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SERVING SENIORS THROUGH THE 

OLDER AMERICANS ACT 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HIGHER EDUCATION 

AND WORKFORCE TRAINING 

COMMITTEE ON EDUCATION 

AND THE WORKFORCE 

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

HEARING HELD IN WASHINGTON, DC, FEBRUARY 11, 2014 

Serial No. 113–45 

Printed for the use of the Committee on Education and the Workforce 

( 

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

committee.action?chamber=house&committee=education 

or 

Committee address: http://edworkforce.house.gov 

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(II) 

COMMITTEE ON EDUCATION AND THE WORKFORCE 

JOHN KLINE, Minnesota, Chairman 

Thomas E. Petri, Wisconsin 

Howard P. ‘‘Buck’’ McKeon, California 

Joe Wilson, South Carolina 

Virginia Foxx, North Carolina 

Tom Price, Georgia 

Kenny Marchant, Texas 

Duncan Hunter, California 

David P. Roe, Tennessee 

Glenn Thompson, Pennsylvania 

Tim Walberg, Michigan 

Matt Salmon, Arizona 

Brett Guthrie, Kentucky 

Scott DesJarlais, Tennessee 

Todd Rokita, Indiana 

Larry Bucshon, Indiana 

Trey Gowdy, South Carolina 

Lou Barletta, Pennsylvania 

Joseph J. Heck, Nevada 

Susan W. Brooks, Indiana 

Richard Hudson, North Carolina 

Luke Messer, Indiana 

George Miller, California, 

Senior Democratic Member 

Robert E. Andrews, New Jersey 

Robert C. ‘‘Bobby’’ Scott, Virginia 

Rube ́n Hinojosa, Texas 

Carolyn McCarthy, New York 

John F. Tierney, Massachusetts 

Rush Holt, New Jersey 

Susan A. Davis, California 

Rau ́l M. Grijalva, Arizona 

Timothy H. Bishop, New York 

David Loebsack, Iowa 

Joe Courtney, Connecticut 

Marcia L. Fudge, Ohio 

Jared Polis, Colorado 

Gregorio Kilili Camacho Sablan, 

Northern Mariana Islands 

Frederica S. Wilson, Florida 

Suzanne Bonamici, Oregon 

Mark Pocan, Wisconsin 

Juliane Sullivan, Staff Director 

Jody Calemine, Minority Staff Director 

SUBCOMMITTEE ON HIGHER EDUCATION AND WORKFORCE TRAINING 

VIRGINIA FOXX, North Carolina, Chairwoman 

Thomas E. Petri, Wisconsin 

Howard P. ‘‘Buck’’ McKeon, California 

Glenn Thompson, Pennsylvania 

Tim Walberg, Michigan 

Matt Salmon, Arizona 

Brett Guthrie, Kentucky 

Lou Barletta, Pennsylvania 

Joseph J. Heck, Nevada 

Susan W. Brooks, Indiana 

Richard Hudson, North Carolina 

Luke Messer, Indiana 

Rube ́n Hinojosa, Texas 

Ranking Minority Member 

John F. Tierney, Massachusetts 

Timothy H. Bishop, New York 

Suzanne Bonamici, Oregon 

Carolyn McCarthy, New York 

Rush Holt, New Jersey 

Susan A. Davis, California 

David Loebsack, Iowa 

Frederica S. Wilson, Florida 

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(III) 

C O N T E N T S 

Page 

Hearing held on February 11, 2014 ....................................................................... 1 

Statement of Members: 

Foxx, Hon. Virginia, Chairwoman, Subcommittee on Higher Education 

and Workforce Training ............................................................................... 1 

Prepared statement of ............................................................................... 3 

Hinojosa, Hon. Rube ́n, Ranking Minority Member, Subcommittee on 

Higher Education and Workforce Training ................................................ 3 

Prepared statement of ............................................................................... 5 

Statement of Witnesses: 

Cruz, Yanira, President and CEO, National Hispanic Council on Aging, 

Washington, D.C. .......................................................................................... 26 

Prepared statement of ............................................................................... 28 

Kellogg, Lynn, Dr., Chief Executive Officer, Region IV Area Agency On 

Aging, St. Joseph, Michigan ......................................................................... 15 

Prepared statement of ............................................................................... 17 

Niese, Denise, Executive Director, Wood County Committee On Aging, 

Inc., Bowling Green, Ohio ............................................................................ 31 

Prepared statement of ............................................................................... 33 

O’Shaughnessy, Carol, V., Principal Policy Analyst, National Health Policy Forum, Washington, D.C. ....................................................................... 6 

Prepared statement of ............................................................................... 9 

Additional Submissions: 

Mr. Bonamici: 

Biancato, Robert, B., National Coordinator, Elder Justice Coalition, 

prepared statement of ........................................................................... 64 

Biancato, Robert, B., Executive Director, National Association of Nutrition and Aging Services Programs (NANASP), prepared statement of .................................................................................................... 68 

Snowdon, Shane, Director, Health and Aging Program Human Rights 

Campaign, prepared statement of ........................................................ 66 

Tullis, Eddie, L., Chairman, National Indian Council on Aging, Inc. 

(NICOA), prepared statement of .......................................................... 71 

Chairwoman Foxx questions submitted for the record to: 

Mrs. Kellogg ............................................................................................... 153 

Mrs. Niese .................................................................................................. 159 

Ms. O’Shaughnessy ................................................................................... 164 

Response to questions submitted: 

Mrs. Kellogg ............................................................................................... 156 

Mrs. Niese .................................................................................................. 162 

Ms. O’Shaughnessy ................................................................................... 167 

Mr. Holt: 

Daroff, William, C., Senior Vice President, Public Policy and Director 

of the Washington Office, The Jewish Federations of North America prepared statement of ..................................................................... 74 

Mr. Miller: 

Gonzalez, Ariel, AARP Government Affairs, prepared statement of .... 78 

Ms. O’Shaughnessy: 

The Aging Network: Servicing a Vulnerable and Growing Elderly 

Population in Tough Economic Times .................................................. 83 

Mr. Petri: 

Meals On Wheels of America, prepared statement of ............................ 134 

Mr. Thompson: 

Alzheimer’s Association, letter dated Feb. 21, 2014 ............................... 144 

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IV 

Additional Submissions—Continued 

Mr. Tierney: 

Hon Charles J. Fuschillo, Jr., Chief Executive Officer, Alzheimer’s 

Foundation of America, prepared statement of ................................... 147 

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SERVING SENIORS THROUGH THE 

OLDER AMERICANS ACT 

Tuesday, February 11, 2014 

House of Representatives, 

Subcommittee on Higher Education 

and Workforce Training, 

Committee on Education and the Workforce, 

Washington, D.C. 

The subcommittee met, pursuant to call, at 10:03 a.m., in Room 

2175, Rayburn House Office Building, Hon. Virginia Foxx [chairwoman of the subcommittee] presiding. 

Present: Representatives Foxx, Petri, Thompson, Walberg, Salmon, Guthrie, Heck, Hudson, Hinojosa, Tierney, Bonamici, and Wilson. 

Also present: Representatives Kline and Gibson. 

Staff present: Janelle Belland, Coalitions and Members Services 

Coordinator; Lindsay Fryer, Professional Staff Member; Amy Raaf 

Jones, Deputy Director of Education and Human Services Policy; 

Rosemary Lahasky, Professional Staff Member; Nancy Locke, Chief 

Clerk; Daniel Murner, Press Assistant; Krisann Pearce, General 

Counsel; Jenny Prescott, Staff Assistant; Nicole Sizemore, Deputy 

Press Secretary; Emily Slack, Professional Staff Member; Alex 

Sollberger, Communications Director; Alissa Strawcutter, Deputy 

Clerk; Tylease Alli, Minority Clerk/Intern and Fellow Coordinator; 

Kelly Broughan, Minority Education Policy Associate; Jody 

Calemine, Minority Staff Director; Jamie Fasteau, Minority Director of Education Policy; Melissa Greenberg, Minority Staff Assistant; Scott Groginsky, Minority Education Policy Advisor; Julia 

Krahe, Minority Communications Director; Brian Levin, Minority 

Deputy Press Secretary/New Media Coordinator; Leticia Mederos, 

Minority Director of Labor Policy; and Megan O’Reilly, Minority 

General Counsel. 

Chairwoman Foxx. A quorum being present, the subcommittee 

will come to order. Good morning, and welcome to today’s hearing. 

I would like to start by thanking our panel of witnesses for joining us to discuss serving our nation’s seniors through the Older 

Americans Act. 

