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68–180 PDF 2011

S. HRG. 112–106 

MEALS, RIDES, AND CAREGIVERS: WHAT MAKES 

THE OLDER AMERICANS ACT SO VITAL TO 

AMERICA’S SENIORS 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

WASHINGTON, DC 

MAY 26, 2011 

Serial No. 112–6 

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 UDAL, 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 

JERRY MORAN, Kansas 

RONALD H. JOHNSON, Wisconsin 

KELLY AYOTTE, New Hampshire 

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 Herb Kohl ............................................................. 1 

Statement of Senator Bob Corker .......................................................................... 2 

Statement of Senator Bill Nelson ........................................................................... 3 

Statement of Senator Mark Udall .......................................................................... 3 

Statement of Senator Bob Casey ............................................................................ 4 

PANEL OF WITNESSES 

Statement of Rosalynn Carter, President, Rosalynn Carter Institute for 

Caregiving, Americus, GA ................................................................................... 5 

Statement of Kathy Greenlee, Assistant Secretary, Administration on Aging, 

Department of Health and Human Services, Washington, DC ........................ 7 

Statement of Elizabeth Marshall, OAA Service Recipient, York, PA .................. 15 

Statement of Max Richtman, Chair, Leadership Council of Aging Organizations, Washington, DC ......................................................................................... 17 

Statement of Heather Bruemmer, State of Wisconsin Long-Term Care Ombudsman, Madison, WI ........................................................................................ 19 

Statement of Timothy Howell, CEO, Senior Citizen Home Assistance Services, 

Knoxville, TN ........................................................................................................ 21 

APPENDIX 

WITNESS STATEMENTS FOR THE RECORD: 

Rosalynn Carter, President, Rosalynn Carter Institute for Caregiving, Americus, GA ................................................................................................................. 32 

Kathy Greenlee, Assistant Secretary, Administration on Aging, Department 

of Health and Human Services, Washington, DC ............................................. 64 

Elizabeth Marshall, OAA Service Recipient, York, PA ........................................ 71 

Max Richtman, Chair, Leadership Council of Aging Organizations, Washington, DC ............................................................................................................. 76 

Heather Bruemmer, State of Wisconsin Long-Term Care Ombudsman, Madison, WI .................................................................................................................. 98 

Timothy Howell, CEO, Senior Citizen Home Assistance Services, Knoxville, 

TN .......................................................................................................................... 103 

RESPONSES TO ADDITIONAL QUESTIONS FOR THE RECORD: 

Rosalynn Carter, President, Rosalynn Carter Institute for Caregiving, Americus, GA ................................................................................................................. 113 

Kathy Greenlee, Assistant Secretary, Administration on Aging, Department 

of Health and Human Services, Washington, DC ............................................. 115 

Max Richtman, Chair, Leadership Council of Aging Organizations, Washington, DC ............................................................................................................. 123 

ADDITIONAL STATEMENTS SUBMITTED FOR THE RECORD: 

Senator Robert P. Casey, Jr. (D-PA) ...................................................................... 125 

American Bar Association, Washington, DC ......................................................... 126 

Center for Advocacy for the Rights and Interests of the Elderly, Philadelphia, 

PA .......................................................................................................................... 131 

East Tennessee Area Agency on Aging and Disability ......................................... 145 

LeadingAge, Washington, DC ................................................................................. 149 

National Association of Senior Legal Hotlines, Austin, TX ................................. 152 

The OASIS Institute, St. Louis, MO ...................................................................... 159 

(1) 

MEALS, RIDES, AND CAREGIVERS: WHAT 

MAKES THE OLDER AMERICANS ACT SO 

VITAL TO AMERICA’S SENIORS 

THURSDAY, MAY 26, 2011 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:03 p.m., in Room 

SD–106, Dirksen Senate Office Building, Hon. Herb Kohl, Chairman of the Committee, presiding. 

Present: Senators Kohl [presiding], Nelson, Casey, Udall, 

Manchin, and Corker. 

OPENING STATEMENT OF SENATOR HERB KOHL, CHAIRMAN 

The CHAIRMAN. Good afternoon. We’d like to thank all of you for 

being with us today. 

In 1965, the same year Medicare was created, President Johnson 

signed another landmark bill for America’s seniors, the Older 

Americans Act. Today the programs authorized by the OAA serve 

more than 10 million older Americans nationwide and over 386,000 

in my State of Wisconsin. They help seniors live independently in 

their communities through home care, home-delivered and group 

meals, family caregiver support, transportation, as well as other 

services. 

While the need for such vital OAA services has increased during 

these difficult economic times, Federal funding for OAA programs 

has not. This year OAA programs were cut by 17 percent from last 

year. 

Every five years, Congress takes a fresh look at OAA programs 

to assess whether they are meeting the needs of the people they 

serve. Last September I held a field hearing in Milwaukee to gather ideas for strengthening and improving OAA programs. Since 

then we’ve incorporated many of the recommendations we received 

into priorities, and we will work with our colleagues to include 

these priorities in the new bill. 

One of our priorities will address helping the nearly 44 million 

family members providing care to an older relative by simply asking them: ‘‘What do you need?’’ By permitting States to assess 

whether family caregivers need services such as respite care and 

counseling, we can delay more costly institutional placements of 

frail and disabled seniors. 

We also believe we must strengthen the long-term care ombudsman program, which provides an advocate for elderly and disabled 

2 

patients to help resolve complaints of abuse and neglect in longterm care settings. We will work to expand the capacity of the National Ombudsman Resource Center and increase the ombudsmen’s 

access to resident health care records so they can be more efficient 

as well as more effective. 

Once again, we’d like to thank you all for being here. We look 

forward to your remarks, particularly those who are testifying, on 

how we can improve the Older Americans Act. 

We turn now to Senator Bob Corker. 

STATEMENT OF SENATOR BOB CORKER 

Senator CORKER. Thank you, Mr. Chairman. As always, thanks 

for calling the hearing on the Older Americans Act. We want to 

thank the witnesses here today to share your expertise and experience, and I want to especially thank Rosalynn Carter, our First 

Lady, for sharing her experience, and Tim Howell with the Senior 

Citizen Home Assistance Services in Knoxville, for coming to Washington to testify on the good work that they are doing for seniors 

of East Tennessee. I look forward to learning more about Older 

Americans Act programs today. 

When the Older Americans Act was passed in 1965, it was designed to be the human services support for seniors and complement the health support offered by the brand-new MedicareMedicaid programs. This non-medical support envisioned by the 

Older Americans Act was proven to be what seniors need to stay 

in their own homes and independent as long as possible. 

These services, like home-delivered meals, rides to appointments 

and activities, housekeeping and personal care, case management, 

caregiver support, and senior centers, are the first—are the sort of 

home and community-based services that seniors and their families 

across the country rely upon. 

In Tennessee Older Americans Act home- and community-based 

service programs serve about 159,000 people. Almost 2,000 people 

are working and learning new skills for future sustainable employment because of the senior community service employment program. The service providers in Tennessee work hard to help seniors 

maintain dignity and independence with the latest innovations and 

programs. 

For example, Tennessee has started to get in place aging and disability resource centers. These centers are to serve as a single point 

of entry for all services a senior may be eligible for. I look forward 

to reviewing the upcoming evaluation by the U.S. Administration 

on Aging of these centers and to see if any necessary improvements 

in the information and referral—in this information and referral 

innovation. 

In 2020—and this is something that I think all of us are focused 

on as we look at future budgets—there will be more than 75 million people over the age of 60 and thereby eligible for the Older 

Americans Act programs. With our population growing older, these 

programs become more and more important. But at the same time, 

we are experiencing a fiscal crisis and need to seriously review 

spending on all government programs. This means that Older 

Americans Act programs will have to continue to innovate and increase efficiencies to meet increasing demand. 

3 

I look forward to working with my colleagues and with our panelists to continue to modernize the Older Americans Act so that it 

can be flexible and appropriate to serve the needs of our Nation’s 

seniors. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you very much, Senator Corker. 

Senator Nelson of Florida. 

STATEMENT OF SENATOR BILL NELSON 

Senator NELSON. Thank you, Mr. Chairman. I want to take this 

opportunity to thank you for your long and distinguished career. 

This is the first opportunity publicly that I could say that to you, 

as we have already discussed privately, because last week you announced that you are going to retire from public service. Your 24- 

year career in the United States Senate is most distinguished and 

most appreciated by a lot of folks who never get a chance to tell 

you. 

Like most citizens of the United States that have a connection 

one way or another with Florida, so you do as well. The Senator’s 

brother is one of our distinguished citizens in Palm Beach. 

I want to, Ms. Carter, thank you for you just keeping on keeping 

on. It was a long time ago when you and your husband were campaigning in the Florida primary in 1976, and you have been his 

partner every step of the word in the best sense of that word, and 

you continue today rendering service to our country and to our people. So thank you very much. 

Mr. Chairman, I just wanted to mention that, on this subject 

that we are discussing today, that a good example is a bill that I’ve 

had to file. I say had to file because, for example, in all the good 

stuff that programs like community development block grants do, 

CDBGs, but it has, for example, a limitation of 15 percent of the 

funds that can go to feeding programs for seniors. In one particular 

case, the City of Miami wants so desperately to use those, the remaining CDBG funds, for assistance to seniors in the feeding programs. But they’re limited to 15 percent. 

So I filed a bill to raise that a modest amount to 25 percent, that 

would give the recipients of CDBGs that flexibility to tailor their 

particular needs of the community, in this particular case the 

needs of senior citizens. I just wanted to get that out on the record 

for the committee. 

