law in 1965 when the country 

was concerned seniors were not getting the services that they needed. Today, 45 years later, we’ve made progress in many areas, but 

we still have a lot to do to ensure that seniors have the resources 

they need to be independent and the support they deserve at the 

end of life. These issues are especially salient now because our 

country’s demographics are changing. Next year, the first baby 

boomers will begin to turn 65. My brother, Owen, will be 65 next 

August. I can’t believe it, because that means I’m older, too. 

Thanks to medical advances and to the boomers’ commitment to 

stay active, boomers are expected to live longer than members of 

any previous generation. By 2030, almost 20 percent of our population is estimated to be over the age of 65. So now more than ever, 

we need to be ready to help seniors stay healthy and independent 

as they age. 

During the past few months my staff and I have held 17 listening sessions across the State, actually I asked my staff to do 17, 

and I got a report back from them, I’ve done three since. I’ve 

learned a lot from these conversations and the information is guiding legislation that I will be introducing this fall. I’ve learned that 

Minnesotans, Minnesota seniors, want to stay in their homes as 

long as possible, and to do that they need access to transportation 

and other support services. They want nursing home care only 

when they really need it, and even when they’re in a nursing home, 

seniors don’t want to be told exactly when they want to eat and 

sleep, and they definitely don’t want to be forced to go to bed before 

the Twins game is over. [Laughter.] 

Especially this year. 

The main message I’ve heard from Minnesota seniors across the 

State is that they want to remain vital and active in their later 

years, they want to take their grandkids fishing, go to the State 

fair, work in the garden, and be as independent as possible. So, 

how do we make that happen? 

Well, the Older Americans Act does a lot—does a lot to keep our 

seniors in their homes. A little support goes a long way, and that’s 

what the Older Americans Act is all about. 

Today we’ll hear testimony from Jan Ferrier from Coon Rapids 

who uses Older American Act services for leaf raking, snow shoveling, and the occasional lunch at the Coon Rapid’s Senior Center. 

As Jan will tell you, just because you can’t shovel your driveway 

any more, or you need help with meals now and then, that does 

not mean that you should have to move into a nursing home. It 

doesn’t mean that you should have to give up your independence. 

Just like Jan, more Minnesota seniors are looking for ways to receive services at home so they can continue to live independently. 

The demand for home and community-based services is increasing 

and people are actually moving out of nursing homes to receive 

care at home. 

Minnesota has been at the forefront of this national movement, 

this culture change to support seniors’ independence, and that’s 

why it’s critical that we seize the opportunity presented by next 

year’s reauthorization of the Older Americans Act, to increase acVerDate Nov 24 2008 08:01 Feb 17, 2011 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 H:\DOCS\64224.TXT SAG PsN: JOYCE
3 

cess to high quality home and community-based services for all 

seniors, whether they’re down in Dodge county or right here in the 

metro area. 

When lawmakers passed the Older Americans Act 45 years ago, 

they tried to anticipate the needs of future generations of seniors. 

They set up a national infrastructure that included the U.S. 

Administration on Aging, and State units on aging, like the Minnesota Board on Aging, both of which are represented here today. 

These agencies are vital resources for seniors and have been successful in helping seniors remain independent. However, many 

Older Americans Act programs struggle to find enough resources to 

meet the needs of seniors. We need to take steps to ensure that the 

Older Americans Act is able to deliver on its promise to support our 

seniors. 

As we move forward with the reauthorization, I’m committed to 

championing legislation that builds on Minnesota’s leadership in 

aging services, like our State’s Homecare Bill of Rights, and the report card on quality for home and community-based services. I 

want to strengthen the Older Americans Act for Minnesota seniors 

and I’m looking forward to hearing from our witnesses about the 

opportunities they see for promoting senior independence in the reauthorization. 

Thank you all again for being here, and thank you to those who 

submitted testimony for publication in the Congressional record in 

connection with today’s hearing. 

I would like now to introduce Jim Varpness, Regional Administrator for the United States Department of Health and Human 

Services Administration on Aging. Mr. Varpness is filling in for Assistant Secretary Kathy Greenlee of the Administration on Aging 

whose flight was unfortunately delayed and unable to join us 

today. Mr. Varpness was kind enough to fly in today from Chicago 

to deliver Assistant Secretary Greenlee’s testimony and answer 

questions on her behalf. 

Mr. Varpness currently oversees the administration of the Older 

Americans Act in Minnesota and the Midwest, and has over 28 

years of experience with Minnesota’s aging services. Prior to his 

current position at the U.S. Administration on Aging, Mr. Varpness 

served as the Executive Director of the Minnesota Board on Aging 

and the Director of the Division of Aging Services at Minnesota’s 

Department of Human Services. He was also Director of Minnesota’s Office of the Ombudsman for long-term care. Mr. Varpness 

holds a Masters in Public Administration from Hamlin University. 

Thank you, Mr. Varpness for joining us today on such short 

notice, and I look forward to hearing your testimony delivered on 

behalf of Assistant Secretary Greenlee. Thank you. 

4 

STATEMENT OF JIM VARPNESS, REGIONAL ADMINISTRATOR 

FOR THE UNITED STATES DEPARTMENT OF HEALTH AND 

HUMAN SERVICES ADMINISTRATION ON AGING 

Mr. VARPNESS. Thank you, Senator Franken, and again, I extend 

Assistant Secretary for Aging Greenlee’s apologies for not being 

able to be here. But as you know, when they tell you there’s something wrong with the plane, you don’t get on it. So— 

Senator FRANKEN. Smart, smart policy. 

Mr. VARPNESS. Yeah, she’s a very smart lady. 

Anyway, thank you, Senator Franken for the opportunity to testify before the Senate Special Committee on Aging hearing on the 

upcoming reauthorization of the Older Americans Act. We’re 

pleased to discuss our efforts to solicit input from throughout the 

country and to hear Minnesota’s perspective on this important legislation that provides vital home and community-based services to 

older adults and their caregivers. 

At the outset, we would like to commend you, Senator, for your 

leadership as a member of the Senate Special Committee on Aging, 

as well as a member of the Committee on Health, Education, Labor 

and Pensions, Judiciary Committee, and the Senate Committee on 

Indian Affairs, whose jurisdictions impact many of the Older Americans Act programs and services administered by the Administration on Aging. We are grateful for the support you have provided 

for Older Americans Act programs and especially for your strong 

interest in consumer fraud and elder rights issues. 

We’re impressed by the level of commitment and dedication of 

Minnesota’s aging network as well, and by the interest and enthusiasm of your older citizens and their families. We would like to 

also recognize Kathleen Harrington, who is Chair of the Minnesota 

Board on Aging, the local area agencies on aging, the Tribal organizations, and other advocates for seniors here in Minnesota, and 

commend them all for their continued work on behalf of older citizens here in this State and across this land. 

Minnesota is a leader in so many areas related to health and 

well-being of seniors and soon-to-be seniors, like your brother, and 

the rest of our Nation has much to learn from your citizens. 

On July 14, 1965, as you noted, President Johnson signed the 

Older Americans Act into law. Sixteen days later, on July 30, he 

signed legislation creating Medicare and Medicaid. These three 

programs, along with Social Security created back in 1935, have 

served as the foundation for economic, health and social support for 

millions of seniors, individuals with disabilities and their families. 

Because of these programs, millions of older Americans have lived 

more secure and healthy and meaningful lives in this country. The 

Older Americans Act has quietly but effectively provided nutrition 

and community support to millions of people across Minnesota and 

across this land. It has also protected the rights of seniors, and in 

many cases, has been the key to their independence. 

In 1965, there were about 26 million Americans age 60 and over. 

Today, there are 57 million older Americans 60 years and over, 

with many more on the immediate horizon. Our senior population 

is not only growing larger, but is also becoming more diverse. The 

older population, age 85 and older, is also projected to increase 

significantly. In 1990, the 80-plus population was about 3 million 

5 

people. In 2020, that figure is projected to be more than double by 

about 6.6 million according to the Census. Many will need longterm care, both in the community and when that becomes impossible, in nursing homes and other facilities. Reliance on family 

members who currently provide 80 percent of long-term care assistance for seniors will also increase. 