Enacted in 1965, the Older Americans Act was established to 

help older individuals continue living independently in their homes 

and remain active in their communities. The Act combines federal, 

state, and local resources to support programs and services that adCEWDOCROOM with DISTILLER

2 

dress the needs of the senior population, now estimated at more 

than 41 million Americans. 

At the federal level, the Older Americans Act established the Administration on Aging, now known as the Administration for Community Living, to oversee most of the law’s programs. However, the 

Act largely relies on a national network of 56 state agencies on 

aging, 629 Area Agencies on Aging, and nearly 20,000 service providers to plan, coordinate, and deliver services to local seniors. 

Using formula-based grants authorized under Title III of the law 

and other funding sources, state and Area Agencies on Aging develop programs tailored to meet the needs of local seniors. These 

programs provide supportive services such as transportation to and 

from doctors’ offices and pharmacies, financial support for senior 

centers and family caregivers, and disease prevention and health 

promotion activities. 

But the Older Americans Act is perhaps best known for supporting key nutrition services, such as group and home delivery 

meal programs, the latter being more commonly known as Meals 

on Wheels. States match 15 percent of their federal grant to ensure 

local agencies can provide nutritious meals to the elder population 

most in need. In fiscal year 2011, the most recent data available, 

more than 223 million meals were served to approximately 2.5 million people. 

The Older Americans Act plays a vital role in helping seniors access services that promote health, independence, and longevity. In 

fiscal year 2010 alone the law’s programs served nearly 11 million 

older Americans and their caregivers. 

As we work toward reauthorizing the Older Americans Act, we 

must acknowledge the law faces challenges. The population of senior citizens has changed dramatically since the law was first drafted in the 1960s. 

U.S. Census projections estimate the number of Americans age 

65 and over will increase from 40 million in 2010 to 72 million in 

2030. This means that for the next 19 years roughly 10,000 baby 

boomers will turn 65 every day. 

As a result, many are concerned that the Older Americans Act 

cannot effectively meet the needs of the rapidly growing senior population, especially amid current fiscal constraints. 

As we explore ways to strengthen the law, it is critical we seek 

to enhance program coordination and efficiency so that we may better serve those with the greatest social and economic needs. Equally important is preserving the law’s federalist structure, which balances a national framework of programs and funding with significant local flexibility in order to effectively meet the needs of local 

seniors. 

Last year the Senate Committee on Health, Education, Labor, 

and Pensions approved the Older Americans Act Reauthorization 

Act of 2013. Today we have the opportunity to begin the committee’s process of exploring the best ways to improve the law’s flexible policies and targeted programs that are essential to providing 

care for America’s seniors. 

I look forward to working with my colleagues in a bipartisan effort to reauthorize the Older Americans Act and help seniors age 

with dignity and comfort. 

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3 

With that, I yield to my colleague, Mr. Rube ́n Hinojosa, the senior Democrat member on the subcommittee, for his opening remarks. 

[The statement of Chairwoman Foxx follows:] 

Prepared Statement of Hon. Virginia Foxx, Chairwoman, Subcommittee on 

Higher Education and Workforce Training 

Good morning and welcome to today’s hearing. I’d like to start by thanking our 

panel of witnesses for joining us to discuss serving our nation’s seniors through the 

Older Americans Act. 

Enacted in 1965, the Older Americans Act was established to help older individuals continue living independently in their homes and remain active in their communities. The Act combines federal, state, and local resources to support programs 

and services that address the needs of the senior population – now estimated at 

more than 41 million Americans. 

At the federal level, the Older Americans Act established the Administration on 

Aging, now known as the Administration for Community Living, to oversee most of 

the law’s programs. However, the Act largely relies on a national network of 56 

state agencies on aging, 629 area agencies on aging, and nearly 20,000 service providers to plan, coordinate, and deliver services to local seniors. 

Using formula based grants authorized under Title III of the law and other funding sources, State and Area Agencies on Aging develop programs tailored to meet 

the needs of local seniors. These programs provide supportive services such as transportation to and from doctor’s offices and pharmacies; financial support for senior 

centers and family caregivers; and disease prevention and health promotion activities. 

But the Older Americans Act is perhaps best known for supporting key nutrition 

services, such as group and home-delivery meal programs, the latter being more 

commonly known as Meals on Wheels. States match 15 percent of their federal 

grant to ensure local agencies can provide nutritious meals to the elder population 

most in need. In Fiscal Year 2011, the most recent data available, more than 223 

million meals were served to approximately 2.5 million people. 

The Older Americans Act plays a vital role in helping seniors access services that 

promote health, independence, and longevity. In Fiscal Year 2010 alone, the law’s 

programs served nearly 11 million older Americans and their caregivers. 

As we work toward reauthorizing the Older Americans Act, we must acknowledge 

the law faces challenges. The population of senior citizens has changed dramatically 

since the law was first drafted in the 1960s. U.S. Census projections estimate the 

number of Americans age 65 and over will increase from 40 million in 2010 to 72 

million in 2030. This means that, for the next 19 years, roughly 10,000 Baby 

Boomers will turn 65 every day. As a result, many are concerned that the Older 

Americans Act cannot effectively meet the needs of the rapidly growing senior population – especially amid current fiscal constraints. 

As we explore ways to strengthen the law, it is critical we seek to enhance program coordination and efficacy so that we may better serve those with the greatest 

social and economic needs. Equally important is preserving the law’s federalist 

structure, which balances a national framework of programs and funding with significant local flexibility in order to effectively meet the needs of local seniors. 

Last year the Senate Committee on Health, Education, Labor, and Pensions approved the Older Americans Act Reauthorization Act of 2013. Today we have the 

opportunity to begin the committee’s process of exploring the best ways to improve 

the law’s flexible policies and targeted programs that are essential to providing care 

for America’s seniors. 

I look forward to working with my colleagues in a bipartisan effort to reauthorize 

the Older Americans Act and help seniors age with dignity and comfort. With that, 

I yield to my colleague, Mr. Rube ́n Hinojosa, the senior Democrat member of the 

subcommittee, for his opening remarks. 

Mr. HINOJOSA. Thank you, Chairwoman Foxx. 

Today’s hearing will focus on the vital importance of the Older 

Americans Act in serving our nation’s older adults. Our distinguished panel of witnesses includes Dr. Yanira Cruz, executive director of the National Hispanic Council on Aging. 

CEWDOCROOM with DISTILLER

4 

I personally want to thank Dr. Cruz for bringing a very unique 

perspective to this hearing and for sharing her expertise on the 

Hispanic elderly and the many diverse populations you have 

worked with. 

Over the next 20 years the proportion of the U.S. population over 

age 60 will dramatically increase, as our chairwoman pointed out, 

as 77 million baby boomers reach traditional retirement age. According to the U.S. Census Bureau, by 2030 more than 70 million 

Americans—twice the number in 2000—will be 65 and older. Older 

Americans will comprise 20 percent of the U.S. population, representing one in every five Americans. 

Our nation’s aging populations is also becoming increasingly diverse, with Latinos; African-Americans; Asian-Americans; Native 

Americans; and lesbian, gay, bisexual, and transgender seniors 

comprising a larger segment of the elder population. 

In light of these significant demographic shifts, the committee 

must work together to continue to improve the law and to adequately fund OAA programs. 

As you know, OAA was passed in 1965 to address concerns over 

the lack of community and social services for the elderly. Today a 

range of services, including health, nutritional, and social supports, 

and job training provided through the OAA programs remove the 

barriers to economic and personal independence for older adults. 

In recent years the Act has been expanded to cover long-term 

care ombudsman and family caregiver support. OAA programs reduce costly institutional care and medical intervention by focusing 

on in-home and community-based long-term care. Targeted spending on programs authorized by OAA makes it possible for older 

adults to stay in their homes, helping to reduce those costs. 

While OAA programs are available to all Americans 60 years or 

older and require no income eligibility for services, OAA programs 

also target resources to seniors with the greatest economic and social need. Notably, a 2012 GAO report found that low-income, limited English-speaking, minorities, and very elderly populations had 

higher need for OAA services than their counterparts. 

Finally, despite bipartisan support for these OAA programs and 

the sharp increases in the aging population, OAA programs have 

been inadequately funded for several years. What is more, in my 

congressional district in Deep South Texas there are older adults 

who are victims of elder abuse and financial scams that many 

times go unreported. 

Low-income seniors in South Texas also experience food insecurity. This is clearly unacceptable to me and to members of our committee. In my view, adequately funded OAA programs and better 

financial literacy programs for seniors could help to address these 

issues. 

As this committee considers the reauthorization of OAA, I ask 

my colleagues to put our nation’s seniors first. OAA programs have 

had longstanding bipartisan support and older Americans deserve 

nothing less. 

With that, Madam Chair, I yield back. 