The CHAIRMAN. Very good. Thank you, Senator Nelson. 

Senator Mark Udall. 

STATEMENT OF SENATOR MARK UDALL 

Senator UDALL. Thank you, Mr. Chairman. Good afternoon to everybody. I too want to associate myself with Senator Nelson’s remarks about your leadership. I haven’t forgiven you yet, Senator 

Kohl. I want that to be on the record. 

The CHAIRMAN. I have your note. 

Senator UDALL. But I wanted to welcome our panelists. I unfortunately have to step out. I serve on the Intelligence Committee, 

and we’re having an important debate on the Patriot Act and its 

reauthorization. 

4 

But I did want to acknowledge the First Lady. The Udall and 

Carter families have been intertwined for many decades and we 

have great respect for their commitment to public service, and it’s 

wonderful to see you here today. 

Ms. Greenlee, you were a hit in Pueblo last summer. You were 

a real crowd-pleaser. I can’t say the same about myself, but thank 

you for holding a hearing with us in Pueblo. I know the chairman 

and many members of the committee have been holding hearings 

all over our great country on the OAA. 

We have a real opportunity in my opinion to modernize the act 

for a new and unique generation of seniors. I’m a member of the 

baby boom cohort. These Americans, my remarks say, which are 

my people, are fast approaching Medicare eligibility, and I think 

we have different expectations, different experiences, about how we 

can make our golden years really meaningful. 

So this is an important hearing. Mr. Chairman, I look forward 

to working with you to modernize the act in ways that take advantage of the potential and the contributions that every American can 

make regardless of their age. So thank you again. 

The CHAIRMAN. Thank you, Senator Udall. 

Senator Casey. 

STATEMENT OF SENATOR BOB CASEY 

Senator CASEY. Mr. Chairman, thank you. I’ll be brief, and I’ll 

add a statement to the record. But we want to commend you, not 

only for today’s hearing, but of course for your great service to the 

United States Senate. You’ve been—you’ve been a great leader of 

this committee, and we’ll miss you. We know you’re going to be 

here for a while yet. We’re not saying goodbye yet, but we want to 

commend you for that. 

To Rosalynn Carter, former First Lady, we’re grateful that you’re 

here and appreciate your important witness on these issues over 

many years and your leadership and your testimony today. 

Assistant Secretary Greenlee, we’re grateful to have your testimony today as well. 

On the second panel, I’m honored to say as a Pennsylvanian we 

have a former Mayor of York, Pennsylvania, Elizabeth Marshall, 

who is here. We will say hello to her in a more personal way a little later, but I am grateful she’s here. 

Just a couple words about why we’re here. This legislation, of 

course, the Older Americans Act, has often been described as the 

glue that holds a whole series of programs that benefit older citizens together. I think what brings us into this room today is not 

just legislation and policy, but a shared commitment that we have 

more work to do as it relates to older citizens, those who have 

fought our wars, worked in our factories, taught our children, built 

our economy, and gave us life and love; that we’ve got an obligation, an enduring, abiding obligation, to do all we can. And one of 

the ways to fulfil that obligation is to make sure that we make the 

right choices on legislation and policy, and I’m happy to be part of 

this hearing today. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you very much, Senator Casey. 

5 

We’re honored to have with us today former First Lady Rosalynn 

Carter. We’re all familiar with Ms. Carter’s tireless advocacy alongside her husband, President Carter, on behalf of human rights and 

conflict resolution around the world. She is also a dedicated advocate for caregivers and mental health issues here at home. 

Mrs. Carter is President of the Rosalynn Carter Institute for 

Caregiving at Georgia Southwestern State University, where she 

leads the institute’s efforts to promote the well-being of family 

caregivers throughout our country. She is an inspiration for many 

and a legend in her own right. 

Next we’ll be hearing from Kathy Greenlee, the Assistant Secretary for Aging at the U.S. Department of Health and Human 

Services. Ms. Greenlee has a wealth of experience advancing the 

health and the independence of seniors and their families. Previously Ms. Greenlee served as Secretary for Aging for the State of 

Kansas, as well as the Kansas State Long-Term Care Ombudsman. 

We thank you very much for being here, and we’ll take your comments and testimony, Mrs. Carter. 

STATEMENT OF ROSALYNN CARTER, PRESIDENT, ROSALYNN 

CARTER INSTITUTE FOR CAREGIVING, AMERICUS, GA 

Mrs. CARTER. I’m very pleased to be here this afternoon to speak 

about caregiving, an issue that is very important to me. It has been 

part of my life since I was 12 years old and my father was diagnosed with leukemia at age 44. We lived in a very small town and 

all the neighbors rallied around. But I still vividly remember going 

to my secret hiding place, the outdoor privy, if you can believe that, 

to cry. That’s where I could be alone. 

I was the oldest child, and I felt the burden of needing to help 

care for my father and my three younger siblings. Yet I was afraid 

and didn’t always feel like being strong. But my mother depended 

on me. 

Less than a year after my father died, my mother’s mother died, 

and my grandfather came to live with us. He was 70 and lived to 

be 95. My mother cared for him at home until he died. I helped 

as much as I could, but I was married and living away much of 

the time. During the last few years of his life he was bedridden and 

totally dependent on her, our family members, neighbors, and 

friends for all his needs. 

My story is not unique, but today the informal support networks 

that were so much a part of my life in a small town—neighbors, 

extended family, the church—are not there for millions of Americans. Families are fractured and dispersed. Women, the traditional 

caregivers, are now an integral part of the work force. Advances in 

medical science mean we are living much longer, yet resources to 

enable us to live independently are sorely lacking. 

We face a national crisis in caregiving, especially for our elderly 

citizens. Most frail elderly and disabled people live at home today. 

About 90 percent of the care they need is provided by unpaid, informal caregivers, most often family members, providing tasks that 

only skilled nurses performed just a decade ago, and with minimal 

preparation and training. 

Many of these caregivers are frail and elderly themselves and 

find the burdens of caregiving overwhelming. Consider these facts: 

6 

Older people caring for their spouses have a 63 percent higher mortality rate than those of similar age without caregiving responsibilities; the stress of caring for a person with dementia negatively impacts the caregiver’s immune system for up to 3 years after 

caregiving ends, making them more susceptible to all kinds of illnesses; caregivers report chronic conditions such as heart disease, 

cancer, and diabetes at twice the rates of noncaregivers; and up to 

50 percent report struggling with depression. It’s even higher when 

caring for a loved one with dementia. 

While experts estimate the value of care provided by unpaid informal caregivers to be more than $375 billion annually, many 

caregivers have to reduce their working hours or even quit their 

jobs, losing health and retirement benefits worth hundreds of thousands of dollars. 

The economic consequences are devastating. Our nation’s family 

caregivers are enduring both physical and mental problems and 

even dying sooner because of the responsibilities in caring for a 

loved one. 

Mr. Chairman, there are only four kinds of people in the world: 

those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need 

caregiving. That’s all of us. Caregiving knows no geographic or political boundaries. 

The Rosalynn Carter Institute for Caregiving at Georgia Southwestern State University near my home town is doing 

groundbreaking work to help Americans with their challenging 

caregiving responsibilities. In one of our programs, with support 

from our corporate partner Johnson and Johnson, we undertook a 

national assessment of the state of caregiving in our country. We 

discovered innovative programs proven to be effective, but they 

were not and are not reaching people in need. 

One of them focuses on the spouses of people with Alzheimer’s 

disease. It provides concrete advice on how to deal with difficult behaviors like wandering, repeatedly asking questions, and agitation. 

It also focuses on taking care of oneself and on simple techniques 

to reduce stress. A woman at home who’s been through our program told me that it changed her life. She said she was overwhelmed by difficulties and stresses of assuming care for her mother after her father died unexpectedly. She now is proud of being 

able to allow her mother to stay in her home. Just think what a 

difference this kind of program would make in lives of caregivers 

across this country. 

The RCI, which is what we call the Rosalynn Carter Institute, 

has been working in Georgia and in demonstration sites around the 

country to introduce these interventions at the community level. 

But much more needs to be done. 

There must be a fundamental shift in how this nation values and 

supports caregivers and caregiving. Last October the Rosalynn Carter Institute released a very important report, ‘‘Averting the 

Caregiving Crisis: Why We Must Act Now.’’ This report is the result of 3 years of intensive study which involved hundreds of experts. I urge each of you to read it carefully, for it contains a blueprint for a national initiative to support family caregivers. 

7 

Its recommendations include: better assessments of caregiver 

health; increased use of evidence-based interventions in communities across the country; and greater flexibility in both public and 

private insurance programs to provide training and support for 

family caregivers. Its most important recommendation, however, is 

a call for leadership. We propose a National Quality Caregiving 

Task Force in the President’s office, with shared leadership between the Secretary of Health and Human Services and the Secretary of Veterans Affairs. We have the knowledge base to solve 

the caregiver crisis, and we are already spending billions of dollars 

which can be used much more effectively. 

These are challenging times for our country, with extreme pressure on federal, state, and local resources. Families and communities are struggling to cope. Yet if we fail to act now, the consequences for those in need of care will be increased rates of institutionalization, higher risk of abuse and neglect, unnecessary isolation, and perhaps even premature death. For family caregivers it 

will mean much greater burden, increased risk of physical or mental health problems, and more financial hardships. For our already 

overtaxed health care system, it would be impossible to find the 

work force to deliver high-quality institutionalized care. 