The historic enactment of the Affordable Care Act by President 

Obama on March 23rd of this year, provides us with another tremendous opportunity to harness the success and progress of the 

last four decades to further improve the health and lives of older 

Americans and support their caregivers. As you know, the Affordable Care Act represents the biggest change in our national health 

care delivery system since 1965. Just as they were in 1965, the programs of the Older Americans Act and our national aging network 

of State, tribal and community organizations, senior advocates, volunteers, providers and family caregivers will be called upon to complement, support and enhance these changes. How successfully we 

weave these multiple responsibilities together will say much for 

how we will care for seniors in the future. 

As part of the process for reauthorizing the Older Americans Act, 

early this year the Administration on Aging sought input from people all across this Nation in a number of very specific areas. We 

sponsored three onsite listening sessions, in Washington, Dallas, 

and San Francisco. We co-led the first of its kind listening webinar 

with Department of Labor on workforce issues for seniors and the 

Older American Community Service Employment Program. We encouraged the conduct of State and local listening events throughout 

the country and we received on-line summaries of the events and 

we provided online and downloadable individual input forms on its 

reauthorization website at the administration. 

Over 400 individuals from 48 States and Territories have participated in the public input process and sessions. We believe the individuals and organizations that provided input represent the interest and concerns of thousands of Americans and consumers 

throughout this land. 

I am pleased to report that Minnesota was an active participant 

in this process with input topics including: sustaining aging programs as the older populations expand; providing more flexibility 

in Title III programs in funding streams; increasing support for 

family caregivers; simplifying cost-sharing provisions; and supporting direct service workers. 

Overall, the types of input we received throughout the country 

can be grouped into the following general categories: structure 

administration and service delivery and expansion. Specifically, we 

heard some of the following recurring themes at these listening sessions. One, the importance of the original Declaration of Objectives 

in Title I of the Act that establishes the guiding principles and 

goals of the Act in creating a society that enhances the lives of 

older persons. 

The importance of the role of the assistant secretary in advocacy 

in coordinating and advocating on behalf of older persons and aging 

issues within and across Federal agencies and departments. Also, 

the role of Administration on Aging and the entire aging network 

6 

in advocating on behalf of older individuals at the Federal, State, 

tribal and local levels. 

The importance of home and community-based services and the 

aging network infrastructure for responding to the needs and preferences of older persons, the importance of information and assistance, and the need for consolidated access, such as single points of 

entry, another area that Minnesota is a national leader through 

your Senior LinkAge Line and your Minnesota Help Network, the 

need for flexibility in programming to respond to local and area 

needs, the need to include a broad range of evidence-based interventions as a component of Health Promotion, Disease Prevention 

part of the Older Americans Act, the need for greater inclusiveness 

of various kinds of kinship care and more respite services in the 

provisions of caregiver services, the unique challenges of providing 

services and meeting the needs of individuals residing in rural, remote and frontier areas across this country. 

The importance of innovation, research, demonstrations and 

training authority and funding and how it has played a significant 

role in building the aging network and enhancing the field of aging 

in this country. The need to restore more of a sense of community 

services back in the Older American Community Service Employment Program, and to look at ways to distinguish the program 

from other workforce and job placement programs at the Department of Labor. The need to fully recognize the sovereignty of tribal 

nations in Title VI and to consolidate programming for Tribes from 

other parts of the Act to Title VI. The importance of focusing, of 

course, on elder rights and elder justice issues and to look broadly 

on building effective infrastructures through enhanced coordination 

with domestic violence, adult protective services, ombudsman, consumer protection agencies, and other such entities. 

Within the Administration, the process for the reauthorization 

has already begun. We are discussing the input we have received 

within the Department of Health and Human Services. For the 

past 45 years, the Older Americans Act has become recognized and 

highly regarded for stimulating the development of comprehensive 

home and community-based services system that has enhanced the 

lives of older persons and their family caregivers. We look forward 

to the reauthorization process as a means to strengthen and position this important piece of legislation so that its programs and 

services will continue to carry out the important mission of helping 

elderly individuals maintain their health and independence in their 

homes and communities. 

Thank you, Senator Franken, and I will be glad to answer your 

questions. 

[The prepared statement of Mr. Varpness follows:] 

7 


64224.001
8 


64224.002
9 


64224.003
10 


64224.004
11 


64224.005
12 


64224.006
13 


64224.007
14 


64224.008
15 


64224.009
16 

Senator FRANKEN. Thank you, Mr. Varpness. I’m kind of assuming that most of the people here have an understanding and knowledge of the Older Americans Act. But for those who may have come 

and don’t really know the day to day of what it is. You gave us a 

nice, view from 30,000 feet, and on some of the kinds of areas that 

need attention in—or need focus on the reauthorization, but having 

gone through a number of these, I just want to touch on some of 

the things you said before I ask you questions, because you have 

so much experience here in Minnesota on this, on what we’re really 

talking about, because you talked about things like employment 

and nutrition and transportation and respite services. 

Nutrition is Meals on Wheels, and is also congregate dining. 

Now, you know, I’ve been in these listening sessions where you 

hear that Meals on Wheels is not just providing nutrition, but it’s 

providing companionship. Sometimes it will be the only time during the day that the senior will see someone. Sometimes it’s finding 

a senior who has gone to their mailbox and collapsed, and Meals 

on Wheels can be—that person who can save a life. So, I just want 

to give people a very quick overview because I don’t want to take 

from your time and my time of asking you questions. 

Transportation, I want to ask you about transportation in rural 

areas particularly, this is the one thing I anticipated before I asked 

my folks to go out there and have these listening sessions, I said 

you’re going to hear most about transportation. I want to get your 

ideas on what we can do because, I want to ask you about an idea 

my wife has. But, this is basically so that seniors can go to a doctor’s appointment. Sometimes this is like a bus line, you know, 

sometimes this is volunteers who come out and drive seniors to a 

haircut or to a senior center or to a congregate meal. When I say 

nickel and diming, some of these volunteers get reimbursed only 

for the period of time when the senior is in the car. So if you drive 

out to where the senior lives, you don’t get reimbursed for the gas 

for that time when you’re driving without the senior in the car, 

that to me is kind of silly. 

It’s helping with chores, senior companions, these are the kinds 

of things that we’re talking about. So, I think as this hearing continues on, I think we’ll hear more and more about these things, but 

I want to have people get a feel for what the Older Americans Act 

does, and how it is more than just providing services, it’s a human 

thing and the people that are involved in this field are unbelievably 

great people, and thank you for your many, many years of service 

here in Minnesota and nationally. 

I want to ask you how you feel Minnesota has been a leader in 

the Older Americans Act and what we can use from Minnesota in 

the reauthorization. 

Mr. VARPNESS. Thank you, Senator. Minnesota really is truly a 

leader in so many different kinds of areas. I think Minnesota has 

a strong policy toward providing assistance for people to age in 

place, to receive help as much as possible and to stay at home as 

long as possible. You see that in your waivered service programs 

under the Medicaid program and you see it also—— 

Senator FRANKEN. Can you explain that for everyone? 

Mr. VARPNESS. Under the Medicaid program, Minnesota, of 

course pays for nursing home care for individuals, but also pays for 

17 

home and community-based services. Minnesota is a leader in 

terms of really trying to redirect its Medicaid dollars toward helping people to stay more at home. It’s one of the top five or so States 

in terms of really moving and serving more and more people in 

long-term in community-based settings and in their home than in 

nursing home care. So it’s—and Minnesota’s been in that area for 

quite some time and has done so. 

Minnesota has done a great job and has really been a national 

leader in terms of its Senior LinkAge Minnesota Help System, really trying to identify a single place where individuals can go for all 

kinds of answers, connecting with coaches to help the identify services that might help them, their mom, their dad. 

Senator FRANKEN. What you call the single point of entry. 