[The statement of Mr. Hinojosa follows:] 

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Prepared Statement of Hon. Rube ́n Hinojosa, Ranking Minority Member, 

Subcommittee on Higher Education and Workforce Training 

Thank you, Chairwoman Foxx. 

Today’s hearing will focus on the vital importance of the Older Americans Act 

(OAA) in serving our nation’s older adults. Our distinguished panel of witnesses includes Dr. Yanira Cruz, Executive Director of the National Hispanic Council on 

Aging (NHCOA). I personally want to thank Dr. Cruz for bringing a unique perspective to this hearing and for sharing her expertise on the Hispanic elderly and diverse populations. 

Over the next 20 years, the proportion of the U.S. population over age 60 will dramatically increase, as 77 million baby boomers reach traditional retirement age. According to the U.S. Census Bureau, by 2030, more than 70 million Americans – 

twice the number in 2000 – will be 65 and older. Older Americans will comprise 

nearly 20 percent of the U.S. population, representing one in every five Americans. 

Our nation’s aging population is also becoming increasingly diverse, with Latinos, 

African Americans, Asian Americans, Native Americans, and Lesbian, gay, bisexual, 

and transgender (LGBT) seniors comprising a larger segment of the elderly population. 

In light of these significant demographic shifts, this committee must work together to continue to improve the law and to adequately fund OAA programs. 

As you know, OAA was passed in 1965 to address concerns over the lack of community and social services for the elderly. Today, a range of services, including 

health, nutritional, and social supports and job training provided through the OAA 

programs remove barriers to economic and personal independence for older adults. 

In recent years, the Act has been expanded to cover long-term care ombudsmen and 

family caregiver support. 

OAA programs reduce costly institutional care and medical intervention by focusing on in-home and community based long-term care. Targeted spending on programs authorized by OAA makes it possible for older adults to stay in their homes, 

helping to reduce costs. 

While OAA programs are available to all Americans 60 years or older, and require 

no income eligibility for services, OAA programs also target resources to Seniors 

with the greatest economic and social need. Notably, a 2012 GAO report found that 

low income, limited English speaking, minorities, and very elderly populations had 

higher need for OAA services than their counterparts. 

Finally, despite bipartisan support for OAA programs and the sharp increases in 

the aging population, OAA programs have been inadequately funded for years. 

What’s more, in my congressional district, there are older adults who are victims 

of elder abuse and financial scams that many times go unreported. Low-income Seniors in South Texas also experience food insecurity. This is clearly unacceptable. 

In my view, Adequately funded OAA programs and better financial literacy programs for Seniors could help to address these issues. 

As this committee considers the reauthorize of OAA, I ask my colleagues to put 

our nation’s Seniors first. OAA programs have had long-standing bipartisan support, 

and older Americans deserve nothing less! 

With that, I yield back. 

Chairwoman Foxx. Thank you, Mr. Hinojosa. 

Pursuant to committee rule 7(c), all subcommittee members will 

be permitted to submit written statements to be included in the 

permanent hearing record. And without objection, the hearing 

record will remain open for 14 days to allow statements, questions 

for the record, and other extraneous material referenced during the 

hearing to be submitted in the official hearing record. 

It is now my pleasure to introduce our distinguished panel of witnesses. 

Ms. Carol O’Shaughnessy is a principal research associate with 

the National Health Policy Forum at George Washington University in Washington, D.C. Mrs. Lynn Kellogg is chief executive officer of the Region IV Area Agency on Aging in Southwest Michigan. 

Dr. Yanira Cruz is the president and CEO of the National Hispanic Council on Aging. Mrs. Denise Niese serves as the executive 

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6 

director of the Wood County Committee on Aging in Bowling 

Green, Ohio. 

Before I recognize you to provide your testimony, let me briefly 

explain our lighting system. 

You will have five minutes to present your testimony. When you 

begin the light in front of you will turn green; when one minute 

is left the light will turn yellow; when your time is expired the 

light will turn red. At that point I ask that you wrap up your remarks as best as you are able. 

After you have testified, members will each have five minutes to 

ask questions of the panel. 

I now recognize Ms. Carol O’Shaughnessy for five minutes. 

STATEMENT OF MS. CAROL V. O’SHAUGHNESSY, PRINCIPAL 

POLICY ANALYST, NATIONAL HEALTH POLICY FORUM, 

WASHINGTON, D.C. 

Ms. O’Shaughnessy. Good morning, and thank you, Chairwoman 

Foxx, Ranking Member Hinojosa, and members of the subcommittee. I am pleased to appear before you today to talk about 

the Older Americans Act of 1965. 

As you mentioned, the purpose of the Act is to help people age 

60 and older maintain maximum independence in their homes and 

communities and to provide a continuum of care for the vulnerable 

elderly. The 1965 law authorized generic service programs, but in 

successive amendments Congress has authorized more targeted 

programs under various titles. 

In 1973, Congress extended the reach of the Act by creating authority for sub-state Area Agencies on Aging. This decentralized 

planning and service model has meant that state and area agencies 

are largely in control of their aging agendas and can be responsive 

to state and local needs within federal guidelines and priorities. 

The major function of these agencies is to advocate for, plan, and 

coordinate, and promote a coordinated service system for older people. 

Under its seven titles, the Act supports the aging services network, comprised, as you mentioned, of 56 state Agencies on Aging; 

over 600 Area Agencies on Aging; thousands of service providers 

and volunteers; and research, demonstration, and training initiatives. Total federal funding is about $2 billion. 

Title III, the largest component of the Act, representing over 70 

percent of funding, creates authority for four service programs. 

The first, the elderly nutrition program, the oldest and perhaps 

most well-known of the Act’s services, is intended to address inadequate nutrition by providing meals in congregate settings and to 

frail older people in their homes. The supportive services program 

provides home care, adult day health care, and transportation services, among others, to help impaired older people live independently. 

The family caregiver program provides grants to develop caregiver support programs, such as family counseling and respite care. 

The smallest of Title III programs authorizes disease prevention 

and health promotion activities, such as nutrition counseling, Medicaid management consultation, and immunizations. 

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Title III services are available to all older people who need assistance, but the law requires that services be targeted to those 

with the greatest economic and social need. Compared to all older 

people, Title III participants are the most vulnerable, such as those 

with advanced age, those who have income below poverty, live 

alone, or have multiple chronic conditions and impairments, making Title III services important and critical for older people and 

their families. 

States receive Title III funds according to their relative share of 

the total U.S. population age 60 and older. States allocate funds to 

area agencies based on state-determined formula, and then area 

agencies determine how to best serve the target populations defined by law. 

Participants are encouraged to make voluntary contributions for 

the services they receive, and states may implement cost-sharing 

policies on a sliding fee scale for certain services. Means testing is 

prohibited. 

Title VII of the Act provides grants to support the long-term care 

ombudsman program. About 10,000 paid and volunteer ombudsman work to improve the quality of life for residents of nursing 

homes and other residential facilities. 

The Act authorizes other programs, such as elder abuse, neglect, 

and exploitation prevention; community service employment; aging 

and disability resource centers; and grants to Native American organizations. 

Over the years, many state and area agencies have broadened 

their responsibility beyond the administration of the Act’s funding—for example, administering the Medicaid state and finance 

long-term services and supports programs. 

The law was not intended to meet all the community needs of 

older people. Its resources are meant to leverage other funds. 

States are required to match other funds, as you mentioned, and 

aging services network agencies garner other federal and nonfederal funds to support aging services. Also, voluntary contributions match state and local funds. According to AOA, states typically match two or three dollars for every federal dollar. 

In conclusion, the mission of the aging services network is designed to meet many competing needs of older people. Even with 

its modest funding, the Act has encouraged the development and 

provision of multiple and varied services over the last 49 years. 

Nationwide, state and area agencies connect thousands of providers with people who need assistance. The law allows flexibility 

to state and area agencies to develop programs where they see the 

greatest need. 

Even though the Act’s funds reach relatively limited numbers of 

older people, programs are targeted to the most vulnerable. Efforts 

by state and area agencies to act as planning, coordination, and advocacy bodies have improved policies that affect broader groups of 

older people. 

As the U.S. population rapidly ages, as you mentioned, the sheer 

number of elderly will continue to present challenges to communities across the nation and to the aging services network. 

Thank you, and I would be happy to answer any questions you 

may have. 

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[The statement of Ms. O’Shaughnessy follows:] 

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Chairwoman Foxx. Thank you very much. 

I now recognize Mrs. Lynn Kellogg for five minutes. 

STATEMENT OF MRS. LYNN KELLOGG, CHIEF EXECUTIVE OFFICER, REGION IV AREA AGENCY ON AGING, ST. JOSEPH, 

MICHIGAN 

Mrs. KELLOGG. Good morning. It is my honor to share how the 

Older Americans Act uses AAAs—Area Agencies on Aging—to fulfill its mission. 