The overall impact would be an unprecedented burden. In human 

terms, it will lead to unparalleled suffering for millions of older 

Americans and their family caregivers. We cannot let this happen. 

Thank you for the opportunity to speak with you about this most 

significant national issue. Mr. Kohl, thank you. 

[The prepared statement of Rosalynn Carter appears in the Appendix on page 32.] 

The CHAIRMAN. Thank you very much, Mrs. Carter. 

We’ll hear from Ms. Greenlee. 

STATEMENT OF KATHY GREENLEE, ASSISTANT SECRETARY, 

ADMINISTRATION ON AGING, DEPARTMENT OF HEALTH AND 

HUMAN SERVICES, WASHINGTON, DC 

Ms. GREENLEE. Thank you. Senator Kohl, it’s good to see you 

again. Senator Corker. Members of the Special Committee on 

Aging: Thank you for the opportunity today to talk about the reauthorization of the Older Americans Act. In preparation for this 

process, at the Administration on Aging we went through the most 

extensive outreach effort in the history of the agency to seek input 

from all across the country, from family caregivers, seniors, and 

other individuals providing support. We have a lot of information 

that we have gathered about the value of these programs and look 

forward to continuing to work with this committee as we take up 

the challenge of reauthorization. 

Senator Kohl, I would like to join your colleagues in commending 

you in your service on behalf of older Americans. I think I have 

mentioned to you before I first heard of you from our mutual friend 

George Petrosky, the former Wisconsin long-term care ombudsman. 

Not only have you been instrumental in helping seniors; you have 

paid particular attention to those seniors in nursing homes in this 

country. And many of us—I think I can speak on behalf of the 

whole aging network—have valued your contributions and will 

miss your leadership. So thank you for your service. 

8 

It’s also wonderful to appear today with Mrs. Carter, a tremendous honor to be here. I met Mrs. Carter last fall when I traveled 

to Americus to the Rosalynn Carter Institute to talk specifically 

about what we need to do to continue to advance the cause and the 

supports for caregivers. She had released her report about that 

same time. 

Mrs. Carter is a leader in the field of caregiving. The work that 

they’re doing at the institute is innovative. The leadership she is 

asking for she is herself providing. I also want to acknowledge her 

work in the field of mental health, not something we will spend as 

much time on at this hearing. But Mrs. Carter’s work in mental 

health is really important for individuals dealing with mental 

health and their family members. 

So I applaud your work, Mrs. Carter. It’s an honor to be here. 

As you know and mentioned, I was the Secretary of Aging in the 

State of Kansas. I have served now for 2 years as the U.S. Assistant Secretary for Aging, and in both of those capacities I have listened to and spoken to thousands of individuals and families in a 

variety of settings. And I have seen first-hand how the Older Americans Act reflects the values that we have in this country: supporting independence, helping people maintain their health and 

well-being so they are better able to live with dignity, protecting 

the most vulnerable among us, and providing basic respite care and 

other supports for families so that they are better able to take care 

of loved ones in their homes and their communities for as long as 

possible. This is what Americans of all ages overwhelmingly tell us 

they prefer, to age at home in their communities. 

One of the real strengths of the Older Americans Act is that it 

doesn’t matter if an individual lives in a rural area, a frontier area, 

or an urban center. The programs and the community-based supports are flexible enough to meet the needs of individuals in all of 

these diverse communities and settings. 

Over the past year alone, nearly 11 million older Americans and 

their family caregivers have been supported through the Older 

Americans Act comprehensive community-based system. These 

services, as you mentioned, Senator Kohl, complement medical and 

health care systems. They help to prevent hospital readmissions. 

They provide transportation to doctor’s appointments and support 

some of life’s most basic functions, such as bathing or having a 

home-delivered meal. 

This assistance is especially critical for nearly 3 million seniors 

who receive intensive in-home services, half a million of whom 

would otherwise qualify for nursing home admission. 

For more than a year, as I have mentioned, we have received reports from more than 60 reauthorization listening sessions around 

the country, and have received on-line input from a variety of sectors, individuals, and organizations and their caregivers. This input 

represents the interests of thousands of individuals with regard to 

the Older Americans Act’s services. 

During this process we heard an overriding issue that Mrs. Carter has already spoken to today, and which was also advanced 

through the Vice President’s Middle Class Task Force, and that is 

the issue with regard to families. Families are doing the best that 

they can, but they’re struggling between balancing the demands of 

9 

work, child care, and elder care. Families tell us that they need 

some basic assistance in supporting their care for their loved ones. 

During our process of soliciting input, we heard that the Older 

Americans Act is working and it needs to continue to be flexible. 

We also heard two particular themes that I want to suggest in 

terms of further conversation. One suggestion or recommendation 

that we have heard is that we continue to improve the program 

outcomes by embedding evidence-based interventions and disease 

prevention programs, encouraging comprehensive person-centered 

approaches, providing flexibility to respond to local nutrition needs, 

and increasing efforts to fight fraud and abuse. 

Second, we need to remove barriers and enhance access, extending caregiver supports to parents who care for their adult children 

with disabilities, providing ombudsman services to all residents of 

nursing facilities, not just seniors, and using aging and disability 

resource centers as single access points to provide information regarding public and private resources for long-term supports and 

services. 

Let me give you three brief examples we would like to discuss 

as we continue our work: One, we should ensure that we utilize the 

best evidence-based interventions for helping older individuals 

manage chronic disease. These have been effective in helping people adopt healthy lifestyles, improve their health status, and reduce their use of hospitals and emergency room visits. 

We want to improve the Senior Community Services Employment Program by integrating it with other senior programs. As you 

know, the President has recommended in 2012 through this budget 

process that we transfer the older workers program from the Department of Labor to the Administration on Aging. 

We would also like to continue to combat fraud and abuse of both 

Medicare and Medicaid by permanently establishing the authority 

for the operation of the senior Medicare patrol program as a basic 

component of the Older Americans Act, so we can continue to use 

retired volunteers to help us detect and deter fraud in the area of 

Medicare and Medicaid. 

The Older Americans Act has historically enjoyed widespread bipartisan support. Based in part on this extensive public input, we 

believe that reauthorization can strengthen the Older Americans 

Act and put it on solid footing to meet the challenges of a growing 

population of seniors, while continuing to carry out the critical mission of helping elderly individuals maintain their health and independence in their homes and communities. 

Thank you again, Senator Kohl and Senator Corker, for your 

leadership. I look forward to working with you and the rest of your 

committee. Thank you. 

The CHAIRMAN. Thank you very much, Ms. Greenlee. 

[The prepared statement of Kathy Greenlee appears in the Appendix on page 64.] 

We’ll now commence questioning. We’ll start with Senator 

Corker. 

Senator CORKER. Thank you, Mr. Chairman. I’ll be brief. 

Again, thank you both for your testimony. Mrs. Carter, I notice 

the chairman said you were a legend in your own right. Certainly 

10 

not in relation to anybody up on this panel, we serve with a lot of 

folks here that are a legend in their own mind. 

[Laughter.] 

Senator CORKER [continuing]. So we thank you so much for having earned that and certainly bringing such focus on this issue. But 

thank you very much for your testimony. 

I have a few organizational issues to ask Ms. Greenlee about. I 

know the President’s budget this year transfers some additional responsibilities into your agency, the Title VSenior Community Services Employment Program, the State Health Insurance Assistance 

Program, the CLASS Act. I know you were talking about some of 

the flexibilities and other kind of things that need to happen within 

your organization. Is that going to, in your opinion, distract at all 

from your ability to efficiently carry out the other responsibilities 

of the organization? 

Ms. GREENLEE. No, Senator Corker. The agency has a 45-year 

history and experience in providing community supports to individuals. One of those components is the economic security of seniors, 

and we have a variety of programs that have worked on pension 

counseling, benefits outreach. Bringing the older workers program 

to AOA will help strengthen our mission, not detract from it. It is 

the only one of the Older Americans Act programs that we do not 

administer. 

The senior health insurance assistance programs are primarily 

delivered at the local level through our area agencies on aging. And 

the reason for the CLASS Act, the underlying need for the CLASS 

Act, is to provide a different type of option for individuals to maintain their independence in the community. We feel like we have a 

wealth of knowledge to support these other programs and can 

make them all work to help individuals, people with disabilities, 

and seniors remain independent. 

Senator CORKER. I know that Secretary Sebelius has mentioned 

that the CLASS Act is an unsustainable program unless numbers 

of changes are made. I know that you are probably closest to it 

since, as you mentioned, you’re going to be involved in implementing it. Are there things that you are already looking at, major 

structural changes to actually cause the CLASS Act to be sustainable? I know there are people on both sides of the aisle who have 

a lot of concerns about that. 

Ms. GREENLEE. Senator, as you have referenced, I was designated officially in January as the administrator of the CLASS 

program at the Administration on Aging. The Secretary and I have 

both had opportunity to testify, most specifically on the House side, 

and committed ourselves and our efforts to the financial solvency 

of this program. 

We both agree that there are reforms that need to be made to 

the program in order to sustain the program and make it financially sound for 75 years, as required by the law. We will this fall 

issue preliminary regulations with regard to the program and at 

that time be able to provide more information about the kinds of 

things that we need to do through a regulatory process to strengthen the program. 

11 

There are things that we were looking at, considered by the Senate before the bill was passed, that we will return to first as we 

find ways to support the program for its financial solvency. 

Senator CORKER. As you go about looking at implementing it, I 

know there has to be some investments made, if you will, through 

your organization to begin that implementation. How are we accounting for that? Is that something that goes into the actual cost 

of the CLASS Act itself or is that something—how is that being accounted for? 