Mr. VARPNESS. Single point of entry types of things, but providing it in a sense of trying to help people find programs they may 

be in fact eligible, trying to direct them toward places and services 

that they can pay for and purchase out of their own pockets when 

they’re able to do so, but also to connect them with specialists and 

people that really understand various kinds of chronic diseases to 

really help them try to deal with some of those kinds of things. 

Minnesota has been a great leader, I think, in that particular area 

as well. 

Senator FRANKEN. Jim, I’m being told by my staff that we’ve got 

to keep moving on, but I want you to stay and be available for 

questions when I ask questions of the second panel. 

So, thank you, Jim, and please stick around. 

Now I’d like to invite the second panel of witnesses to come forward. Joining us today is Sherilyn Moe, on behalf of Deb Holtz. 

Deb is Minnesota’s State Ombudsman for Long-Term Care, and 

Sherilyn—I’m not sure, we’ll find out soon on what basis Sherilyn 

feels she can fit in—— [Laughter.] 

For Deb who oversees this important program to protect consumers of long-term care services from abuse and neglect. Ms. 

Holtz has worked for 30 years in long-term care and she has 

worked with home and community-based services, nursing homes, 

and with the Centers for Medicaid and Medicare services, and we’ll 

find out exactly what Sherilyn’s history is when she testifies. 

Next is Kathleen Harrington. Ms. Harrington serves as Chair of 

the Minnesota Board on Aging, which is responsible for administering the Older Americans Act funds in Minnesota. Ms. Harrington also works with Carol Corporation, a Minneapolis-based 

healthcare company that helps healthcare systems transition from 

a volume-base to value-base model of care, which is a big part of 

the affordable care Act, a big purpose of it. Ms. Harrington has also 

worked on healthcare policy in the United Stated Congress, the Executive Branch, and as Director of External Affairs at the centers 

for Medicare and Medicaid services. Ms. Harrington also served in 

senior positions at United Healthcare. 

Next is Jan Ferrier, who I spoke of earlier. Ms. Ferrier is a resident of Coon Rapids, where she has lived since 1966. In her forties, 

Ms. Ferrier suffered from two consecutive strokes that resulted in 

limited mobility on her right side. She currently received services 

funded by the Older Americans Act through the Chores and More 

program. To stay active, Ms. Ferrier enjoys gardening and quilt 

18 

making, she holds degrees in Aviation Administration and Aviation 

Business. 

Next is Iris Freeman. Ms. Freeman is Associate Director and a 

Professor of Law at the Center for Elder Justice and Policy at the 

William Mitchell College of Law in St. Paul. She has also taught 

at the University of Minnesota Graduate School of Social Work. 

Ms. Freeman has directed the Advocacy Center for Long-Term 

Care, now the Elder Rights Alliance for over 20 years. She was the 

Staff Director of Public Policy at the Minnesota Dakota’s Chapter 

of the Alzheimer’s Association. Since the 1970’s, Ms. Freeman has 

brought the consumer perspective to State and national discussions 

on long-term care. She holds degrees from Barnard College and the 

University of Minnesota, and publishes widely in professional and 

scholarly journals. 

Finally, we have Neil Johnson, Executive Director of the Minnesota Homecare Association, which represents homecare agencies 

across the State. Previously Mr. Johnson served as Administrator 

of First Choice Homecare in St. Paul. He has 12 years of experience in planning and development, and has served as owner and 

business administrator of several Twin Cities child development 

centers. Mr. Johnson is currently co-chair of the Minnesota Leadership Council on Aging. Mr. Johnson is a licensed social worker and 

holds a Masters of Social Work from the University of MinnesotaDuluth. 

Thank you all for being here, and I look forward to hearing all 

of your testimony. 

Let’s start now with Ms. Moe. 

STATEMENT OF SHERILYN MOE, OFFICE OF OMBUDSMAN FOR 

LONG-TERM CARE, ST. PAUL, MINNESOTA 

Ms. MOE. Good afternoon. 

Senator FRANKEN. Good afternoon. 

Ms. MOE. My name is Sherilyn Moe, and I work at the Office of 

Ombudsman for Long-Term Care. 

Senator FRANKEN. Can you talk directly into the mic? 

Ms. MOE. Yes. I’ve been with the Ombudsman Office for 20— 

thank you. That helps. 

Senator FRANKEN. It’s a very directional mic. 

Ms. MOE. That helps. I’ll start over. 

I have worked at the Office of Ombudsman for Long-Term Care 

for a total of 23 years, and my position is an Ombudsman Specialist. My specialty is in home and community-based services and 

elder housing. I oversee our State-wide volunteer program and I coordinate all of our continuing education for Ombudsman and our 

volunteers. 

Senator Franken, thank you for the honor of representing the experiences and concerns of the Ombudsman Office. Most of the people that we represent are not here because they are in nursing facilities or in other settings and are much more vulnerable than the 

average older Minnesotan and that is why they are in those settings. 

The Minnesota Office of Ombudsman for Long-Term Care has a 

broad Federal mandate to enhance the quality of life and quality 

19 

of services for long-term care consumers through advocacy, education, and empowerment. 

The Long-Term Care Ombudsman Program was established in 

1978 through the Federal Older Americans Act mandating that 

states establish ombudsman programs that advocate for people living in nursing homes and board and care homes. In the late 

eighties, Minnesota expanded this role to include Medicare and 

homecare clients under auspices of Jim Varpness. 

Minnesota is one of only twelve other States that their LongTerm Care Ombudsman programs have expanded into the 

homecare role through additional State funding. But it’s important 

to note that this additional State funding does not meet the needs 

of the increased calls that we are receiving. There are limitations 

in having an expanded authority with limited State dollars in this 

kind of economy. 

Ombudsmen investigate complaints, meet personally with customers who have issues with their long-term care services, work to 

resolve individual concerns, and identify problems and advocate for 

changes to address them. Ombudsmen promote self-advocacy and 

the development of problem-solving skills through education and 

training for consumers, their families, friends, caregivers, providers 

and the community. 

We currently serve persons who live in the State veterans’ 

homes, nursing homes, board and care homes. We also serve persons who receive in-home services and certain community services, 

tenants in housing with services, Medicare beneficiaries who seek 

assistance with concerns regarding hospital access, denial of inpatient or outpatient services, or discharge questions and concerns. 

We also work with many older Minnesotans who live in adult foster 

care homes, people who will receive hospice services and many 

other long-term care services and supports. 

I feel—it sounds like I am whistling. Does it sound like that to 

anyone else? Am I too close? 

Senator FRANKEN. There might be a little feedback, I don’t know. 

Ms. MOE. Push it back. Thank you. 

One of the main purposes of our office is to ensure that people 

know what their rights are and make real informed choices about 

where they want to live and then to live without fear of neglect, 

abuse, or financial exploitation. 

We have many good laws in Minnesota that explain people’s 

rights. Knowledge of these laws and enforcement is key to success. 

The Minnesota Home Care Bill of Rights is an excellent example 

of the initiative that Minnesota has taken. In 1987, the Minnesota 

Homecare Bill of Rights was enacted for people receiving in-home 

services or homecare services. This, again, is an excellent example 

of consumer protection that can easily be duplicated on a national 

level, as there is no national homecare bill of rights. There is under 

Medicare, of course, for homecare consumers. 

This Bill of Rights has many excellent components, including the 

right to receive information, the right to be free from abuse, the 

right to take an active part in creating or changing a care plan or 

a service plan. Included in this information must be the name and 

address of the long-term care ombudsman. 

20 

This Bill of Rights, however, like any other bill of rights, is only 

as good as the enforcement, and the ability of people to understand 

choices, and to have real choices. Like all bills of rights, it is also 

only as good as what people understand and know, and of course, 

information is power. 

We know from experience, unfortunately, that many people will 

often accept what might otherwise be termed unacceptable assistance in their own home, because the fear of going somewhere else 

is so high. Or in some minds, there is no choice if the only choice 

is perhaps a nursing home. So information about choices and options are all good, but they must be real choice and real options. 

We must avoid policy by sound bite, ‘‘age in place’’, ‘‘choices’’, 

‘‘live well age well’’ all sound good, but what do they really mean? 