The core mission of the Act is to develop comprehensive coordinated systems of care. How? Let me reduce the roles of AAAs into 

three core areas, then provide examples of how this spurs innovation. 

First role: planning and program development. AAAs are charged 

by the Act with developing a system of home and community-based 

services. It can’t be done by the Act alone. 

Beyond administering service dollars, AAAs drive development of 

aging as an economic sector. Leveraging resources has resulted in 

a three-for-one return on every OAA dollar spent. The AAA role in 

bottoms-up local planning identifies need areas, which are also potential business markets. 

AAAs encourage private and public businesses to expand services 

into need areas using OAA dollars as a catalyst. The impact on expansion is robust. A schematic of this is included in written testimony. 

Home and community-based service dollars—the services are 

critical for a raft of in-home support services to help with daily activities, such as dressing and bathing and eating. The Act requires 

AAAs to identify, assess, and wrap around other services in order 

to target OAA to gap areas. 

AAAs end up connecting disparate services to create a local system. The vision of the Older Americans Act to create a national 

means through AAAs to direct services to flexibly fill gaps left by 

other federal, state, and local initiatives is genius. It works. 

Caregiver support is the third area. The Act includes the National Family Caregiver Support Program, a mechanism to support 

family and friends caring for loved ones. Services include caregiver 

classes on how to cope and provide care without toppling one’s own 

health, and provision of respite and adult day care, which temporarily provide relief, enabling caregivers to go on. 

The Older Americans Act mission to create systems spurs many 

innovations and business startups. Let me give you three examples 

from my own AAA; more are in written testimony. 

Person-centered contracting is one. AAAs provide information 

and care planning. Region IV AAA developed person-centered contracting within its care management service. Rather than awarding 

a large sum to a single service provider to provide X number of 

units of a predesignated service, available funds are placed in a 

purchasing pool and used on a person-by-person basis. 

This allows diversity in scope of services purchased and the numbers of providers participating. Ability to tailor services is enhanced, and impact is based on whether the needs of the person 

are met rather than whether contractual obligations are met. The 

innovation went statewide and quickly spread to other states. 

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16 

Business startups are common. Recently, AAA—my AAA started 

a PACE, PACE Program of Southwest Michigan, now co-located 

with the Area Agency on Aging. 

Another innovation is working with a hospital and federally 

qualified health clinic to create an interagency care team to help 

patients with high recurrent use of hospital emergency departments. Problems at home impact directly patient health outcomes. 

By incorporating the AAA as a partner with the medical team, solutions occur and readmissions decrease. Though the project is just 

starting, positive outcomes are already reported as a result of planning. 

Using the mission of the Older Americans Act as a springboard 

to systems development, such as my agency has done, is not an aberration; it is common. Area agencies operate complex local service 

delivery systems augmented by a range of other funders. 

In addition to nine core services required by the Older Americans 

Act, the average AAA offers more than 12 non-mandated services. 

How? Leveraging and partnerships. 

In 2010, AAAs secured funds from an average of seven sources 

other than the Older Americans Act. While the Older Americans 

Act funding remains the critical unifying structure, this forms the 

base, not the breadth. 

Other funding streams view the AAA structure as key. Common 

sources of funding coming through AAAs are state, local, Medicaid 

waiver, grant funds, cost-sharing, and private. 

Collaborations abound. On average, area agencies have 11 informal partnerships and five formal partnerships. 

The Older Americans Act is about independence and personal 

empowerment. AAAs are engines of change to do this, and the existing structure of the Act is well-suited. 

Some concluding observations, considering reauthorization: 

Administrative leanness: With the growth of responsibility, it is 

notable that AAAs remain administratively lean compared to virtually all other national systems. The Older Americans Act limits 

administrative dollars, and targeting is done with minimal bureaucracy so no change is needed. 

Linkage potential: The Older Americans Act is a not-well-understood gem that should be paired with other initiatives. For example, AAAs stabilize complex, home-based needs in a low-cost, person-centered ways. If those needs aren’t met, other goals, like 

health outcomes, suffer. 

It is imperative that reauthorization recognizes and strengthens 

the role of AAAs wherever feasible to bridge the medical or health 

interventions with the social human service side of needed supports. Other acts should be encouraged to reach to AAAs as a goto partner. 

Finally, local flexibility: The core structure of the Act to provide 

bottoms-up planning and local flexibility in systems design is the 

genius of the Older Americans Act. To safeguard this flexibility, the 

transfer authority between all relevant Title III service subtitles 

within the Act must be maintained. 

Thank you for letting me come today. 

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Chairwoman Foxx. Thank you. 

I now recognize Dr. Yanira Cruz for five minutes. 

STATEMENT OF DR. YANIRA CRUZ, PRESIDENT AND CEO, NATIONAL HISPANIC COUNCIL ON AGING, WASHINGTON, D.C. 

(DEMOCRAT WITNESS) 

Dr. CRUZ. Thank you for the opportunity to testify at this hearing. 

I am president and CEO of the National Hispanic Council on 

Aging, the leading national organization working to improve the 

lives of Hispanic older adults, their families, and caregivers. We 

are a member of the Diverse Elders Coalition, a coalition of five organizations advocating for aging policies that improve the lives of 

racially and ethnically diverse Americans, including American Indian, Asian American, and LGBT communities. 

Though the particular needs of each community differ, maintaining health and economic security is something all seniors strive for, 

and the Older Americans Act helps them achieve this. We know 

that the OAA and its services work. 

Older adults experiencing the threat of hunger tell us that oftentimes their only meal is through a local senior center. We also hear 

stories about selfless caregivers who have received training and 

respite as part of the National Family Caregiver Support Program. 

Across the nation older adults are learning new skills and going 

back to work because of training received from the Senior Community Services Employment Program. The OAA also helps seniors to 

receive the services and support they need to maintain their health 

and independence, as well as avoid more expensive forms of care. 

Sequestration harms the Older Americans Act’s ability to fulfill 

its mission. Every day 10,000 people turn age 65. Yet, OAA funding 

has not increased enough to meet this new demand. 

On the contrary, some of its programs have been cut. This means 

that millions of meals are not being delivered to senior centers or 

homes, hundreds of thousands of seniors are losing access to daily 

living assistance, and thousands of low-income older adults who are 

eager to learn new skills are turned away from job training. 

Although the OAA has been successful, it is in need of an update 

because the demographics of the seniors it serves are changing. 

Currently there are about 8 million diverse seniors, and these numbers will only increase as the general U.S. population ages. 

The OAA must respond to these demographic changes. In general, diverse older adults experience health inequities and disproportionate levels of economic insecurity. 

The American Community Survey estimates that around 5 percent of Hispanics over age 65 lack health insurance. In comparison, 

less than 1 percent of non-Hispanic seniors lack health insurance. 

This makes the health community services offered through the 

OAA particularly important for Latino seniors. 

Similarly, the American Community Survey finds that 19 percent 

of American Indian older adults live in poverty. African-American 

seniors—currently the largest group of diverse seniors in the country—endure diabetes at disproportionately high rates. We know 

that the Older Americans health education and nutrition programs 

can help reduce these inequities. 

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At our regional community forums I hear from our older adults 

struggling to access OAA services because of cultural and linguistic 

barriers. A Hispanic older adult in Los Angeles explained to us, 

‘‘Many of the services do not have employees that have the capacity 

or the patience to help us. There is a huge lack of respect—there 

is a huge lack of respect seniors.’’ A report by Hispanics in Philanthropy entitled ‘‘The Latino Age Wave’’ found that there is a lack 

of places Latino seniors can go to access aging services. 

Cultural factors form a barrier to services for LGBT older adults 

as well. Many LGBT seniors have endured a lifetime of discrimination based on their sexual orientation and gender identity. As a result, many feel uncomfortable seeking out services from mainstream providers. 

We strongly support the reauthorization of the Older Americans 

Act. And I know that we are currently in a challenging budgetary 

situation, but the OAA needs more funding. The cuts of sequestration are harming the ability of our country to care for our older 

adults. 

Additionally, in recognition of current demographic changes, the 

provision of services in a culturally and linguistically competent 

manner should be made a priority of the law. LGBT older adults 

and people with HIV/AIDS should be identified as a population in 

greatest social need. 

Thank you for the opportunity to testify. I am happy to answer 

any questions you may have. 

[The statement of Dr. Cruz follows:] 

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Chairwoman Foxx. Thank you, Dr. Cruz. 

I now recognize Mrs. Denise Niese for 5 minutes. 