Ms. GREENLEE. Senator, as you know, the Department of Health 

and Human Services was given money to implement the Affordable 

Care Act. It is from those funds that we have currently been paying for our operational costs. We have made sure that we can identify all the staff who are working on the CLASS program full time 

and those of us who split our time between CLASS and the Administration on Aging’s traditional work, so that we can fairly account 

for the work that we’re doing. I believe we’re adequately handling 

the accounting that needs to be done. 

Senator CORKER. I know there’s going to be a tremendous 

amount of focus on Medicare and its sustainability over the course 

of this summer. My hope is that we will in a bipartisan way figure 

out a way to make it solvent. We all know it’s going to be insolvent 

as is. The trustees are stating by the year 2024. 

As you move ahead with the CLASS Act, I think people believe 

it’s already at that stage as it’s been set up, and I do hope you’ll 

let us know of some of the major frailties that exist there and continue to keep us apprised of that. 

We thank you for your service, and I look forward to having several questions for the second panel. 

Thank you, Mr. Chairman. 

Ms. GREENLEE. Thank you, Senator. 

The CHAIRMAN. Thank you, Senator Corker. 

Senator Casey. 

Senator CASEY. Thank you, Mr. Chairman. 

I want to thank you both for your testimony and the personal 

witness that you bring to these issues. 

I wanted to start with our former First Lady, Mrs. Carter, on a 

question that relates to the specialized training that is often needed in these circumstances. I have been over many years as a State 

public official for a decade and now in my fifth year in the Senate 

overwhelmed by the kind of care that’s delivered by direct care 

workers, how strong they are, how dedicated they are, willing to do 

backbreaking and sometimes impossible, seemingly impossible 

work on behalf of those who need that care and on behalf of their 

families. 

But I wanted to ask you about it. I noted in your testimony on 

the four recommendations that you made, as well as Assistant Secretary Greenlee, about evidence-based programs. I wanted to get 

your sense of that, based upon your experience, as to evidencebased programs on this question of specialized training and preparing folks for doing that difficult work. What can you tell us 

about that in your experience? 

Mrs. CARTER. Well, we’ve been working with evidence-based programs for a good while now at the Rosalynn Carter Institute. One 

12 

that we are working on—we’re doing six in all—with Johnson and 

Johnson. Johnson and Johnson has been great, because they were 

the first ones that did clinical trials in nursing homes working with 

those who were suffering from mental disorders. So they’ve been 

very good to us. 

But we have six programs and a couple of them are Alzheimer’s. 

We are actually doing an Alzheimer’s one at home. We train people 

to go into the homes. They don’t have to come in. When we were 

trying to get them to come to the Institute for training they didn’t 

want to. Caregivers don’t want to come in, and they don’t want to 

admit they’re caregivers. So many of them don’t want to admit they 

have to have help; it’s just their job to do what they should do for 

a family member. 

But we send them into the houses. When they find out that this 

person can come to the house, they welcome them. So we go I think 

6 weeks, go in a couple times a week. And it’s just made—we have 

found that it increases the time people can stay at home without 

being institutionalized. The depression is lifted to a certain degree, 

and it just—it’s working. 

We’re also trying this in other places around the country. But 

we’re working with three different ones now, and we’re kind of 

comparing them to see which is best for Alzheimer’s. We’ve done 

one with cancer. And we’ve had—at the Rosalynn Carter Institute, 

we had everybody that we knew of, I think, in the United States 

who was working on evidence-based programs. I think we had one 

person from Ireland that came to that meeting. 

We have had great reports, and actually it just helps the caregiver so much when the program works. It’s cost-effective because 

they don’t have to try things and try things. They just know what 

works, and if they will follow the guidelines of the program it can 

help. 

So we just need evidence-based programs in the whole country. 

It’s going to be a long time before we get there. But we’re really 

working and doing research right now on those programs in many 

parts of the country. 

Senator CASEY. I thank you for that. I know that part of what 

we’re trying to do is to not only improve care and provide the kind 

of highest level of care we can, but also to provide options for the 

work force. Sometimes I guess they’re described as career ladders, 

ways for people to move up if they’re at entry level, in an entry 

level position. 

So I think that evidence-based, evidence-based research and the 

care that can come from that is going to be critically important. 

I know I’ve got about 20 seconds, but, Assistant Secretary 

Greenlee, anything that you wanted to add on this question of 

training or the evidence-based methods? 

Ms. GREENLEE. This will state the obvious. It’s such a broad topic 

that it will take many different Federal organizations working together. We have a community living initiative within HHS that 

looks at issues with regard to people with disabilities, as well as 

seniors. Senator Corker mentioned the CLASS Act. This was identified even in the law of the CLASS Act, how will we support the 

public programs that we will have in the future, such as the 

CLASS Act; the Medicaid and Medicare programs; the programs 

13 

that we have under the Older Americans Act; and disability programs, with a paid work force that allows them to have meaningful 

career ladders, as well as a skill set necessary to serve an increasingly aging population. It will take both a paid and unpaid workforce to provide the care that’s needed in this country. 

Senator CASEY. Thank you very much. 

The CHAIRMAN. Thank you, Senator Casey. 

Senator Manchin. 

Senator MANCHIN. Thank you, Mr. Chairman, and thank both of 

you for being here and we appreciate it very much. The State of 

West Virginia appreciates the work that you have done and also 

the assistance that we get in the Older Americans Act and what 

it’s done for our State. 

As you know, we have the second most aged State in the Nation 

per population and probably one of the most rural States. So it’s 

quite costly for us to give the services that are needed. But we’ve 

expanded those, and I think the word that you mentioned earlier 

was ‘‘flexibility.’’ I can’t explain enough how much flexibility that 

we need in some of these States so that the money is not sliced to 

where transportation is one, meals on wheels is another. 

The formula that’s used for small States and rural States such 

as myself, and there’s more populated States—and I know that the 

funding mechanism is based on population. It should be based on 

the services that are given, if you could just consider that. We 

serve an awful lot of people in West Virginia and our funding is 

much lower, but we’re feeding many, many, many more than other 

States that might not have the need as we have. 

With that, I think you might be aware of some of the programs 

we’ve expanded, the FAIR programs and the Lighthouse programs. 

We did some things and during the most difficult recession times 

we expanded programs because it was a priority of ours to allow 

our seniors to live in dignity in their own homes, with a little bit 

of assistance. 

Need-based is a big thing in West Virginia because we have a lot 

of seniors who want to be able to contribute and pay their way or 

pay part of their way if they can. So we try to develop flexible 

plans to where they felt like they were still contributing, but yet 

they just couldn’t find the service anywhere. A lot of times if you’re 

on a certain cuff and you get—if you’re not within certain guidelines as far as income, the service is not even offered. I think that’s 

something that should be considered, too, because it’s not for a lack 

of need. They just can’t find anyone else to provide those services, 

and they’re willing to pay. So we hope those flexibilities are taken 

into consideration. 

But in transportation, that’s the one that we’re having some concerns about. I don’t know if—I support the OAA lock, stock, and 

barrel. So tell me what you think you can do to help us help ourselves more? 

Ms. GREENLEE. Senator, we have transportation support that we 

can provide through the Older Americans Act. Transportation is 

such a huge issue that I don’t think there’s a way to completely address transportation needs with such a program of this size. We 

need to talk to other partners at the Federal level and at the State 

14 

and community level to figure out what is the best way to provide 

transportation services. 

I think one of the best things that we can do—and for this answer I’m actually relying on my Kansas experience—is to make 

sure that we remove any barriers, so that if we provided support 

for, say, a van at any level with government funds, we use it to 

the best ability in serving all populations. 

So I think we need to be innovative, work with our transportation partners, and figure out how we can make sure that we’re 

not in the way of what needs to happen in the community to get 

the job done. 

Senator MANCHIN. What recommendation do you have—I know, 

Mrs. Carter, from your experience. What recommendation would either one of you have, how we can be more efficient with the dollars 

we have? As you know, the budget constraints are going to be 

tough on all of us. But by setting the priorities we can make sure 

that the dollars we have are in place, but yet they go further. And 

we’re all growing older and in need of the services, I’m sure. 

But is there anything that we can do that would give you the efficiencies or help you have more efficiencies? Have we tied your 

hands in any way, Mrs. Carter? 

Mrs. CARTER. One of the greatest helps would be to have data 

so we could know how to allocate the resources. One of the recommendations that our study has made is that we use the Behavior Risk Factor Surveillance System that the Centers for Disease 

Control has developed. They have developed a caregiving module. 

If we could use that in the states in the OAA, it wouldn’t cost very 

much, because the question is not—it’s not on the survey—all surveys—and you have to ask for it. 

So we checked to see—Georgia doesn’t have it in their survey. So 

we checked to see how much it would cost, and it would cost just 

$21,000 a year to get that data in Georgia, and that would be so 

helpful in cutting costs. 

Ms. GREENLEE. For about a decade now, the Administration on 

Aging has been focused on evidence-based practices. We do this a 

lot in the field of Alzheimer’s support for individuals and their family members, the evidence-based practices that I mention in my testimony. 

Those of us who work in the social services arena understand 

that science is not just for people who are in the laboratory, that 

good evidence, good outcomes in science is a critical part of delivering quality and effective social service programs. That’s why 

we’re suggesting that we continue to work in this effort with real 

regard to the health programs in the Older Americans Act, to make 

sure that we’ve got good outcomes. 