Choices are based on feasible choices for the person, choices that 

allow them to still have control, choices that allow them to keep 

the relationships in their lives, and choices that enable them to live 

their days in dignity. 

We know that some choices are made because of people not wanting to lose that last connection with family, even if it is a grandson 

financially exploiting grandma by threatening not to visit if she 

does not give him some money. We know that choices are sometimes made because vulnerable adults feel too guilty to turn in 

their abusive daughter or son. 

So along with real choices, we know that people also need eyes 

and ears to voice with them when they are need of strength or help 

them stand up and voice for those who can not speak for themselves. The ombudsman is that voice. We first seek to provide information to all, so that people know what their rights are and how 

to stand up for them. We provide eyes and ears so that for those 

individuals who are in vulnerable situations, we are able to speak 

for them when they may not be able to. 

Finally, we may need to re-think the definition of staying at 

home and what supports are really needed. As we strive to assist 

people to stay in their community and live in their own homes as 

long as possible, we may not always factor in, and adequately fund, 

the most important part of people’s lives, which is relationships. It 

does no good to most people to stay in their own homes and then 

become isolated from everyone including family, friends, their faith 

community, and social activities. There is so much more to aging 

than simply being free of maltreatment and having our basic needs 

met. 

It should be a given that we all age without any abuse or neglect, 

and that our lives will continue to be filled with dignity, real 

choices and relationships that give our lives meaning. 

Senator Franken, thank you so much for taking the leadership 

to listen to the people of Minnesota as we move to the next year 

for the renewal of the Older Americans Act. We appreciate your 

commitment to these issues, and look forward to working with you. 

[The prepared statement of Ms. Moe follows:] 

21 


64224.010
22 


64224.011
23 


64224.012
24 

Senator FRANKEN. Thank you, Ms. Moe. I have been reminded by 

staff to ask people to keep their testimony to 5 minutes. We don’t 

have a clock, here, so I don’t know how you’re going to know 

whether you’re doing it. Oh, we do? Oh, well, I stand corrected. So, 

we have a clock. So, shame on you to exceed 5 minutes. [Laughter.] 

Ms. Harrington. 

STATEMENT OF KATHLEEN HARRINGTON, CHAIR, MINNESOTA 

BOARD ON AGING, ST. PAUL, MN 

Ms. HARRINGTON. OK, since I’m on the clock, I will begin by 

quickly thanking you, Senator Franken, for your—the opportunity 

to speak to you today, but most importantly for your passionate 

commitment to the people of Minnesota. The quality of representation you bring, and your obvious interest in your constituents and 

in seniors, particularly, is greatly appreciated—— 

Senator FRANKEN. If you want to take more than 5 minutes—— 

[Laughter.] 

No, no. OK. Five minutes starts now. 

Ms. HARRINGTON. OK. [Laughter.] 

I could go on and on. [Laughter.] 

Senator FRANKEN. Why don’t you get to the thing—— [Laughter.] 

Ms. HARRINGTON. OK. All right. 

Can I be like Darsen Keeler and just throw my—all right, seriously. Shinatova, and thank you. 

Senator FRANKEN. Right. 

Ms. HARRINGTON. We also—on behalf of the Minnesota Board, 

want to thank Jim and Assistant Secretary Greenlee for both of 

their commitment to—Jim’s commitment—long-term commitment 

to—service, here in Minnesota and the region, and to Assistant 

Secretary Greenlee’s leadership. We already feel her imprint and 

greatly appreciate the support of the Administration on Aging in 

helping us in Minnesota to innovate and develop new models to 

help serve our seniors. 

Here in Minnesota, as in states across the country, we are beginning to experience the age wave—it’s not just your brother, Senator. Many of our rural counties already have populations with significant proportions of older adults. At the same time, I think Minnesota faces particularly challenging issues with the increase in 

ethnic diversity, compounding with the aging. The demographic 

and ethnographic changes real challenges, and opportunities, for 

our State. 

The needs of older Minnesotans are diverse, they are not monolithic, they do not fit into one category. They are dynamic and dependent on geography, income, literacy and health status, to name 

a few. 

Within that context I want to speak with you today about three 

themes that reflect the Minnesota Board on Aging’s work over the 

past several years and encompass the recommendations we have as 

you work on the reauthorization of this important statute. 

First, supporting our area agencies on aging who have to do more 

with less, to meet the increasing needs of an aging population. Second, the ability to engage in public and private partnerships to expand our home and community-based service capacity and the social fabrics in our community. Third, strengthening our programs 

25 

and services to support self-direction and ensure that the rights of 

older Minnesotans are protected and enforced. 

The mission of the Minnesota Board on Aging is to ensure that 

older Minnesotans and their families are effectively served by State 

and local policies and programs in order to age well and live well. 

We make this mission a reality through our three main roles: Advocacy, advisorship, and administrator. As an advocate, we promoted policies to the State legislature and the executive branch. As 

an advisor, we provide objective innovation that promote public 

education on ways to meet the challenges of Minnesota’s older population. As administrator, we educate seniors and their families, 

their caregivers in programs and opportunities to help them do just 

as I said, live well, and age well. 

We operate the Senior LinkAge Line, as you’ve heard. We work 

closely with your very dedicated casework staff in meeting the specific needs of constituents when the bureaucracy sometimes fails 

them, and checks are lost and things are missing. So, we work very 

closely with staff, and appreciate their commitment, as well. We 

also operate the Office of the Ombudsman, as you heard, here, and 

appreciate the incredible dedication of that small staff to accomplish large deeds. So, the accomplishments of the Office are written 

and articulated in my testimony, so rather than sit here and pat 

myself on the back, and our staff, let me get to the meat of what 

you want us to do here today and talk about three areas of recommendations for you to consider as you and your staff do this 

hard work. 

We’re looking to see if it’s possible to increase the simplicity and 

flexibility in financing within the Older Americans Act. I know 

that’s a big surprise to you. [Laughter.] 

Simplify the Act by—and this may be asking, sir, for a mission 

impossible, but consolidating its six separate home and communitybased services funding streams under Title III into one, might be 

a way to de-complicate and save administrative time and funds to 

ensure more flexible service delivery in a person-centered model 

subservice to older adults whose needs reach beyond any one specific service program. 

In my professional life, in healthcare, we often say that, ‘‘disease 

does not recognize the tax year.’’ Similarly, social needs do not recognize program definition. So, the more we can weave things together, we think, the better we can serve our population. 

Similarly, and this one may be as difficult, we would like to suggest you think about consolidating the Congregate Meals and the 

Home-Delivered Meals in order to provide us with greater flexibility in meeting the needs of people. The shift in the current discretionary funding of Aging and Disability Resource Centers, evidence-based self-management and caregiver support programs, and 

Community Living Programs, to consolidate those—that funding, 

as well. 

Second, strengthen the Ombudsman role in the community—and 

this really falls under modernization. We are working very hard in 

your home State to expand the living-at-home opportunities, but 

the Ombudsman Office does not have the resources or the role 

scope to help those who stay in their home and helping them in 

protecting their rights, as well. We ask that this be considered. 

26 

Finally, we need to encourage partnerships to expand community 

service capacity. Strengthening the Act to emphasize the critical 

need for coordination, particularly in transportation, across Federal, State and local funding streams is really critical to meet the 

needs of this State and, we think, across the Nation. We seek new 

opportunities to partner with others across different parts of the 

government, and we hope that this can be accomplished through 

the reauthorization. 

In conclusion, thank you very much for this opportunity, sir. I 

appreciate it, I know the Board—my colleagues on the Board do, 

as well, and thank you for your leadership. 

[The prepared statement of Ms. Harrington follows:] 

27 


64224.013
28 


64224.014
29 


64224.015
30 


64224.016
31 


64224.017
32 


64224.018
33 


64224.019
34 

Senator FRANKEN. Thank you, Ms. Harrington. 

Ms Ferrier? Ms. Ferrier, you take advantage of some of the services, both—that you pay for, right, and also that—volunteers help 

you with, right? 

Ms. FERRIER. That’s correct. 

Senator FRANKEN. Can you tell us a little bit about your story. 