STATEMENT OF MRS. DENISE NIESE, EXECUTIVE DIRECTOR, 

WOOD COUNTY COMMITTEE ON AGING, INC., BOWLING 

GREEN, OHIO 

Mrs. NIESE. Thank you. 

Chairman Kline, Chairwoman Foxx, Ranking Member Hinojosa, 

and subcommittee members, on behalf of the governing board of 

the Wood County Committee on Aging and the older adults that we 

serve, I appreciate this opportunity to appear before the subcommittee. 

As a nonprofit organization with the mission to provide older 

adults with services and programs which empower them to remain 

as independent as possible and to improve the quality of their lives, 

we support and we advocate for the Older Americans Act reauthorization. 

We operate seven designated multipurpose senior centers 

throughout Wood County and a centrally located production kitchen from which all meals for the senior centers and home-delivered 

clients are prepared. As a direct service provider at the local level, 

we work closely with our local Area Agency on Aging. While entities such as ours are in local communities delivering programs and 

services, we look to them for technical assistance and to best serve 

our client base. 

In 1977, the Older Americans Act represented 61.6 percent of our 

budget. In 2014, Older American Act funds account for 9 percent 

of our total agency budget. 

The remaining 91 percent of our budget are comprised of other 

sources, including a countywide property tax dedicated to senior 

services and donations for meals. As you can see, the majority of 

funds for programs and services in Wood County, Ohio, are nonfederal. 

Each component of the Act impacts local communities. With this 

structure from the federal level, with the guidelines and accountability inherent, the Act also allows for states, local Area Agencies 

on Aging, and providers like us to have the flexibility to develop 

and implement programs and services that meet the needs of our 

local constituency. 

The flexibility to collaborate with businesses, schools, institutions 

of higher learning, and other partners allow us to expand our programs and services to meet local needs. Some of the local needs 

that we are addressing, totally local-funded or sponsored, include 

Club Fit. This is an exercise program we do throughout the county 

and we collaborate with local nursing homes who provide and sponsor the physical therapists and occupational therapists who come 

in and lead the exercise classes. 

We also do Title IIIB medical escort—nonmedical—nonemergency transportation. But the unique component that we do 

with this and with these Title IIIB funds, it is a door-through-door 

service. So if the older adult needs someone to help them out to the 

car, into the doctor’s office, back into their home when we get back, 

it is provided. 

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But we also make sure that the level of assistance is in keeping 

with what the older adult wants. We don’t impose aid if it is not 

requested. 

Nutrition services are by far the largest program that we operate. It continues to grow in participants for both the congregate 

and home-delivered meal service. We are able to provide and continue to meet the demand through the use of volunteers in the production kitchen as well as delivering meals. 

Our staff process all home-delivered meal intakes. The client 

must be 60 years of age and over, live in Wood County, and be considered homebound. 

In addition to receiving a hot lunch Monday through Friday, each 

client also benefits from a midday safety check from our home-delivered meal drivers. In many instances in our rural county, the 

home-delivered meal driver is the only face-to-fact contact with 

someone on a regular basis. 

We were serving an average of 567 meals per day in 2004 and 

identified that we were nearing capacity of production. It was anticipated that within three years it would be necessary to create a 

waiting list for meals—not because of funding, but because of production capacity. 

It was at this point that we approached our then-State Senator 

Randy Gardner and then-State Representative Bob Latta, who 

many of you know, to secure state capital funding for a construction project. Today we are serving an average of 746 meals daily, 

and that is coming from the new production kitchen. 

We were fortunate and our community partner, the Bowling 

Green State University, agreed to be the fiscal agent for processing 

the state funds. This official relationship has also benefitted BGSU 

greatly, as the placement of interns, capstone projects, and research by graduate and doctoral candidates has drastically increased. 

The Older Americans Act has a significant impact on the lives 

of older adults. Impact is measured with established standards and 

measurements for services and annual monitoring conducted by the 

Area Agency on Aging. Pre-and post-testing is also conducted for 

evidence-based programs. 

There are multiple levels of assessment for programs and services provided by multipurpose senior centers, including accreditation by the National Council on Aging. WCCOA became the first 

senior center in Ohio to receive this designation. 

As the reauthorization process of the Act moves forward, please 

maintain the flexibility that is an integral part of the success of 

this Act. The flexibility permits service providers to meet the 

unique needs of our communities while maintaining the high 

standards of the Act. 

In honoring the genuineness of the Older Americans Act of 1965, 

focus on opportunities for the Older Americans Act to be used as 

seed money that will allow service providers to leverage other dollars to further develop needed services. 

I hope to inspire you today to consider the legacy that you will 

impart to the senior citizens of today and those that will age into 

the reauthorized Older Americans Act. Thank you. 

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Chairwoman Foxx. Thank you very much. 

I now recognize Mr. Walberg for five minutes for questioning. 

Mr. WALBERG. I thank the chairman. 

And I thank the panel for being here and for the work that you 

do. 

Mrs. Kellogg, delighted to see that you broke out of the subfreezing cold and snow drifts of western Michigan. 

Mrs. KELLOGG. Counted my blessings when the skies were blue. 

Mr. WALBERG. Yes. And here in the balmy climes of Washington, 

D.C., for at least a while. 

Your testimony talks about Area Agencies on Aging being experts in stabilizing the home environment for seniors in a low-cost, 

person-centered way, ultimately enabling—and I think this is important where possible, and would hope even more possibility—enabling seniors to stay in their own homes. We had the privilege of 

having my mother stay in her home—own home on our property 

for 13 years, which impacted her and us very well, and hopefully 

the taxpayer also in that process. 

If you could add some examples of the expertise of the AAA you 

operate, I would appreciate that. And also maybe you could comment on other networks and systems, what they could benefit from 

utilizing the expertise of the AAAs so as to avoid specifically duplicative services and costs. 

Mrs. KELLOGG. Certainly. When we go into the home, I think we 

are one of the few networks that has truly life in the home and stabilizing how to live, with the things we all take for granted—dressing, eating, running errands, doing chores—is our core competency. 

There are many other—and we send—we have nurses and social 

workers that specialize in that, and then have to be aware of everything else that exists in the community. 

There are the major federal streams of resources—Medicaid, 

Medicare, so forth—but to know the limits of all those as well as 

what else is being provided locally so that you don’t leave gaps and 

try to—that is what I meant by creating a system, I think, is a particular expertise. 

I think nowadays, and perhaps this is where you are going, with 

so many people realizing that if people are overwhelmed by their— 

the barriers they face just living daily in the home, they sometimes 

can’t focus on other things that might need to happen, and I think 

this happens in the health professions and health industries sometimes. So there is a natural reach to—we have to work in the 

home. We have to reach out to the home. 

And we have had many partnerships locally with PACE, with the 

Medicaid waiver through the Older Americans Act is a great gapfiller. Explaining to people how those gaps should be filled. Many 

of our colleagues in the health and medical professions have a hard 

time seeing home-based services beyond the required follow up, 

maybe, from a hospitalization, to go in and provide short-term, inhome—and that is kind of their entire world of in-home. 

And many people need assistance without having a presenting 

health issue. That is the expertise of the area agencies and their 

whole network of providers. 

I think that is what I meant, an unused—not fully utilized gem, 

I think, linking that entire system that understands the basis of 

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people just trying to live and what can be fostered to maintain life 

and independence. It is the American dream: independence for as 

long as possible in life, to the end of life. And capping that rather 

than recreating a new system of home supports, perhaps through 

a different, more medical lens is critical. I think there is a great 

potential there for the Older Americans Act. 

Mr. WALBERG. Can you talk about any relationships you form 

with private businesses to do some of those services? 

Mrs. KELLOGG. Yes. Local businesses have been major partners 

in some of our initiatives because I think many of them recognize— 

one, they are good corporate citizens locally, but also recognize the 

increasing reality of the aging society. What we have realized for 

years is now becoming well-known everywhere, and they are in— 

Mr. WALBERG. Some examples of that? 

Mrs. KELLOGG. Employees that are struggling with caregiving. 

People think of caregiving as hands-on and giving someone a bath, 

but an employee who is also trying to remember to leave early to 

run by the store to pick up something for someone or to remember 

to remind somebody of appointment, or maybe to stop by and shovel some snow because they are worried about somebody slipping 

are also caregivers. 

And I think the awareness of how important that is in a community and how they, as corporate citizens, are—on a different note, 

they are becoming very involved with us in what we call—it has 

many names nowadays—livable communities for all ages, universal 

design. Every municipality, every corporation is spending some 

funds as corporate citizens or local planning entities. 

It is important that they recognize the challenges people face as 

they grow old and embrace them for universal design in all investments. In that way, some of our larger corporations have become 

major partners with us in championing that cause of awareness of 

aging and reaching to—our largest employer is very multifaceted 

and they are very aware of cultural issues, as well, so they have 

become our champion. 