I agree with Mrs. Carter about the global issue of data. Our ability to continue to research our programs makes the case with regard to their effectiveness. Their ability to provide cost savings to 

other programs such as Medicare and Medicaid is also a critical 

component of this conversation as we figure out, as we go forward, 

how to balance the supports that are needed with the increasing 

pressures of more seniors and the struggling budgets at the Federal and State level. 

15 

Senator MANCHIN. I’ll wait until my second round. Thank you 

very much, both of you. 

The CHAIRMAN. Thank you very much, Senator Manchin, and 

we’d like to thank you both profusely for being here today. You 

have made tremendous contributions today, as you have in the 

past, and again we appreciate your being here. Thank you so much. 

Ms. GREENLEE. Thank you, Senators. 

The CHAIRMAN. We’ll turn now to the second panel, if you’ll step 

up to the table, please. First we’ll be hearing from Elizabeth Marshall, a recipient of home-delivered meals. Ms. Marshall was elected as the first female Mayor of York, Pennsylvania, in 1977. She 

also served as a member of the York City Council. 

Next we’ll be hearing from Max Richtman, who serves as Chairman of the Leadership Council of Aging Organizations, a coalition 

of 66 national aging organizations. Mr. Richtman is a former staff 

director at this committee and is currently the Acting CEO of the 

National Committee to Preserve Social Security and Medicare. Welcome. 

Next we’ll be hearing from Heather Bruemmer, who is the Executive Director and State Ombudsman for the Wisconsin Board on 

Aging and Long-Term Care. She also chairs the State’s Long-Term 

Care Council and serves on the Coalition of Wisconsin Aging 

Groups’ Advisory Council. 

Senator Corker has a witness from Tennessee. 

Senator CORKER. Yes, sir. I’d like to introduce Timothy Howell, 

who is the Chief Executive Officer of the Senior Citizen Home Assistance Services, a nonprofit that provides in-home caregiving in 

East Tennessee. SCHAS aims to improve the lives of seniors and 

persons with disabilities while maintaining their independence and 

dignity. Mr. Howell has worked for SCHAS for 10 years, has been 

the CEO since 2008. 

As CEO, Mr. Howell oversaw the completion of Renaissance Towers, an assisted living community targeted to low-income seniors 

who wish to pay for their own care. He’s President of the Tennessee Association of Homemaker Services Providers, a member of 

the National Council on Aging, and the Downtown Rotary. 

Thank you for traveling all the way from East Tennessee to be 

here. 

The CHAIRMAN. Thank you. 

We’ll hear now from Mrs. Marshall. 

STATEMENT OF ELIZABETH MARSHALL, OAA SERVICE 

RECIPIENT, YORK, PA 

Ms. MARSHALL. Thank you very much. 

This is addressed to you, Chairman Kohl, and to Senator Casey 

and other members of the committee. Thank you for inviting me to 

testify before you today. I am pleased to be able to share with you 

my thoughts on the Older Americans Act. Throughout my life I 

have always strived to be an independent woman. Born in 1918, 

I’m a child of the Great Depression and have continued to live by 

the values of economy, thrift, and self-reliance that I learned during my formative years. 

My husband Howard and I married after he returned from serving overseas. We moved to York, Pennsylvania, in 1948 and we 

16 

bought our first and only home there in 1954. This is the same 

house I live in today. Our two sons still live near me, and my 

daughter resides in New Hampshire. 

An old song by Joseph Burke called ‘‘A Little Bit Independent’’ 

is my theme song, if you will: ‘‘A little bit independent in your 

walk, a little bit independent in your style.’’ I have worked 

throughout my life to be an independent woman, to find my 

strengths and use them, whether in service to my family, community, or country. 

In the early 1960s I increasingly became involved in the York 

community, which was undergoing a turbulent time, and eventually in 1971 I was elected the first member of city council and later 

served—oh, I’m sorry. It led to my election to York City Council in 

1971, and then I was elected as the first female Mayor of York in 

1977. I later served as Deputy Comptroller for the City of York. So 

I know something about government and the challenging choices 

faced by decisionmakers as to the best use of taxpayer dollars. 

After my public service career, I worked as a real estate agent 

for 18 years. I retired just 11 years ago at 81 years of age. I have 

been on my own now for 10 years since my husband passed away 

in 2001. 

Many of us in our neighborhood are long-time residents. Our 

tight-knit community is essentially aging in place and helping each 

other remain in our homes for as long as possible. I am proud to 

still be an independent woman. I want to be able to stay in my 

home, near my family and neighbors. 

I am grateful that the York County Area Agency on Aging is 

there for me and for thousands of other seniors in my community. 

I have a care manager at the Area Agency on Aging. She was able 

to connect me to the home-delivered meals program and if I need 

additional support, services, or even just information, she will be 

ready to assist me and my family. 

Three times a week a volunteer from the local senior center delivers both hot and cold meals to me in my home. I appreciate the 

meals service, and it’s also nice to have a friendly visitor check in 

to make sure I’m safe and doing well. 

I understand that the home-delivered meals service is funded in 

part through the Older Americans Act. The act allows the coordination and provision of many other in-home and community programs. There’s even a part of the act focused on family caregivers, 

to help them help us. 

And we can’t forget our senior centers, which are more important 

than ever to help older adults stay connected to their community. 

Many recipients of services are like me; they just need one or two 

little bits of help. Others may need more services. But the act allows seniors to receive just what they want to stay healthy. Even 

if you need a high level of support, receiving this care in your home 

is still more affordable for you and the taxpayers than care in a 

nursing home. 

As our leaders struggle to balance the budget and reduce the deficit, the cost savings that Older Americans Act programs generate 

are even more critical. 

My story—my story is not necessarily a unique one. My peers 

and I have served our families, communities, and country for many 

17 

years, and with the right balance of help we can continue to remain contributing members of our society and maintain our health, 

independence, and dignity for as long as possible. I’m glad to be 

able to continue living in my home of 57 years, where I can still 

be, quote, ‘‘a little bit independent in my walk.’’ 

The Older Americans Act allows you to retain your dignity, 

health, and independence with just a little bit of support. I urge 

this committee and your colleagues in the Senate and House to understand how vital these little bits of support are to millions of 

older Americans determined to age in place. We need to reauthorize the Older Americans Act in a timely and bipartisan fashion and 

prepare our country for the wave of baby boomers standing behind 

my generation. 

Thank you, Senator Kohl and members of the Aging Committee, 

for inviting me to share my thoughts about the Older Americans 

Act with you here today. 

[The prepared statement of Elizabeth Marshall appears in the 

Appendix on page 71.] 

The CHAIRMAN. Thank you, Mrs. Marshall. That was a beautiful 

statement. 

Ms. MARSHALL. I’m sorry, I didn’t hear that. 

The CHAIRMAN. That was a beautiful statement. Thank you so 

much. 

Ms. MARSHALL. Oh, thank you. 

The CHAIRMAN. Mr. Richtman. 

STATEMENT OF MAX RICHTMAN, CHAIR, LEADERSHIP 

COUNCIL OF AGING ORGANIZATIONS, WASHINGTON, DC 

Mr. RICHTMAN. Mr. Chairman, members of the committee: First 

of all, let me say to Mrs. Marshall: You’re a tough act to follow, 

but I’ll do my best. 

On behalf of the Leadership Council of Aging Organizations, I’m 

honored to testify before the Special Committee on Aging about the 

LCAO Older Americans Act reauthorization consensus document. 

LCAO is a 66-member coalition of diverse national nonprofit organizations dedicated to preserving and strengthening the well-being 

of America’s older population. Historically, LCAO has played a significant leadership role in past reauthorizations of the Older Americans Act. 

In preparation for this year’s reauthorization, we’ve worked for 

over 6 months to develop the consensus document that we have 

submitted to the committee. Under the leadership of the LCAO 

community services committee, individual organizations presented 

their ideas and suggestions for improving the Older Americans Act. 

These ideas were incorporated into the consensus document, which 

was enthusiastically endorsed by the full LCAO at our April 6th 

meeting. 

The LCAO Older Americans Act reauthorization document contains 98 recommendations. They do a number of things. They reinforce key existing priorities in the current statute and seek to address challenges and opportunities brought about by the exponential growth of our older population. We agree that the Older 

Americans Act continues to work very well for older adults across 

the country. The act’s core mission, infrastructure, and programs 

18 

remain relevant, effective, and very much relied upon by older 

adults and caregivers. 

The problem we face, of course, is insufficient funding, which 

makes it difficult for the aging network to carry out Older Americans Act priorities as established by Congress in past reauthorizations. There simply is not enough money for all the needs that 

exist. 

On that note, I’d like to thank you, on behalf of our organization, 

Mr. Chairman, for your request to the General Accounting Office 

to examine the true magnitude of this unmet need. We also acknowledge that the Older Americans Act, like other statutes, is a 

dynamic document that can and must change to address emerging 

needs and embrace new innovations. 

It’s notable that the Older Americans Act is up for reauthorization the same year that the first of the baby boomers turn 65. Not 

only are the numbers of older adults increasing at a historic rate, 

but this population is becoming much more diverse. Additionally, 

as older Americans live longer they face growing health and economic challenges. All of these issues are converging to place tremendous strain on the aging network, a network that is already 

overburdened, but eager to expand capacity and enhance planning 

to meet the demands and opportunities presented by our aging population. 