How’s that, for about 5 minutes? 

Ms. FERRIER. OK, you want my testimony. 

Senator FRANKEN. Yes, I’d like your testimony. 

STATEMENT OF JAN FERRIER, ANOKA, MINNESOTA RESIDENT, 

USER OF OLDER AMERICANS ACT SERVICES, COON RAPIDS, 

MN 

Ms. FERRIER. Can you hear me? 

During 1990, at the age of 49, I had 2 strokes affecting my right 

side, including loss of my hand, an acute sensitivity to cold and 

hearing loss. Doctors ruled the underlying cause as Sneddons Syndrome, which is slowly but progressively disabling. By the way, 

Sneddons Syndrome is a form of Lupus. Things became very challenging for me at that time. What a blessing to become aware of 

the Anoka County Community Action Program called Chores and 

More. At that time, I began using volunteers to help with spring 

and fall leaf raking and eventually to help provide lawn moving 

and snow removal. 

When it became medically necessary for me to take an early retirement at the age of 62, I began using the Chores and More Program for other things I was unable to do on my own including tree 

trimming, gutter cleaning, small carpentry projects, installation of 

a new mailbox and other things as the needs arise, at a reduced, 

affordable rate. These services have allowed me to stay in my home 

where I have lived for the past 44 years. 

In addition to lawn and leaf raking, the program has provided 

me with volunteers who have helped dig up space to put in a vegetable garden, refinish a wooden picnic table, put up curtain rods 

and much more. With today’s ever-increasing costs, the program 

helps me to be able to continue to live independently in my home. 

Other things I have utilized the Coon Rapids Senior Center for 

include occasional noon lunches, numerous free or low cost seminars and presentations such as Social Security benefits, medical insurance and much, more. 

In conclusion, I am deeply grateful for the Chores and More Program and the help it provides aging residents of Anoka County at 

a fair, affordable rate. Perhaps utilizing television and/or newspapers could make the elderly more aware of the program. 

As our United States Senator, I strongly urge you to consider 

Chores and More Program when making funding decisions for the 

aging. We need your help and support. 

Thank you for allowing me to testify before the Senate Special 

Committee on Aging regarding the Older Americans Act Reauthorization. 

[The prepared statement of Ms. Ferrier follows:] 

35 


64224.020
36 


64224.021
37 

Senator FRANKEN. Thank you, Ms. Ferrier. Let me just say that 

you—it’s great to have you here because you put a real human face 

to this. 

When we get back to you, I want to ask you about some of your 

volunteers—some people who volunteered for you. Because as I 

have gone around the State, I have met some of these volunteers, 

and it is really—these are great, great Americans, great Minnesotans, and I think people should hear about them. But thank you 

so much. 

Ms. Freeman. 

STATEMENT OF IRIS C. FREEMAN, ASSOCIATE DIRECTOR, 

CENTER FOR ELDER JUSTICE AND POLICY, WILLIAM MITCHELL COLLEGE OF LAW 

Ms. FREEMAN. Thank you, Senator Franken. 

These comments will focus on elder justice issues. [Laughter.] 

Supporting independence is at the heart of the Older Americans 

Act. 

Ms. FREEMAN. For some, especially those most frail, independence is a generous and misleading term for isolation. Real independence for older Americans means safety from abuse, neglect and 

financial exploitation. Moreover, real independence means the ability to access help for the daily care and chores that one can no 

longer manage. My testimony addresses these two facets of elder 

justice: protection from that maltreatment, and safety in home and 

community services. 

Elder abuse, neglect, and exploitation are more than personal 

tragedies. They translate to public costs: medical care to treat 

wounds, broken bones, and starvation, housing and healthcare for 

victims left destitute by the swindles of people they trusted. Reported allegations in MN for Fiscal Year 2009 exceeded 25,000, 

with 39 percent of those alleging caregiver neglect. Reported cases 

are widely acknowledged to be just a fraction of the reality. 

Priority: Address abuse, neglect, and exploitation in home and 

community settings with increased Title VII funding, while maintaining efforts on behalf of nursing facility residents. 

Minnesota receives $21 million from the Older Americans Act 

funding. Only $79,000 of that is Title VII Elder Abuse money; a 

fraction of a percent. The narrow dollars and ratio promise shortchanged services. 

Priority: Make uniform national data collection a condition of receiving Federal funds by 2015. 

Practitioners and policymakers just do no have the data needed 

to tackle elder abuse, neglect and exploitation head on. We lag behind that work in the fields of domestic violence and child abuse, 

but we can learn from their models. 

Another priority: Create six coordinating Centers of Excellence 

on Elder Abuse and Neglect through the Reauthorization. 

The Center of Excellence at the University of California at Irvine 

Medical School is a beacon and a model of medical, forensic, and 

victim services. But realistically it can not respond to an entire Nation’s needs. 

38 

Let me turn, now, to consumer protection in home and community-based services and reprise some of the issues and recommendations that you have heard so far. 

We are facing a barrel of challenges, and probably two barrels of 

mysteries. We know that the overwhelming percentage of care is 

provided by family. But we do not know how sustainable that is 

into the future. We know that paid caregivers are in such short 

supply that even one’s ability to pay does not promise enough, or 

good enough, care. We are unwilling to give these jobs livable 

wages. We know that monitoring the delivery of care for persons 

inside the walls of private homes makes the challenges of monitoring care in congregate settings seem like small potatoes. Some 

of the technological possibilities for keeping watch are controversial. Technology may bridge miles and guard against isolation, but 

I, for one, do not want to wear a wire or line up with a monitor 

to use the toilet. 

Priority: Include a Bill of Rights for Home and Community-based 

Services in the 2011 reauthorization. 

Minnesota’s Home Care Bill of Rights applies only in licensed 

home care services. Similar limits exist in those codified in other 

states. A Federal bill of rights, across services and regulatory jurisdictions, would promote both professional standards and public expectations. 

Priority: Plan for ongoing public awareness efforts to raise people’s expectations of good care and individual rights. 

Individual rights are intrinsically difficult to monitor, especially 

in private homes. A few of us remember contract details when we 

sign up for services, especially in a crisis. 

Priority: Expand the mandate and funding of the Ombudsman 

program to include advocacy for elders in home and community 

services. 

Quality standards and a bill of rights set us on the right path. 

Ombudsmen explain the complexities, intercede, and use persuasion to repair situations regardless of whether there is a specific 

violation of law. 

Priority: Assure that Ombudsman programs also have the independence in their settings and mandate to provide advocacy at the 

policy level as well as in individual cases. 

Ombudsmen are in an ideal position to use case data, trends, and 

experiences to advocate for consumer rights and safety. The Older 

Americans Act must ensure their freedom to represent their constituencies in public decisions about service systems. 

Finally, this is a very good time for State Units on Aging, Ombudsman Programs and Adult Protective Services systems to plan 

strategically for delivering elder justice in the future. None of these 

systems is uniquely able to handle the growing needs for protective 

services and consumer safety. Regardless of funding levels, cooperative efforts will promote cost efficiency. 

Thank you, Senator Franken and your fellow committee members for your leadership on the Reauthorization of the Older Americans Act. Throughout Minnesota today, there are older people desperately clinging to their homes, some in frighteningly abject circumstances. Ensuring their basic safety while respecting their individuality and privacy requires our steady, shared commitment. 

39 

[The prepared statement of Ms. Freeman follows:] 


64224.022
40 


64224.023
41 


64224.024
42 


64224.025
43 

Senator FRANKEN. Thank you, Ms. Freeman. 

Mr. Johnson. 

STATEMENT OF NEIL JOHNSON, EXECUTIVE DIRECTOR OF 

THE MINNESOTA HOMECARE ASSOCIATION, ST. PAUL, MN 

Mr. JOHNSON. Thank you, Senator Franken. I also want to praise 

you and thank you for your work. I also want to thank your staff, 

as well, Melissa and Lauren did a wonderful job in working with 

us and preparing us and getting information to us about the hearing today. 