Mr. WALBERG. Thank you. 

My time is expired. 

Chairwoman Foxx. Thank you very much. 

Ms. Wilson, you are recognized for five minutes. 

Ms. WILSON. Thank you, Madam Chair. 

I believe that the most critical time in our lives—happens when 

we begin to get older, and I think that with dementia on the rise 

and Alzheimer’s on the rise this is an extremely important topic. 

I have a couple of questions. 

This question is for Ms. Cruz: When you consider the positive 

outcomes of OAA programs, such as increased tax revenues and 

spending power from working seniors, reduced emergency visits, 

and Medicare and Social Security costs, can you quantify how 

much OAA programs benefit both the economy and the taxpayer? 

Dr. CRUZ. We know that the Older American Act reduces complications resulting from chronic illnesses, for example, and prevents unnecessary hospitalizations that can be very costly. 

So one example is that the cost of providing annual meals through the Older Americans Act is approximately $1,300 per year. 

That would be the equivalent probably of a day of hospitalization, 

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so that is one example that I can offer you that speaks to the value 

of prevention that comes through the Older Americans Act, prevention that can reduce high hospitalizations, high complications that 

are very costly not only for the individual, the family, but also for 

the overall society. 

Ms. WILSON. Thank you. 

Would all of you agree that it makes sense to spend more money 

to feed seniors and fund the OAA than to pay much more for the 

emergency health care costs that arise when people are hungry? 

Do you agree with that, Mrs. Niese? 

Mrs. NIESE. I think when you look at preventative measures, 

they have a large impact, so, yes. 

Dr. CRUZ. We are very concerned with the levels of hunger in the 

community, particularly older adults of diverse background, and so 

I would say that is absolutely critical to ensure that everyone is 

aging with dignity. 

Mrs. KELLOGG. I think you are spot on in prevention and recognizing that preventative quality of all of these services. I think 

meals are critically important. 

In every household it will be a balance. Sometimes you have an 

adult son who is willing to prepare a meal but not give a bath, so 

the issue that presents will vary, so the flexibility to respond for 

all of those needs in a prevention mode is critical. 

Ms. WILSON. Thank you. 

Ms. O’Shaughnessy. I think it is very difficult to come up with 

numbers in terms of tax savings or dollars saved through the Older 

Americans Act. However, I would say that when you are dealing 

with a frail older person who prefers to live in a home and community-based environment, the services that the Older Americans Act 

provides, such as home care, the meals programs, adult day care, 

is less expensive for most people, unless you are totally impaired 

and need 24-hour care, than going in a nursing home. And that is 

where we have the clearest sort of research evidence that there is 

a savings. 

In addition to that, when you have an older person who is being 

cared for at home, you have family caregivers who are, you know, 

providing the most care. They are the primary caregivers for people 

with many impairments, and that is a cost that is not realized. It 

is a savings that is not realized by the federal budget. It is an, you 

know, unexpended or not able to be quantified number, so I think 

we have to take that into account when we are looking at cost-benefit issues. 

Ms. WILSON. Thank you. 

I am very familiar with the PACE program, and we are starting 

a brand new sort of outreach for PACE with veterans. And I think 

it is important for us to understand that it is not so much that people are poor that they don’t eat; it has a lot to do with them, sometimes, remembering to eat and knowing how to prepare the food 

and having the strength, because they have to remember to take 

their medication, they have to remember all sorts of things. So if 

someone brings them a meal it is there and they will eat it. 

So it is important. I especially am a champion for Meals on 

Wheels. 

Thank you. 

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Chairwoman Foxx. Thank you, Ms. Wilson. 

Dr. Heck, you are recognized for five minutes. 

Mr. HECK. Thank you, Madam Chair. 

And thank all of you for being here today. You know, obviously 

the Older Americans Act appropriately prioritizes individuals with 

greatest economic need and greatest social need to receive services 

to age in place in their homes and communities, and, Dr. Cruz, you 

listed a long list of the varying and diverse senior demographics 

that we face. 

One that was missing, and one that represents a big part of my 

constituency, is Holocaust survivors who are minorities at risk of 

isolation. For them, institutionalization has potentially devastating 

traumatic consequences, due to the loss of control and autonomy 

over their daily life. 

Ms. O’Shaughnessy, if you could tell me how we are doing from 

a national perspective, and perhaps, Mrs. Kellogg, if you could tell 

me from a AAA perspective, how we are doing to ensure that the 

survivors, especially the ones who are living in poverty who continue to teach us the most valuable lessons about humanity, diversity, perseverance, and the strength of the human spirit—how we 

are doing in making sure they have access to the services and supports to enable them to age in place with dignity, comfort, and security? 

Ms. O’Shaughnessy. Well, the national data is very clear on this 

in terms of the three million people who receive intensive services 

under the Older Americans Act, and 11 million to 12 million who 

receive less intensive services, those services such as home care, 

adult day care, the meals programs, are very well targeted to people who have the greatest social and economic need, so I think that 

we do have a well-targeted, and the state and area agencies have 

been known to, you know, take that provision under advisement 

and do outreach strategies to make sure that those who are the 

most vulnerable get services. 

However, research has shown that there are many people who 

need services who are not getting them, either because they don’t 

know about the services or there is not enough funding to expand 

services. So that is an issue of concern in terms of unmet need 

among the elderly population that we have to always be concerned 

about. And that is an issue of using resources more wisely, but obviously it is also a resource-based issue to contend with. 

Mr. HECK. Mrs. Kellogg? 

Mrs. KELLOGG. I would agree with that. If your question is how 

do people respond locally, when we target resources there are various criteria or discussion points that you talk about with someone 

as to whether they would receive the—basically support through— 

directly through Older Americans Act resources. It could be based 

on age, income self-declaration, whether or not they have any support in the home, whether they are able to do their daily routines 

in the home. 

You work through that, and we set—because we receive so many 

calls from people we have a priority system set that no one is denied, but when people presenting issues hit into very high criteria 

of high priority, they will be targeted ahead of someone who maybe 

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has some concerns but they might be more worries than manifesting real in the day to day. 

Mr. HECK. As a AAA, do you interact much with the local social 

service agencies that target specific segments of a diverse community to help identify those in needs of service? 

Mrs. KELLOGG. Yes. Yes. My area is mostly rural and quite diverse culturally, so we have variety of—one of the roles of AAAs 

is also education, so we have tapped for cultural sensitivity for providers, and outreach as to how to communicate and message the 

availability of resources, as well as language barriers. 

Mr. HECK. Great. Thank you. 

Thank you, Madam Chair. I yield back. 

Chairwoman Foxx. Thank you very much. 

Mr. Tierney, you are recognized for five minutes. 

Mr. TIERNEY. Thank you very much. 

And I want to thank all of our witnesses here this morning, as 

well, for your testimony. 

Let me try to just cover a couple of areas quickly on that. One 

is respite care. 

I would be appreciative to hear your comments on the importance of respite care, whether or not we are putting enough resources in that area, because I continually hear from people about 

how difficult it is to continually be responsible for a person that is 

under their care on that, and yet have a possibility—a chance to 

have any respite at all. So if we would just quickly go through whoever wants to respond to that from my left to right? 

Ms. O’Shaughnessy. Well, respite care is a very important service 

for family caregivers who, as I said, are the primary caregiver—primary source of support for impaired older people. Respite services 

can be provided by Title III, and it is a Title III-funded service. It 

comes into play not only in the supportive services allotments that 

states get, but also in the family care giving program because there 

are limited funds for respite services. 

But to be honest, I think that, you know, one could always do 

more because of the enormous strains that there are on caregivers 

who might have to care for a person 24/7, you know, 7 days a week. 

So that is an important consideration. 

Mr. TIERNEY. Are we not funding the program in the aggregate 

enough, or are we not allocating resources that exist to that priority as opposed to others? 

Ms. O’Shaughnessy. Well, when states get their supportive services allotment they decide, you know, what is the most—what are 

the most important services that they want to provide. Under the 

Family Care Giving Program it is an identifiable service, but under 

the supportive services allotment there is a laundry list of services 

that people—that area agencies can provide and they have to 

choose among them. 

There are certain priority services, and home care services are 

one of the priority services under Title III, so there might be some 

spending. But again, it is up to the local agencies to decide how 

much to devote to respite care. 

Mr. TIERNEY. Thank you. 

Mrs. Kellogg? 

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Mrs. KELLOGG. It is hard to say from the national level whether 

there is enough because it does wrap around other resources. In 

Michigan, we have state funds also targeted specifically for respite 

and day care because of the tremendous need for caregiver relief. 