Particularly in times of fiscal restraint, times such as now, we 

acknowledge that improvements can be made in the efficiency and 

effectiveness of the Older Americans Act in its delivery of core services and how it interacts and coordinates with other Federal programs that serve older adults. There are recommendations 

throughout the document we presented that call for improved coordination of services and identification and dissemination of best 

practices that already occur in local communities in order to 

strengthen the aging network nationwide. 

LCAO also believes it is crucial to strengthen evaluation, research, and demonstration of aging services. This will not only empower the aging network to continue implementing best practices 

but will also state with authority the degree to which the Older 

Americans Act provides a cost-effective way for older adults to remain in their own homes with health and economic security. 

The Older Americans Act programs, such as in-home assistance, 

home-delivered and congregate meals, and respite for family caregivers, benefit individuals and their families. They also save Federal and State government resources from being spent on otherwise 

unnecessary care in hospitals and nursing homes. 

On behalf of LCAO, I applaud this committee for its leadership 

in calling attention to the upcoming Older Americans Act reauthorization. We urge Congress to continue the long tradition of bipartisan and timely reauthorization of this important statute while 

providing the funding needed for Older Americans Act programs to 

keep older Americans independent and productive. 

Thank you again for the opportunity to testify today on behalf of 

the 66 members of the LCAO, and I welcome your questions and 

comments. Thank you. 

[The prepared statement of Max Richtman appears in the Appendix on page 76.] 

19 

The CHAIRMAN. Thank you, Mr. Richtman. 

Heather Bruemmer. 

STATEMENT OF HEATHER BRUEMMER, STATE OF WISCONSIN 

LONG-TERM CARE OMBUDSMAN, MADISON, WI 

Ms. BRUEMMER. Chairman Kohl, Ranking Member Corker, and 

members of the committee: Thank you so much for this opportunity 

to testify today. I’m the State Long-Term Care Ombudsman of Wisconsin and also represent the National Association of State LongTerm Care Ombudsman Programs, better known as NASOP. 

It is a privilege and honor to be here on behalf of the ombudsman advocates who work daily tirelessly to assure the rights and 

well-being of hundreds of thousands of vulnerable residents living 

in long-term care settings throughout the Nation. The significance 

of this effort to reauthorize the Older Americans Act cannot be 

overestimated. It is a primary duty of this Nation to protect our 

most vulnerable individuals and to preserve their pride and dignity. 

Everyone has a history, a story. We all create memories. So it’s 

our responsibility to assure that all members of our rapidly aging 

population have the proper access to services that will respect their 

right to be who they are and who they’ve been. 

The Older Americans Act provides critically needed home- and 

community-based services that allow older adults to remain for as 

long as possible in the community with needed support. Since 1978, 

the ombudsman program has been a core component of the Older 

Americans Act. It is the only program in that act that specifically 

serves consumers provided by residential care facilities. 

I think that we all appreciate and value the importance of living 

in our own home. We heard from Elizabeth today it’s very special, 

and as a result there has been a remarkable growth in the amount 

of home- and community-based services available for seniors in 

Wisconsin. In November of 2008 we had a significant trend happen. 

We have more assisted living beds in the State of Wisconsin than 

we do nursing home beds. 

Wisconsin was one of the original pilot States when the longterm care ombudsman was first created by Congress, and our State 

has continuously relied and improved the advocacy resources available to aging consumers. The Board on Aging formed in 1981. We 

had five ombudsman. Today we have 15 outstanding regional ombudsman and over 100 volunteers serving 95,000 clients in nursing 

homes and assisted living facilities, and we also provide services 

through the Medicaid waiver programs. 

Nationally, ombudsman visited 79 percent of all nursing homes 

on a quarterly basis last year, yet only 46 percent of assisted living 

facilities and similar homes. Throughout the country, it has become 

increasingly more difficult for ombudsman to participate in visits 

for assisted living. The inability of Congress to provide sufficient 

funding is certainly not the result of trying by the champions of the 

long-term care ombudsman program, such as yourself, Chairman 

Kohl, and the members of this committee. Each year the program 

resolves hundreds and thousands of complaints and, interestingly, 

77 percent of these complaints are resolved to the satisfaction or 

partially resolved to the client’s needs. 

20 

We spend time in nursing homes. If we are able to address the 

needs of people living in assisted living with the same intensity as 

we do the concerns in nursing homes, our numbers would be astronomical. 

The long-term care program offers significant protections to residents. The complexity and diversity of consumers today who live in 

these facilities is growing. We have falls, medical mismanagement, 

medication errors, pressure ulcers, and abuse situations, and unfortunately they are on the rise. We spend a tremendous amount of 

time investigating these incidents and also provide education and 

guidance to facility staff to help prevent reoccurrences of these 

problems. 

Unfortunately, we are still confronted with the reality of inadequate resources, but we keep moving forward and protecting our 

most vulnerable. 

Resident and family councils are vehicles by which open communications are really important in order to deliver excellent quality 

of life and care. When considering this reauthorization, it is important with this requirement to maintain resident and family involvement with the assistance of the ombudsman program. 

Access to confidential information for ombudsman is critically important. We are recommending that this reauthorization ensure the 

private and unimpeded access by individuals to ombudsman service 

in a confidential setting, that it is not compromised. The sections 

of this act relating to the process of and limitations and disclosure 

of client information needs clarification and emphasis. It is important that the text of the Older Americans Act clarifies that the privacy provisions of the Health Insurance Portability and Accountability Act, better known as HIPPA, do not impede the access to 

resident health records by the ombudsman and representatives of 

the program. 

The Administration on Aging had declared in a memo that the 

ombudsman program representatives are performing a health care 

oversight function and they are not impacted by the HIPPA privacy 

rules. Throughout the country we have more and more people that 

can’t speak for themselves and who have no legally authorized representative to speak on their behalf. It’s really our duty, and we 

recommend that we add language to this act to encourage States 

to intensify their efforts to educate the public on the value and importance of completing documents to establish a trustee relationship. 

The Board on Aging and NASOP also support the recommendation to amend Title 2 to provide a base appropriation beginning at 

$1 million to the National Ombudsman Resource Center. It has 

proven to be a valuable site for ombudsman programs to obtain 

training resources and technical assistance. It would be extremely 

helpful to expand the center’s training capacity and ability to work 

with State regulators to improve the investigative process used to 

deal with resident complaints. 

The Older Americans Act gives us a strong foundation and reauthorization gives us a window of opportunity to build an even more 

robust demonstration of the Nation’s concern for our well-being of 

our elders. It is extremely important that Congress and the aging 

21 

network come together to strengthen our long-term care ombudsman programs to provide a safe and home-like environment. 

On behalf of Wisconsin’s long-term care ombudsman program 

and NASOP as advocates for the Nation’s most vulnerable facility 

residents and consumers of long-term care, I thank you, Senator 

Kohl, Ranking Member Corker, and the members of the committee 

for allowing me to share our thoughts on the reauthorization. 

Thank you. 

[The prepared statement of Heather Bruemmer appears in the 

Appendix on page 98.] 

The CHAIRMAN. Thank you very much, Ms. Bruemmer. 

Mr. Howell. 

STATEMENT OF TIMOTHY HOWELL, CEO, SENIOR CITIZEN 

HOME ASSISTANCE SERVICES, KNOXVILLE, TN 

Mr. HOWELL. Thank you, Senators on the Special Committee on 

Aging, for allowing me to address you today. As the CEO of Senior 

Citizens Home Assistance Services that provides homemaker and 

personal care to 20 counties in East Tennessee, I see elders and 

people with disabilities every day that come to me with different 

situations. Although their stories are different, their goal is the 

same: to maintain their dignity. Their health may be fading and all 

their mental status diminishing, but they are still human beings, 

and their dignity should not be diminished over time. 

Senior Citizens Home Assistance Services was formed in 1970 

with a grant from the Older Americans Act as a study to see if people could use homemaker services to stay in their homes. Since 

then we have been on the battle of the forefront of maintaining dignity for our elders. 

The majority of the work that we do is through our homemaker 

and personal care services. We screen, hire, and train caregivers to 

travel to the home and provide light housekeeping, laundry, shopping, companionship, transportation, and personal care like bathing, feeding, toileting, and grooming. This year we will help over 

2,500 people with over 300,000 hours of one on one care to stay in 

their home. 

The good news of this story is that the agency receives funding 

from many different sources. We have a full fee private pay system 

so those that can afford to pay for the services can, and then we 

also receive money from Federal, State, Veterans Administration 

programs. But I think one of the best things that we have and 

something that we could have helped Senator Manchin with with 

his question is that we have a sliding scale fee for people that do 

not qualify for those government programs, but also may not have 

the ability to pay the full fee. We have a sliding scale fee because 

we are able to have fundraisers and we get United Way funding. 

So if somebody comes to us that does not have—that has a gross 

income that keeps them from the government programs, then we 

are still able to help them even though they may have expenses 

such as a home mortgage or medicines or things like that. So we 

are still able to help them with a sliding scale fee, and they can 

pay us like $7 an hour, $9 an hour, or $11 an hour, and so they 

can still get the help that they need to stay in their homes. 

22 

Partnerships are key, we have found, in the battle to provide dignity. We get cleaning supplies donated to us from a local office 

company so that—for those that cannot afford to purchase them, 

and we also receive nonperishable foods from Second Harvest, 

which is another 501[c][3] in our county, and that allows us to give 

food to those that may not have the ability or the money to pay 

for their bills at the end of the month, and we can still get them 

food. 