In the spirit of full disclosure, I am the past co-chair of the Minnesota Leadership Council on Aging, and probably didn’t update 

my vitae when I sent that to you. But, I wanted to let you know 

that I’m still a member of that group. 

Again, thank you for the opportunity to appear before you today 

and for your work on these timely topics. I would like to talk about 

how we can ensure quality in home and community-based services. 

As you can imagine getting your arms around what quality means 

can be challenging. Medicare certified home care agencies have 

measurable outcomes called ‘‘Homecare Compare’’ with which to 

gauge progress on a number of publicly reported areas such as rehospitalizations, falls, taking of oral medications, et cetera. Other 

home and community-based services are measured on the number 

of services that are provided or the timeframe by which they are 

delivered. Many programs, like personal care attendant services 

have no real measures other than to document if the services were 

delivered. 

Oversight by the Minnesota Department of Health and the Department of Human Services for certain licenses provide some 

measure of quality by documenting compliance with rules and, to 

some extent, consumer satisfaction. 

Do any of these things really ensure quality? I don’t think so. Instead, we must start with the consumer. Counties and regional 

planning agencies annually listen to consumers and do a gaps analysis whereby they identify gaps in needs and services in their community, such as transportation, housing, meals, in-home services, 

et cetera, as we’ve heard today. Community needs assessments are 

very important. Most service providers have some kind of assessment process to determine needs, level of care, and eligibility. In 

fact, the new MINN CHOICES tool that is being developed and 

tested by the state of Minnesota will go a long way to ensure some 

continuity in approaches to a comprehensive assessment process 

across funding sources and programs. 

As we enter the age of the savvy computer—excuse me, consumer—we will need to think—maybe that, too. [Laughter.] 

We will need to think of more creative ways to ensure quality. 

First of all, providers need to be transparent with regard to services and costs. Service agreements and contracts should clearly 

spell out what are the costs—what services will be provided, and 

what those services will cost. 

Second, we need to make access to services easier to navigate. 

We have such things as the Senior LinkAge Line and 

Minnesotahelp.info and they are wonderful resources. But we need 

to make sure that consumers are given information on available 

44 

services, as well as those that are providing quality services and 

there is follow-through in the form of care coordination to make 

sure the services were provided in the best way possible. 

We have often talked about a report card approach which would 

be helpful to consumers, but we need to be careful about what we 

are sharing and how accurate that information is. We also need to 

embrace technology in order to provide services in the most costeffective, efficient way possible. Such things as being able to exchange information remotely through TeleHealth, a single repository of information like electronic health records, and assistive 

technology to help keep seniors in the homes. Internet connectivity 

can help families track services for their loved ones and remotely 

participate in their care planning. We need to add broadband width 

to rural areas of the state in order to take advantage of some of 

these forms of technology. 

What kinds of information would be helpful to know for consumers? How long has the agency been in business? What are the 

qualifications of the staff? How long have they been there? What 

is the turnover rate of the staff, including key positions like nurses, 

home health aides, et cetera? What is the extent of their criminal 

background study? Have they had a recent survey by the Health 

Department? If so, what, if any, were the citations? If they have 

not had a recent survey, when was the last survey? Have they had 

a substantiated complaint against them? What services do they 

offer? If I have a problem, who do I call or communicate with? Is 

there a policy to resolve issues with the consumer? Does that agency have a measurable work plan? What is it? How does the agency 

communicate with the consumer/family about the Care Plan? If 

there is a willing and able caregiver in the home how does that 

person receive support from the agency? What kind of training does 

the staff receive? If there are changes in the consumer’s health or 

condition how is that handled? 

This is a starting list of questions; I am sure there are many 

more. Advocating for a broader Bill of Rights like we’ve talked 

about today, like we have in Minnesota is good and something to 

build on. 

So, in conclusion, quality means different things to different people. If we start with the consumer and listen to their needs we are 

on the right track. Next, providers of home and community-based 

services must have practical measures of outcomes across payment 

sources and programs. We must support family caregivers as the 

core of home and community-based services through training, 

coaching, and mentoring. There needs to be regular oversight by 

regulatory bodies, as long as it does not create undue burdens for 

providers. We must all collaborate and cooperate to ensure that 

providers are working toward a goal of helping people stay in their 

homes, even though they’re facing health issues, and provide the 

highest functioning level possible for the consumer so that they can 

live in the least restrictive environment possible. 

Thank you. 

[The prepared statement of Mr. Johnson follows:] 

45 


64224.026
46 


64224.027
47 

Senator FRANKEN. Thank you, Mr. Johnson. 

Thanks to all of you. 

I would—Jim, would you come up and join and share a mic, too? 

Because I’m going to be asking some questions for everyone to 

weigh in on, and if you have a thought I would appreciate that. 

Jan, I want to start with what I was talking about, but first I 

want to ask you how you heard about the Chores and More Program? Because, Mr. Varpness talked about single point of entry, 

and I just wanted to know how you heard about Chores and More? 

Ms. FERRIER. Oh my goodness, it’s been so long ago, I think I 

probably heard about it from a neighbor, originally. 

Senator FRANKEN. OK. 

Ms. FERRIER. Then I called Anoka County, and they referred me 

to the Chores and More Program where I worked with Ann Kusie 

and—— 

Senator FRANKEN. So, it was word of mouth from a neighbor? 

Ms. FERRIER. Yes. 

Senator FRANKEN. OK. 

Let me just—because I just wanted to do this, because I’ve been 

so struck with the volunteers that I’ve talked to around the State. 

Can you tell me what the volunteers—I know you pay for some of 

the services you get, but talk to me about the people who volunteer? 

Ms. FERRIER. They are so amazing. So, so amazing. I have had 

a whole Boy Scout troop help me with lawn and leaf raking, I have 

had church groups—incidentally, the people who raked my lawn 

last year, in the fall—excuse me, in the spring, this past spring— 

they were a young high school student who needed to earn some 

credits for a class in school, and his parents came. So, all three of 

them worked on my lawn. 

Senator FRANKEN. Did his parents get any credit? [Laughter.] 

Ms. FERRIER. The parents—no. 

Senator FRANKEN. From him? [Laughter.] 

Ms. FERRIER. The parents came and worked with him on it, and 

then the neat thing I felt about it, was I spoke with Ann a few days 

ago—we always sign up on the first of September, for the fall 

work—and she informed me that they had requested that they 

work for me again at my home. So I love their volunteer work; 

they’re really great. They did a really good job. Most people do. 

I had one—I don’t remember what the name of the organization 

was, although I did send them a thank you letter, because they did 

such an amazing job, and they are the ones that—and strictly volunteer work—they cleaned my gutters, they refinished my picnic 

table, including sanding it and restaining it—a lot of work in that 

area. They raked the leaves, just so much they did. 

Senator FRANKEN. Thank you. 

Ms. FERRIER. I am really appreciative of volunteers, and what 

they do. 

Senator FRANKEN. We all are. 

Ms. FERRIER. I am probably more than likely going to be looking 

forward to using more things that are available to me down the 

road, because my medical problem is progressively disabling. 

Senator FRANKEN. Thank you. 

48 

Ms. Moe, do you favor increased funding and independence for 

the Ombudsman Program? [Laughter.] 

Ms. MOE. Certainly. [Laughter.] 

Senator FRANKEN. OK, I thought so. [Laughter.] 

Well, because what I’m hearing is, and Ms. Harrington talked 

about recommendations—increase simplicity and flexibility, consolidate funding streams, strengthen the Ombudsman Office, which I 

heard, also, from Neil, and I believe from Iris, too; partnerships to 

coordinate services and transportation—all of this seems desired. 

Part of my experience is, you all know each other, essentially, 

right? I mean, except for Ms. Ferrier, but essentially, this is a community, right? All of you are working incredibly hard on behalf of 

seniors in Minnesota, and Jim on behalf of seniors nationwide. This 

is a community. You kind of really know what you need. 

One thing I heard was these funding streams. You say there 

were six funding streams under Title III, and you’d like to get it 

down to one. 

Jim, is such a thing possible? How do we do that? 

Mr. VARPNESS. Probably with great care. 