There is also an interesting dichotomy because, although I believe that those are incredibly valuable services and they are out 

there, convincing caregivers to use them—people work themselves 

into physical or mental decline, and it is a major challenge to have 

them understand the value of respite day care. I think it is an upand-coming, and will continue to be an up-and-coming, growth area 

because it is hugely prevention-oriented services to help these caregivers. 

Mr. TIERNEY. Thank you. 

Dr. Cruz? 

Dr. CRUZ. Just to say that as I hear you, I echo what you say 

and say that dementia and Alzheimer’s is on the rise, and we are 

very concerned that the demand for caregiving will continue to increase, and so not to lose sight of that and to keep that in mind 

as we—you know, as the law gets reauthorized. 

Mr. TIERNEY. Thank you. 

Mrs. Niese? 

Mrs. NIESE. As a direct service provider and working in all the 

county communities that we have, one of the things that I see are 

the senior centers are the front door for respite care. You have 

many families, the husband and wife are coming in, the wife is 

using the time at the senior center for her respite; the husband is 

there with her, but she can be engaged in other activities, she can 

be socializing. He is safe; he is doing his activities and programs. 

I think one of the things we have to focus on, too, is the education for the caregiver, that it is our right to seek help. Because 

that continues to be a challenge with my staff, to get caregivers to 

embrace the opportunities that they have. 

Mr. TIERNEY. Thank you. 

Thank you all for that. 

And then just quickly, should we be listing LGBT adults as a 

group in largest need? 

Ms. O’Shaughnessy. Well, I think that all people who have need 

for services should have equal access to the services under the 

Older Americans Act. I think that, you know, the Act lists a number of groups already, in terms of those people with low income, 

minority status, at risk of institutionalization. 

One of the issues, as I mentioned earlier, was that people who 

need services now are not getting them, so I think it is an issue 

of, you know, do you add another target group to the— 

Mr. TIERNEY. Well, I am just wondering whether or not you are 

seeing enough particularities with that group as they age that they 

need that special listing on that. 

Mrs. Kellogg, what is your view? 

Mrs. KELLOGG. Well, I think in Michigan our State Office on 

Aging has required area plans to include focus on that population. 

In my region, we have conducted sensitivity trainings in partnerships with those groups. 

Whether or not something was listed in the Act, I don’t think— 

I tend to think a broad sweep is probably the most appropriate beCEWDOCROOM with DISTILLER

51 

cause it is hard to respond to what are you specifically doing for 

one if you are already becoming active in a certain area. 

Mr. TIERNEY. Fair enough. 

Dr. Cruz? 

Dr. CRUZ. Yes. Our research is showing that LGBT elders are not 

fully accessing the current system. They feel isolated, and we need 

to review that. 

Mr. TIERNEY. Thank you. 

And Mrs. Niese? 

Mrs. NIESE. I think we have to look at it at a local level and 

make sure that we are welcoming and we are doing the outreach. 

I think even if it were in the Act, if we as service providers are 

not providing opportunities and making a safe place and a welcoming place, even if it is in the Act it is not going to be successful. 

Mr. TIERNEY. Thank you. 

Thank you, Madam Chairman, for your time. 

Chairwoman Foxx. Thank you. 

Mr. Salmon, you are recognized for five minutes. 

Mr. SALMON. Thank you, Madam Chairman. 

The older I get, the more up close and personal this becomes, and 

let me say what I mean. I mean, obviously we are all going to be 

in that situation in the not-so-distant future, but right now, dealing 

with that with my own parents. My father, World War II veteran, 

a hero in my estimation, passed away about four years ago. My 

mom, 92, has been living by herself for the last four years since he 

passed away, and she is in the hospital right now with some issues 

and has finally acquiesced and will be—when she comes out of the 

hospital, she will be moving in with my brother and his wife, who 

are empty nesters. 

In about three weeks—well, let me go on. My in-laws, my fatherin-law was diagnosed about a year ago with Alzheimer’s disease; he 

is 84. And my mother-in-law, 84, is kind of at wit’s end because, 

you know, she is frustrated and scared and doesn’t know how to 

cope completely. 

And in three weeks, they are going to be moving in with my wife 

and I, and we will be caring for them. I know it is a big challenge 

ahead, and in a lot of ways I am kind of frightened. 

But I have got to say, in my younger days I served a mission for 

my church in Taiwan, and one of the things that I really loved 

about that culture—the Chinese culture—is their reverence to their 

elders and their love for the parents, and the idea that the responsibility for their parents is equal to the responsibility their parents 

had for them when they were children. 

And I am glad we have these programs. They are good. And I 

think that taking care of the most elderly and vulnerable in our society is a good function of government. 

I would love to see some kind of a public awareness campaign 

in this country to try to encourage families to be families and step 

up and, you know, to take care of their parents and not neglect 

them and not just forget about them. 

I think a lot of parents who—you mentioned, Dr. Cruz, some of 

them feel really isolated. Maybe they wouldn’t feel so isolated if 

their kids would give them a phone call or if their kids would visit 

them once in a while. 

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52 

And I know that is not a broad brush. There are a lot of good, 

you know, children that take care of their parents and watch out 

for them, but government is no substitute for the love that comes 

from families. It is great to take care of the basic needs, but it is 

no substitute for love of families. 

And I would really like to see some kind of a, you know, a public 

awareness campaign go across this country to remind people that, 

you know, your family responsibilities continue, you know, when 

your children are grown, and it reverses maybe a little bit to the 

people that loved you and nurtured you and brought you into this 

world. 

And so I am not trying to just sermonize. I get really frustrated 

because I have gone to old folks’ homes, and I have visited folks 

that are lonely and abandoned, and I would just really like to see 

all of us maybe focus a little bit more on, you know, the family and 

keeping that together. 

I would like any thoughts that any of you have on that, on roles 

that we can play and maybe making that happen. 

Ms. O’Shaughnessy. Well, so many families are going through 

what your family is going through now, and it is a very difficult 

and stressful time because you see your parents who are declining, 

and it is a very sad thing to watch. 

I do think some of the national organizations have done a good 

job in recent years to try to focus on the family, and I just saw an 

ad, actually, a few days ago. It was an AARP ad that had a picture 

of an older woman and her daughter, who was performing different 

roles in sort of a photo montage, and here she was preparing 

meals, and then she was coordinating her doctors’ appointments, 

and she was doing the housecleaning, and she was, you know, 

being a comfort to her mother. 

So I think it was a very telling ad because it speaks to what you 

are talking about, and I do think that some of the national organizations—and even in the Older Americans Act, by recognizing family caregiving as a—as one of the funded services was a big step 

forward in 2000 when Congress added that new program. 

So I think that there—the research shows, you know, that families are primary caregivers, despite, you know, kind of—we hear 

about families moving so far away, but eventually—and I think 

most people live within a certain geographic range of their family 

so they are available. It is just the stress that happens when you 

are—you have multigenerational families like your own there. 

Chairwoman Foxx. Thank you very much. 

Mr. Hudson, you are recognized for five minutes. 

Mr. HUDSON. Thank you. 

And I thank the witnesses for your testimony today and the time 

you have given us. Very informative. 

I have a question for Ms. O’Shaughnessy. I understand the Older 

Americans Act Title III funding formula generally distributes funds 

to states based on the population of older Americans in the state. 

However, the previous reauthorization back in 2006 included a 

‘‘hold harmless’’ provision that prevents states from falling below 

their 2006 funding levels. This does not take into account current 

populations; in fact, it is based on the 2000 population—2000 census. 

CEWDOCROOM with DISTILLER

53 

What formula changes would you suggest to ensure that states 

are receiving their fair share of available funds while recognizing 

the current fiscal challenges we face, and what are some of the 

issues we need to consider? 

Ms. O’Shaughnessy. Well, Mr. Hudson, that is a very difficult 

and complicated question, and whenever you change a formula that 

has sort of been a longstanding formula, there are winners and losers. And usually there was a change in the 2006 amendments to 

the formula, so a ‘‘hold harmless,’’ as you mentioned, was added. 

And a ‘‘hold harmless’’ is always a compromise because you don’t 

want to negatively affect certain states while certain states are 

being positively affected. So it is a balancing issue. 

I think in the past there have been various proposals to change 

the formula to look at, for example, a function of need of older people, how many individuals within a state have limitations in activities of daily living, or, you know, disability issues. There have been 

proposals to look at a state’s low-income and minority older population. You can look at age as a proxy for disability, for example. 

All those things have tradeoffs because some of the southern 

states have higher proportions of people with disabilities, and you 

kind of get into—not to overgeneralize, but you get a Rust Belt, 

Sun Belt kind of issue. You have growing populations in certain 

states, maybe like North Carolina and other states in the South 

and the Southwest, versus other states in the North-Northeast who 

have higher proportions of the old population, as people have migrated. 