So if you’re looking for employment opportunities—and I understand, Mr. Kohl, that you might be since you’re retiring—we can 

hire you; we can train you to be a caregiver. In fact, our oldest 

caregiver was born in 1921. She is 90 years old and she brings an 

aspect to caregiving that a person my age cannot do. She is unique 

with her companionship. She works about 20 hours a week, and 

she’s able to talk to people and relate to them while she’s cleaning 

their homes and helping them stay in their homes. So even on your 

worst days, she can give you a smile that can brighten up your life. 

In fact, over 50 percent of our 310 employees are older than 50. 

We have a great caregiver training program that our RN and nurse 

trainer uses to teach people to be a caregiver. 

Even with all our programs to keep people in their homes, we realize that the cost does become expensive at times as their need increases. This is why we built Renaissance Terrace, a 48-unit assisted living facility that charges $2200 per month for all the services of an assisted living facility in the State of Tennessee. We are 

able to keep the monthly fee low because we receive Federal, State, 

and local government funding from Knox County and from the City 

of Knoxville, as well as private donors and foundations to construct 

the building. With the construction cost funded, we only have to 

charge enough to pay for the operating costs, such as payroll and 

supplies. 

The people that live in our facility are able to pay for their help, 

or the VA may help, or in some cases family members may help 

pay for the fee. The important fact is that I am not here asking 

you for more money to pay for my assisted living for the residents 

of Renaissance Terrace. Through combining your one-time investment with other partners, we developed a program that can sustain 

itself, sustain itself through the residents paying for their care. 

I want to thank you for taking this challenge of providing care 

to the elders and persons with disabilities while keeping their dignity intact. I encourage you to look for solutions that can maintain 

and support themselves with an investment from you, but I realize 

that this will not always be the situation. 

Again, I thank you for allowing me to be here, and I will answer 

any questions that you may have. 

[The prepared statement of Timothy Howell appears in the Appendix on page 103.] 

The CHAIRMAN. Thank you, Mr. Howell. 

I’d like to ask you, Mrs. Marshall. Your home-delivered meals, 

how important is that in your day and in your week? What would 

you do if you didn’t have the home-delivered meals system? 

Ms. MARSHALL. Well, it’s hard to know, because I have been able 

through my whole life to be independent. My son is worried about 

the fact that I’m alone a lot of the time and he thought that there 

23 

should be somebody looking in on me every day. So I ordered the 

meals on wheels. I get it Monday, Wednesday, and Friday, and 

there’s always someone there in case I should fall or some accident 

of that sort. 

So that takes care of 3 days a week, and it also helps me as far 

as shopping and cooking for myself. The various foods that I get 

are well-balanced and healthy. They sometimes need seasoning or 

fixing up a little bit before you put them in the micro. But it’s a 

very well-balanced, healthy diet, really, and I’m very grateful for 

it. 

On Tuesday and Thursday I’m on my own, and Saturday and 

Sunday. But I have been very grateful for the fact that I have wonderful sons handy to me and a daughter in New Hampshire who 

has been a boon to me. I’m very grateful for the help of my children. It may be a burden on them. I’m sure in many ways it is. 

But I don’t hear about it. 

The CHAIRMAN. How often do you talk to your daughter in New 

Hampshire? 

Ms. MARSHALL. Well, I really grew up in two communities. I had 

a grandmother in New Hampshire who had a stroke in her 60s and 

she lived—she could not speak very well, but she lived at home. 

And my mother went up to New Hampshire in June every year 

after school was done and took care of her or helped take care of 

her, because she was in a wheelchair and completely unable to do 

anything for herself. 

In fact, I never really got to know her because she wouldn’t talk 

very much. She would say ‘‘How be ya?’’ and that was about it. But 

she was very much beloved by her family, and I have many pictures of her in the wheelchair surrounded by family members. 

There wasn’t such a thing as meals on wheels at that time. Generally, there were people, and in New Hampshire many country 

people, because this was in the White Mountains, a village in the 

White Mountains. So we really had two residences growing up. It 

was a wonderful, wonderful experience. 

The CHAIRMAN. Good. 

To the other members of the panel, what is your principal recommendation to us as we go about reauthorizing OAA? Mr. 

Richtman, would you like to give us your opinion? 

Mr. RICHTMAN. Well, I think, as I mentioned in the testimony, 

we feel it is very important that the committee take into account 

ways to improve coordination of services, to identify the best practices, things that work in local communities, and make sure that 

all of the agencies involved have the resources to replicate these 

best practices around the country. 

If I could, Mr. Chairman, to follow up on the question you asked 

about home-delivered meals, and I hope this isn’t presumptuous, 

but I could give this as a recommendation. You mentioned that I 

was staff director of this committee in the 1980s and I was involved in previous reauthorizations. There was a member of this 

committee who was, shall we say, cynical about the Older Americans Act activities, and one of the nutrition service providers from 

that Senator’s State arranged to take that member of the Senate 

to deliver meals on a truck. The reaction that the Senator had 

when he met people who had no other way to get a hot meal or 

24 

have any interaction with anybody turned him around, and he became a strong advocate for the program. 

So I would recommend some first-hand experience by members 

of the committee with some of these programs. 

The CHAIRMAN. That’s very good. 

Mrs. Bruemmer. 

Ms. BRUEMMER. Thank you. I think it’s really important that our 

vulnerable residents in long-term care facilities have access to our 

ombudsman services, which I addressed in my testimony. We have 

so many people who are living in long-term care facilities that don’t 

have family, and it’s important that the ombudsman, who is their 

advocate, be able to express their best interests. 

Secondly, I think we all know—and you recently had a wonderful 

hearing on elder abuse. It is occurring in our world, unfortunately, 

and it’s our duty to protect our most vulnerable people that we 

serve. So it would be wonderful if we could get additional supports 

and funding to provide training and prevention. 

You know, we talk about prevention frequently, and it really 

does make a considerable difference if we can educate people on 

how to prevent. We provide prevention services in nursing homes 

and assisted living to staff, and it really has a positive impact for 

the people that they serve. And also supporting the National Ombudsman Resource Center, which is such a tremendous support to 

all the States in the Nation and really benefits our wonderful residents that we serve. 

Thank you. 

The CHAIRMAN. Thank you, Ms. Bruemmer. 

Mr. Howell, what’s your principal recommendation? 

Mr. HOWELL. I would suggest looking for partnerships and funding opportunities that could be a one-time investment for the government, and then maybe those programs could sustain themselves 

over time through private pay. 

Then also I’d like to say that through the single point of entry 

system we need more case management from the providers at the 

time that the help is being asked for. People go through many 

questions to get into the enrollment process, at least I know in the 

State of Tennessee they do, and they get asked those questions several different times. So I think we need a system to where once you 

are asked those questions once it is shared among the service providers and the case managers and the MCOs, so that you don’t 

have to keep going back and asking that elderly person again and 

again and again, now, what is your income, what is the help that 

you need, and so forth. Because I know we are going to go out and 

do an intake and we’re looking for things like, does that person 

have a pet, because I don’t need to send somebody as a caregiver 

into a home that has cat allergies when that person has a cat. Or 

if they smoke I don’t need to send somebody in that home that has 

asthma. 

So if we don’t know those things up front, we’re already setting 

ourselves up for disaster in helping that person stay in their home 

when we don’t get all the information that we need. 

So those are my two recommendations, just shared information 

among everyone and look for partnerships so that programs can 

sustain themselves over time. 

25 

The CHAIRMAN. Thank you very much, Mr. Howell. 

Senator Corker. 

Senator CORKER. Thank you, Mr. Chairman. 

Ms. Marshall, thank you so much for being here. You mentioned 

you hope you weren’t a burden for your children or grandchildren. 

I know that’s not the case. I’m sure you’re a blessing, and there’s 

probably a whole line of people in your community willing to adopt 

you if they ever felt that was the case. We thank you very much 

for being here and putting a face on an issue that all of us care 

about. So thank you very much. 

Mr. Richtman, I know as director of the National Committee to 

Preserve Social Security and Medicare you’ve been very critical of 

some legislation I’ve offered to get spending back to historic norms 

over the next decade. I understand that, and that’s the world we 

live in today. 

Also, it seems you’ve been very resistant to changes to Medicare 

that might make it sustainable. There are a lot of people in this 

town that know Medicare is going to be insolvent or bankrupt in 

the year 2024. There’s no getting around that. CBO even says by 

2020. I’m wondering if you have put forth your own innovations or 

changes to cause Medicare to be solvent and to cause it to be there 

for seniors down the road? 

Mr. RICHTMAN. Well, of course this isn’t the subject of this hearing, but I will respond. I think the legislation you’re talking about 

is the bill you authored with Senator McCaskill; is that correct? 

Senator CORKER. That’s correct, yes. 

Mr. RICHTMAN. The concern we have is we feel that some of the 

process that legislation deals with will lead to dramatic cuts in the 

programs we advocate for, and will do so in a way that—a more 

indirect way that maybe politically is easier, but nevertheless the 

impact would be the same. 

On Medicare, you’re right, opposed to the bill that was defeated 

yesterday in the Senate. It had passed the House. We feel that 

Chairman Ryan’s proposal to deal with Medicare in effect eliminates the program, turns it into something entirely different. 

Senator CORKER. That really wasn’t what I asked, and I understand that and I’ve read some of the things you’ve said about that. 

But my question is have you offered your own solution, since putting our head in the sand would mean that future wonderful people 

like Mrs. Marshall would not be able to benefit from the program. 