I think—— 

Senator FRANKEN. That’s how to do it—— 

Mr. VARPNESS. Yeah, right. 

We’ve certainly heard from others, besides here in Minnesota, 

about consolidating funding streams. We’ve heard mostly your comment about C–1 and C–2, which is the home-delivered meal and 

the congregate meals, and there seems to be a lot of interest in 

doing those kinds of things, primarily so that, again, getting back 

to the flexibility comment that Kathleen talked about, so that 

States and local communities can decide, where do they need the 

meals money most? Home-delivered meals—— 

Senator FRANKEN. Right. 

Mr. VARPNESS [continuing]. Is growing all over this country. 

Senator FRANKEN. Well, I hear this in every facet of government—I hear it in education, you know, sometimes the funding 

streams dictate the decisions we make, because, ‘‘Well, I need 

money, I can only get it from this funding stream, so I’ve got to 

hire this, when what we really need is that.’’ So, if we can get into 

more detail about that, I’d really like to do it. 

I heard this—Meals on Wheels, or Meals at Home, and Congregate seems to be something that should be done and then I’ve 

heard from a number of you in your testimony and some of the 

other written, submitted testimony. 

I want to bring up my wife’s idea—— [Laughter.] 

Senator FRANKEN. Because if I don’t—she’ll hear about it. 

But, I think this is a good idea, because Ms. Harrington, you 

brought it up. Which is, partnerships to coordinate services and 

transportation. Now, here’s an idea, and I’m wondering—but take 

it more of an example of an idea, which is that school buses—are 

basically used at the beginning of the day and the end of the day, 

right? Then I hear about lack of transit, transportation for seniors, 

so her idea was, to coordinate the use of school buses with senior 

transportation. Is such a thing—has it ever been tried, has it been 

contemplated? Is it doable? Is it a good idea? 

Ms. HARRINGTON. It’s a great idea—— 

49 

Senator FRANKEN. It’s a great idea? OK, use the mic. 

Ms. HARRINGTON. But it—— 

I think you can tell your wife it’s a great idea. It has been tried— 

we, in fact, one member of the Board on Aging has discussed it in 

her local community. We run into—not surprisingly—liability 

issues, cost-effective issues, willingness of Boards of Education to 

cooperate with local governments, so it creates a complexity that 

seems to be unfortunate, but it has been discussed, and I don’t 

think the discussions should cease. 

Senator FRANKEN. But, can those barriers be overcome? It seems 

like, maybe they can. 

Ms. HARRINGTON. I think anything can be overcome, yes. 

Senator FRANKEN. Yeah. 

Ms. HARRINGTON. But, I think we would need leadership in helping make it happen. I think there would be some relief that would 

be necessary from liability issues. Obviously, the cost-effectiveness 

of running buses versus individual cars; there’s—there are issues, 

there. 

Senator FRANKEN. Well, there are some bus lines that do work— 

and I was just in Pine City, and they have a bus line up there that 

really is a life-saver for seniors. 

Ms. HARRINGTON. Oh, I think that’s true in many States, and obviously many areas in this State. But the issue of getting the various governance jurisdictions to cooperate—and I know there is a 

very effective task force going on within Minnesota that is making 

progress, and we could see, you know, if we could get a report—— 

Senator FRANKEN. So, that would be something for someone in 

government to do. 

Ms. HARRINGTON. In government. Well, I think it helps for—— 

Senator FRANKEN. Hm, where could we find one of those? 

[Laughter.] 

Check into that, would you? OK. 

Iris—sorry, I keep going between last names and first names. 

Neil talked about quality, a lot about quality. Would effective 

measures of quality reduce abuse and neglect? 

Ms. FREEMAN. Senator, the most important place to start is simply to keep people safe from charlatans. If we can just get the bad 

actors out of that service, people who—and I say this with great 

respect to Neil and all of the real angels who work in home care— 

there are agencies where they’re printing the nursing licenses in 

the trunk of the car. There is a lot that can be done with quality 

measurement and real—very, very subtle, minute elements of quality. 

But for real consumer protection and safety, let’s start with getting the bad guys out. 

Senator FRANKEN. Yeah, but it’s interesting, because again, 

across anything, there’s bad actors and good actors, right? 

Ms. FREEMAN. Mm hm. 

Senator FRANKEN. Usually, most of the actors are good actors, 

and there are a few bad actors. 

Neil, you headed up, in Minnesota, the Home Care Providers, 

right? 

Mr. JOHNSON. Right. 

Senator FRANKEN. Do they know who the bad actors are? 

50 

Mr. JOHNSON. Well, that’s a good question—— 

Senator FRANKEN. Or, are they fly by-nights? 

Mr. JOHNSON. Well, it’s—you know, I think, we mentioned some 

of the things that you want to look for when you’re—particularly 

your hiring process; hiring is certainly not a perfect science by any 

means, and we do a background study in Minnesota. The problem 

is, of course, you’re only looking at Minnesota. So, we’re looking at, 

you know, trying to broaden out the background studies so you’re 

looking at other states, for example, you’re looking at other types 

of offenses that may be more prevalent to those going in and ripping off people. 

You know, I think, guarding against family members who do it 

is really difficult, because then you—— 

Senator FRANKEN. What percentage of care is provided by family 

members? Because I think it’s in the 80-something percent? 

Mr. JOHNSON. Yeah, it’s probably about 10 percent—I think family caregivers is about 90 percent of the care giving, so it’s a small 

percent. 

Senator FRANKEN. I’ve heard in the testimony about the, I think 

it was Ms. Moe, who talked about the fear of, ‘‘My son won’t visit 

me unless I give him money.’’ So, when we’re talking about some 

of this neglect and abuse—and this is 90-percent of the care, we’re 

talking about a large part of this abuse and neglect coming from 

family members, is that correct? 

Ms. FREEMAN. That is correct, and verifiable, particularly in the 

area of financial abuse, financial exploitation. 

Some of these family members may not be caregivers, per se, but 

they do have a very emotional hold on the vulnerable individual. 

The vulnerable individual is rarely willing to press charges. 

Senator FRANKEN. Do you need to press charges? I mean, that 

means, being a witness and being able to bring a case—you can’t 

bring it without the person saying, ‘‘I’m willing to testify against 

my—’’ 

Ms. FREEMAN. Remember, you’re asking the social worker at the 

law school—— [Laughter.] 

Senator FRANKEN. Well, that’s why I’m asking. I did remember 

that. 

Ms. FREEMAN. But, in fact—— 

Senator FRANKEN. That’s why I asked you. [Laughter.] 

Ms. FREEMAN. It is true that family members may very well be 

the perpetrators. But it is also true that when family members are 

trying to do the good comparison shopping that we would have 

them do to find out about the staffing characteristics at an agency 

and their training and what-not, they may be faced with the reality 

that that is the only service in the area that has a slot open. So 

we want people to ask the right questions and be diligent, but 

sometimes the urgency is to get anybody in there, right away. 

That’s just the sad truth of the matter. 

Senator FRANKEN. Ms. Harrington, I wanted to ask about the 

Senior LinkAge Line, and Minnesota Help dot-info Web site. Say 

I call the Senior LinkAge Line for help after my mom fell and 

couldn’t take care of herself. Walk me through—how that would 

go? I mean, how would the process of talking with the phone counselor help me figure out which services were available to my mom? 

51 

Ms. HARRINGTON. Depending upon the county you called, but I 

think in general, you would get a well-informed person who could 

help you understand all of the available services and the connections to those. If it was an emergency situation, it would obviously 

be done on a rapid-response basis. But, clearly the people who work 

on the Senior LinkAge Line—the front-line people sometimes do 

the triage, but then pass them on to people who are quite expert 

in the resources that are available in the community. 

I can speak of this from a previous life when I was not a Minnesotan, and worked in Washington doing the Part D campaign— 

Minnesota’s Senior LinkAge Line was the premiere service line in 

the entire country, in terms of quality and volume of service that 

it handled for senior trying to find out about their health insurance. 

But, to—I think I answered your question, with a little aside, 

there, that you would get the full complement of available resources and the directory information. 

Senator FRANKEN. Do other States have similar lines? 

Ms. HARRINGTON. There is, in this country, a—what’s called the 

State Health Insurance Program, that is a volunteer-based program sometimes run out of the Office of the Insurance Commissioner, sometimes out of the Aging Office that does—is available to 

help seniors make informed decisions on their Medicare issues, 

long-term care issues, and—but to say that most of them are as robust as Senior LinkAge Line would not be necessarily true. I think 

this one is highly developed—and I’m looking to Jim because I 

want to sound like I’m being a partisan, here—I think it is much 

more robust than many. Probably the most—— 

Senator FRANKEN. Jim, you’re objective. [Laughter.] 

Mr. VARPNESS. This is true, this is true. 

Senator FRANKEN. Now that you’re working for the Federal Government—— 

Mr. VARPNESS. Yes, yes, I can speak from the Federal—— 

Senator FRANKEN. Put on your Federal hat, here. 

Mr. VARPNESS. Yeah, it’s on, it’s on. 

Yes, that’s actually correct. Minnesota really has probably the 

most expansive, comprehensive data base of any State. It has approached doing this by bringing together, really, all of the various 

kinds of departments—it’s really a model of partnerships and coalition-building that’s brought Children’s’ Services, services for people 

with disabilities, veterans’ services, housing services and even 

FEMA-type services in this State. So, it’s a very robust data base. 

What’s great about this particular system that some of the other 

States have, as well, is that you can actually—individuals can actually go through Minnesota Help online and get the information 

themselves. Some people, frankly, aren’t phone people. They want 

to bring, and pull this stuff together. You can, online, actually chat 

with people online. It really is a marvelous example—it’s a model 

service, that piece of it. 

There are 47 other States that have various approaches, but 

they’re not as robust, and they’re not Statewide, they’re demonstration projects, and some States have more investments in terms of 

person capital on the resource side. 

Senator FRANKEN. In terms of what? 

52 

Mr. VARPNESS. Person capital, putting more people at the local 

levels and counties to do some of the coaching and some of the 

triage work. Minnesota, I believe, still does a lot of this through the 

Network. 

Ms. HARRINGTON. Mm hm. Yes. 

Mr. VARPNESS. Through the phone system. Yeah. 

Senator FRANKEN. OK, I’m wondering in reauthorizing the Older 

Americans Act, what can you legislate because I would think this 

is a more efficient system that ultimately saves dollars and saves 

suffering et cetera. How would you legislate something like that? 

Or, can you? 

Mr. VARPNESS. Well, we’ve been funding these as innovation 

projects across the country and demonstration projects. Some 

States have done it in different ways to meet their specific needs. 

In the State of Wisconsin, for example, Wisconsin has a different 

kind of approach, a different model. They fund aging disability resources in each of their 87 counties. It’s much more of a—it’s much 

more of a single point that relies on individuals, essentially, coming 

in, if you will, for different kinds of services. It’s a very successful 

program, too, as Minnesota—— 

Senator FRANKEN. So, allow each State to figure out their 

own—— 

Mr. VARPNESS. I think—— 

Senator FRANKEN [continuing]. To some extent—— 

Mr. VARPNESS. In the sense, it works best for States to try to 

best meet some of the individual needs in their particular areas. 

There’s also issues that—Neil brought up the issue on broadband 

width example. Some States are able to really push a lot of technology options and opportunities. Other larger, rural States, that’s 

not a very realistic approach for them to take. 

So, we’ve got to be careful about how we say how it should be 

done. 

Senator FRANKEN. Ms. Freeman, you said that there were 25,000 

reported allegations in Minnesota in 2009 of some kind of, abuse 

or neglect. 

Ms. FREEMAN. Or financial exploitation. 

Senator FRANKEN. Or exploitation. 

Ms. FREEMAN. Yes. 

Senator FRANKEN. You said 39 percent alleged caregiver neglect. 

How does the rest of it break down? You said it was widely acknowledged to just be a fraction of the reality, so explain that. 

Ms. FREEMAN. Yes. We have asked the Department of Human 

Services to go further into their data to be able to break out of the 

caregiver neglect—how many of those or what percentage of those 

occur with formal providers, how many of those are family caregivers. That information isn’t as readily available as we would 

want it to be, but they are working on it. 

Senator FRANKEN. You asked for more data? 

Ms. FREEMAN. That’s right. Something more refined than those 

large categories. So we’re hoping to have that. I will see to it that 

your staff and office have that. 

But the issue of reported cases being the tip of the proverbial iceberg is what is reported by national studies done by the National 

Adult Protective Services, administrators, as well as scholars in the 

53 

field. It very much—very much resembles what domestic abuse and 

child abuse reporting were like when those phenomena were first 

seen as public issues and not just family tragedies. 

Senator FRANKEN. OK. 

Ms. FREEMAN. So as awareness grows, there are more individuals 

who may be willing—either because they’re a mandated reporter 

under law, or because they just have a feeling of civic duty to 

help—more people will call. 

But, one of the things I also hope to see as we improve these 

services, is greater public awareness about where to call, a more 

streamlined system for making those reports of abuse, neglect, and 

exploitation. Because, unless you really work in the field, it is not 

obvious to anyone, where you call to report a case? 

Senator FRANKEN. Thank you. Thank you, all. This concludes the 

time that we have for today. I really appreciate you all being 

here—everyone who’s here. Especially those who shared your expertise, and your thoughts on the reauthorization of the Older 

American Act. 

I would also like to thank the Maple Grove Community Center 

for making the space available today, for hosting today’s hearing. 

Our discussion has made it clear that in order to help seniors stay 

independent, we must do more to provide high-quality services to 

seniors in their homes. I will soon be introducing legislation—including many of the proposals, we have talked about today, such 

as a Federal Homecare Bill of Rights to ensure that all seniors who 

receive care in their homes have similar protections guaranteed in 

the Minnesota Homecare Bill of Rights. 

I will also be working to ensure that Minnesota has the resources 

we need to protect seniors from abuse and neglect when they receive services in their home. I will work to build on existing resources, like the Senior LinkAge Line, and the Minnesota Help.info 

Web site, to help seniors and families get information that they 

need to make informed decisions about their care. 

Finally, I will be a staunch advocate for robust funding for the 

Older Americans Act, and also for increased flexibility and simplicity and of hopefully, more cost-effective use of funding we do 

have. The Older Americans Act is a cost-effective investment that 

helps keep our seniors in Minnesota and across the Nation in their 

homes, so that they can age happily and healthfully. 

Once again, thanks to everyone for attending today’s hearing. I 

look forward to continuing to work with you to promote senior independence in the 2011 Older Americans Act. 

The hearing is closed. 

[Whereupon, at 3 p.m., the hearing was adjourned.] 

(55) 

A P P E N D I X 


64224.028
56 


64224.029
57 


64224.030
58 


64224.031
59 


64224.032
60 


64224.033
61 


64224.034
62 


64224.035
63 


64224.036
64 


64224.037
65 


64224.038
66 


64224.039
67 


64224.040
68 


64224.041
69 


64224.042
70 


64224.043
71 


64224.044
72 


64224.045
73 


64224.046
74 


64224.047
75 


64224.048
76 


64224.049
77 


64224.050
78 


64224.051
79 


64224.052
80 


64224.053
81 


64224.054
82 


64224.055
83 


64224.056
84 


64224.057
85 


64224.058
86 


64224.059
87 


64224.060
88 


64224.061
89 


64224.062
90 


64224.063
91 


64224.064
92 


64224.065
93 


64224.066
94 


64224.067
95 


64224.068
96 


64224.069
97 


64224.070
98 


64224.071
99 


64224.072
100 


64224.073
101 


64224.074
102 


64224.075
103 


64224.076
104 


64224.077
105 


64224.078
106 


64224.079
107 


64224.080
108 


64224.081
109 


64224.082
110 


64224.083
111 


64224.084
112 


64224.085
113 


64224.086
114 


64224.087
115 


64224.088
116 


64224.089
117 


64224.090
118 


64224.091
119 


64224.092
120 


64224.093
121 

Æ 


64224.094