Mr. RICHTMAN. I was going to get around to that. We supported 

the Affordable Care Act, which has some very significant improvements in Medicare, and—— 

Senator CORKER. Even with the Affordable Care Act, it’s insolvent in the year 2024. So I’m trying to ask—— 

Mr. RICHTMAN. Well, you know, were it not for the Affordable 

Care Act, the Medicare program would be insolvent much earlier 

than 2025, which is the date that the trustees have issued. It’s true 

that the date of insolvency went back 4 or 5 years from previous—— 

Senator CORKER. Closer to today. 

Mr. RICHTMAN. Closer to today. Now, a lot of that has to do with 

the recession, less revenue coming into the program. 

26 

Senator CORKER. Mr. Richtman, are you going to answer my 

question? 

Mr. RICHTMAN. I’m trying to, Senator. 

Senator CORKER. Well, I wish you’d just get—have you offered 

solutions to the program? I haven’t heard any. Instead of sandbagging people that are, have you offered solutions? 

Mr. RICHTMAN. Our solution, which I was trying to explain, included the Affordable Care Act. That is a very positive improvement of Medicare; added 12 years—I’d say that’s a pretty good solution—added 12 years to the solvency of the program, added benefits for seniors that they did not have before, such as preventive 

care without any out-of-pocket costs. So I offer that as a solution. 

I think it’s becoming more and more popular. 

Senator CORKER. It’s very disappointing that someone in your position would stonewall a situation so important as this. 

Let me ask you this. Chairman Kohl and I have both been very 

fortunate in life, he far more than me, but we both have. 

Mr. RICHTMAN. Me too. 

Senator CORKER. Would you agree that it would be an appropriate thing for folks like Mr. Kohl and myself to have minimal, if 

almost no, benefit, where, in other words, Medicare would be more 

based on ability to pay, where we would have to pay far more for 

the benefits of Medicare than someone else who might not have 

been as fortunate? Would you agree that that would be at least a 

portion of a solution, even though that would not solve it? Would 

that be something that your organization would support? 

Mr. RICHTMAN. No, we would not—you’re talking about, I assume, means testing. 

Senator CORKER. That’s exactly right. 

Mr. RICHTMAN. We are opposed to means testing both Medicare 

and Social Security, and I’ll tell you why. These programs, all the 

polling shows that they are tremendously popular, because they’re 

insurance programs. People pay into them while they’re working, 

and they receive the benefits. Means testing these programs turns 

these programs into welfare. That’s what welfare is, a means-tested 

program. 

I’ve said this at many events that I participated in. If you ask 

a group of seniors, how many of you are on Social Security, how 

many of you are on Medicare, and usually at my meetings they all 

are. And you say, how many of you are ashamed to be on these programs, nobody is. But if you ask them, would you be proud to be 

on welfare, they wouldn’t. And I think turning these programs into 

welfare programs, which is what means testing does, puts them in 

a whole different category, and the support, tremendous majority 

support for these programs, would dissipate. 

So we’re opposed to that. 

Senator CORKER. Well, portions of Medicare already are meanstested. What I hear you saying is you’re more interested in 

generational theft than you are in—— 

Mr. RICHTMAN. That’s really not fair, Senator. Most of the surveys we’ve done—in fact, we just did one with Celinda Lake—our 

members, who are almost all on the program, they are just as concerned that these programs be there for their children and their 

grandchildren. And I feel that we reflect that, and really, I take 

27 

issue with the charge that we’re interested in that kind of 

generational warfare. 

Senator CORKER. Well, I’m very disappointed that you’ve offered 

no real solutions. But I look forward to talking with you in another 

venue with that. 

Mr. Howell, thank you so much for traveling up here. I notice 

that, on the other hand, your organization does have a sliding scale 

ability to pay, and you’ve found that to be something that’s very 

useful. I wonder if you might describe that in a little bit more detail? 

Mr. HOWELL. I’d be glad to. When our board set up the nonprofit 

in 1970 they wanted to be able to help everyone that came for assistance to the agency. So the sliding scale fee was one good way 

to do that. I think we have found many benefits from that, and one 

of them being if we are going to United Way and asking them for 

funds and let’s say they appropriate to us in Knox County somewhere around $120,000 and then we provide help to a person over 

here and they are able to pay $7 an hour and that help costs us 

somewhere around $18, $19 an hour, then we really only have to 

come up with about another $11 per hour to get that funding. 

So what that does is that allows that money to be stretched out 

further and to help more people. So we don’t usually have a waiting list for services, so if someone calls me I can usually get the 

help out to them as quickly as they need it. I think that telephone 

call is important because it’s saying, I’ve given up my ability to do 

something in my life and so now I need help; will you come do 

that? So we don’t have to put them on a waiting list to do so. We 

can be there and help them. 

I also think in a lot of ways it makes us more accountable because those people are paying for that service. So even—and that 

sliding scale fee has increased over time. But even if they’re paying 

$7 an hour, to a person that is in their 80s or in their 90s that’s 

a lot of money to something that they consider to be a maid service 

come in and helping them clean or getting them transportation or 

helping them go grocery shopping, getting their medicines, and so 

forth. 

So that is a lot of money to them, and I think some of our proudest moments are when we get a check issued to us from someone 

and it’s for $28, and that’s basically 4 hours of service, but on the 

bottom of it it says ‘‘Thank you,’’ because how many people write 

‘‘Thank you’’ on the bottom of their checks when they pay their 

bills? They do that because they know we are keeping them in 

their homes with some help. Just a little bit of help will keep them 

there. 

So I think the sliding scale fee has been a great system for the 

people that we serve. 

Senator CORKER. Thank you. And has there been any stigma attached to that, as Mr. Richtman just alluded to? 

Mr. HOWELL. In the services that we provide, no, sir, I don’t 

know of any stigma attached to that. We do help people that qualify for the government programs and they’re in those and the government is paying for them, and we also help people that have the 

ability to pay the full fee. So our caregiver may go into the home 

of a very wealthy person one day and then be in the home of a poor 

28 

person the next day. We train them to treat them with the same 

dignity across the board and with the same help when they go in 

that home and provide that service to them. 

Senator CORKER. Well, listen; thank you very much for being 

here, and I look forward to the rest of your testimony. 

Thank you. 

The CHAIRMAN. Thank you very much, Senator Corker. 

Senator Casey. 

Senator CASEY. Thank you, Mr. Chairman. 

What I’ll do, for the record, is to submit questions for Mr. Howell, Ms. Bruemmer, and Max Richtman because I have a constituent on the left there, the Mayor, former Mayor of York, and 

I wanted to speak directly to her for a couple of minutes. You three 

don’t mind, I don’t think, but I’m grateful. I appreciate all of your 

testimony and the work that you do. I’ve known Max Richtman a 

long time, and I appreciate his advocacy for many years on behalf 

of older citizens. 

But I did want to direct my maybe just a comment or two, 

Mayor. First of all, once a mayor always a mayor, and we appreciate your public service to the city of York. Being a Mayor, being 

a member of City Council at any time, is a difficult job, and we appreciate what you did and what you continue to do for the community in York, and for your testimony today. 

I was struck by some, a couple of lines in your testimony which 

in some ways really summarized or encapsulated what we’re talking about today, the Older Americans Act. I was looking at your 

testimony, the last page of your testimony, when you say, and I’m 

quoting: ‘‘Many recipients of services are like me. They just need 

one or two little bits of help.’’ A pretty good summary of what a 

lot of people need, and sometimes it varies. 

Then you go on to say, and I’m quoting again just a line or two 

beyond that, quote: ‘‘The act is flexible that way and allows the 

senior to customize their care plan to just what they need to stay 

healthy,’’ unquote. 

We can often talk and talk in this town describing legislation 

paragraph after paragraph. Rarely do we have a witness who’s able 

to sum it up very directly and with the personal experience that 

you have brought to this. You’ve been able to, through your testimony today and I know in other ways, bring to life and be—in a 

sense, bear witness to the benefits of these services. And we’re 

greatly, greatly appreciative of that, because you didn’t have to do 

that. You could have just lived with the benefit of these services, 

but to travel here and to bring your story and your witness to this 

is very, very important, and we’re truly grateful. 

I know that the whole audience fell in love with you today. I 

don’t think anyone who knows you is surprised by that. But we especially appreciate your testimony and your public service. 

I guess the last thing I’d say is, again quoting you, you say a 

paragraph later, quote: ‘‘The beauty of the Older Americans Act is 

that it allows you to retain your dignity, health, and independence,’’ unquote. You have defined ‘‘independence,’’ and we’re grateful that you’re willing to share your story with us today. And if I 

can think of an intelligent question I’ll write it down and send it 

29 

to you, but I think the answer to most of our questions is through 

your testimony and through your personal witness. 

Thank you very much. 

Ms. MARSHALL. Thank you so much. 

The CHAIRMAN. Thank you, Senator Casey. 

I have also one last question for you, Mrs. Marshall. Might you 

consider making a comeback in politics and running for Mayor? 

[Laughter.] 

Ms. MARSHALL. Well, I have been active in the grassroots, a 

grassroots group, and I helped to rejuvenate the Democratic Party 

because I’m a Roosevelt Democrat. I have always felt that when 

people needed help they should have some programs that help 

them, and it just shouldn’t be such a matter of who has wealth and 

who hasn’t. Human life is precious. 

The CHAIRMAN. Thank you. 

Well, we thank all of you for being here today. This has been 

very important to us as we continue with the reauthorization of 

OAA. You have made an effort to be here today and it’s important 

and you’ve made a big contribution. Thank you so much. 

Thank you all for being here. 

[Whereupon, at 3:38 p.m., the hearing was adjourned.] 

(31) 

APPENDIX 

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Æ 


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