So what you have to really do is look at the numbers and do formula runs that would look at the numbers. I am making work for 

my colleague in the audience here, who works for CRS, but it—you 

really have to look at the numbers and see where people come in, 

and it becomes a very divisive issue in some cases when you 

change a formula. 

So a ‘‘hold harmless’’ is a way to kind of moderate that—those 

influences. I don’t know if that helps, but— 

Mr. HUDSON. It does. And obviously the concern of a state like 

North Carolina, with a growing population, the—you know, the 

‘‘hold harmless’’ seems to penalize states that have a growing seniors population, and certainly I want to assure that North Carolina 

seniors are not being shortchanged because of, you know, shortsighted errors in Washington or the way we are doing the formula. 

Well, how important is it for states and Area Agencies on Aging 

to have maximum flexibility in how they serve seniors? Are there 

areas where your organization could benefit from increased flexibility? 

I guess Mrs. Kellogg? 

Mrs. KELLOGG. You are asking if there are areas that we should 

have increased flexibility? 

Mr. HUDSON. Yes. 

Mrs. KELLOGG. It is a hard issue because I tend to believe maximum flexibility is best, and you have—at the same time, there are 

specific needs that people want to make sure are addressed. So 

right now the Act does look at some areas of categorical limits or 

recognition of a need area and then stop. 

CEWDOCROOM with DISTILLER

54 

That is why I mentioned the construct of the Act right now is 

probably okay the way it is. It provides some categories of very important need—legal, meals, other things—number of—percentages 

of in-home, different things. But if you start drilling down too 

much—because they are all real and people really have those 

needs—you end up losing the flexibility to wrap around what is 

happening in the community in the local level. And I truly believe 

that is paramount to really making the whole Act efficient of how 

it can do its job. 

So in a perfect world, I don’t think there should be hardly any 

limits. The way it is now, it points out high-need areas, sets some 

limits, and leaves it alone at that point. I think that is probably 

a good way to continue and allowing maximum flexibility within 

the different service titles as they are now. 

Mr. HUDSON. Great. Thank you. 

Madam Chair, I yield back. 

Chairwoman Foxx. Thank you. 

Ms. Bonamici, you are recognized for five minutes. 

Ms. BONAMICI. Thank you very much, Chair Foxx, and thank you 

for scheduling this hearing about this important issue. 

I apologize that I wasn’t here for your testimony. We are trying 

to do two things at once this morning. But I have reviewed the testimony. 

I want to start by saying that during the past year a bipartisan 

Senate coalition has worked with diverse stakeholders to report 

language that makes important updates to the Older Americans 

Act. And I have been honored to work with them and our ranking 

member, Mr. Hinojosa, and we will soon be introducing legislation 

that builds on what the Senate has started and includes other key 

updates about our most vulnerable populations. And it is my hope 

that as this committee moves forward with the reauthorization of 

the Older Americans Act that we can work together on both sides 

of the aisle to make important targeted updates to ensure that this 

law continues to serve our seniors. 

And I want to start by asking Dr. Cruz—thank you for your testimony today, especially for advocating for aging policies that meet 

the needs of diverse elders. You note in your testimony that diverse 

seniors generally experience disproportionate levels of economic insecurity, and unfortunately this seems to be true for many LGBT 

elders. 

Indeed, advocates point out that LGBT elders face higher poverty 

rates than heterosexual elders. They are also twice as likely to be 

single, three to four times as likely to be without children. 

This is an important issue and Representative Hinojosa and I are 

working on our legislation, and we have provisions that will 

strengthen services and access for LGBT seniors. Specifically, the 

bill will designate LGBT seniors as a population in greatest social 

need to ensure that they can get culturally competent care that addresses their needs. 

Can you explain how the Older Americans Act falls short currently in serving LGBT elders and how designating LGBT seniors 

as a population in greatest social need would expand access to services for this group of Americans? Thank you. 

Dr. CRUZ. Thank you for your comments and for your service. 

CEWDOCROOM with DISTILLER

55 

I think the current situation, what our research is showing is 

that LGBT elders are not fully accessing services. The infrastructure that is currently in place—clinics, for example, or community 

centers—are not providing culturally competent services for LGBT 

populations, and so therefore, they are delaying services, they are 

delaying preventive services that could, you know, reduce costly 

complications, chronic diseases down the road. 

So that is the—what our research is showing us. And we have 

looked at California, we have looked at New York, D.C., and Florida. 

Ms. BONAMICI. Thank you. 

And I have a follow-up question, too. I think we can all agree 

that preventing the mistreatment of elders should be a priority of 

the Older Americans Act. 

The National Center on Elder Abuse found that despite current 

reporting laws, many cases of elder abuse and neglect go unreported. And the center cites several recent studies estimating that 

up to 10 percent of respondents have been abused in the past year. 

The bill that Representative Hinojosa and I are developing would 

establish a unified database to collect information on elder abuse, 

exploitation, and neglect, and it would also ensure that those who 

work directly with older adults receive training in elder abuse prevention and detection. What steps can we take to prevent elder 

abuse, neglect, and exploitation, and are there particular programs 

that have been successful—I am a big supporter of evidence-based 

programs—at preventing elder abuse and that may be worth expanding? 

And I would be interested in hearing from the other witnesses 

on this, as well. 

Dr. Cruz, do you want to start, or— 

Ms. O’Shaughnessy. Well, as you say, there are many cases—and 

plus, we don’t know exactly how many cases go unreported. There 

are two segments in the Older Americans Act. There is a small program for elder abuse, neglect, and exploitation prevention. It is one 

of the smallest programs in the Act. 

However, there is also the Elder Justice Act that was enacted as 

part of the ACA, and part of that program, although I don’t think 

it has 2014 funding. It did receive a couple of years of funding, but 

one of the components of that Act is to provide training to local officials about being aware of elder abuse issues, and I think you 

might want to look at building on that program for your legislation. 

Ms. BONAMICI. Thank you. 

Mrs. Kellogg? 

Mrs. KELLOGG. It is ironic. In Michigan, we have been championing over the last year a package of 11 bills that would not 

bring money but policy and process changes to raise awareness of 

elder abuse in Michigan, and I think we have got now eight of the 

11 passed. 

And I would echo Carol’s comments in that has brought together—we do training for—and education. That is one thing. 

But then bringing together the different emergency responders 

as well as the services providers and those—the dialogues across 

systems have been very, very helpful. So it is just a matter of doing 

CEWDOCROOM with DISTILLER

56 

that and then making sure you have policies in place that can put 

teeth in laws if you find issues. 

Ms. BONAMICI. Thank you. 

And I see that my time is expired, but I would be interested in 

hearing from the other two witnesses perhaps in writing after the 

hearing. Thank you very much. 

I yield back. Thank you, Chair Foxx. 

Chairwoman Foxx. Thank you, Ms. Bonamici. 

Mr. Guthrie, you are recognized for five minutes. 

Mr. GUTHRIE. Thank you, Madam Chairman. I appreciate that. 

And thank you all for being here. 

I want to point out, it was mentioned about sequestration and 

the programs, and 10,000 people who are—a day who are 65 or— 

are turning 65 every day, and just note that we are going to spend 

hundreds of billions of dollars over the next budget—within this 

next budget on people 65 and older. As a matter of fact, when my 

daughter is my age in 30 years, 100 percent of federal revenues, 

under the current budget if we don’t do anything different,- will be 

Social Security, Medicare, and Medicaid, and a substantial Medicaid goes to the seniors. So that is squeezing out these programs 

and that is what we need to address when they work that way. 

First, Mrs. Kellogg the Areas on Aging—the agencies—you said 

you do needs assessment and then you try to put your services to 

what your needs are. What tools do you do to do needs assessment? 

Is it roundtables, discussions, surveys? 

Mrs. KELLOGG. We started off in our agency doing a series every 

three years of random digit dialing in partnership with the university. We knew if we talked solely to one constituent group we 

would get that perspective, so we went with a kind of a more of 

a approach that looked at barriers to independence rather than 

asking about specific services and really quizzed people on what 

kind of barriers were they having. 

Over a sequence of years, and doing that three—I think three or 

four times—it pointed us directly towards the whole array of longterm supports and services that were needed. After that direction 

was firmly entrenched, we ended up getting involve, because we 

have been around awhile in information services. We have a very 

robust call center as well as care management that goes out to the 

home and talks to people. 

Nowadays you look at what is the nature of those calls coming 

in? What needs are able to be met and what aren’t? We get I think 

it is close to 15,000 reached through that call center every year, 

and we talk about what are the unmet needs, what are people having? 

So that becomes that kind of cold call, as well as when we send 

people out to the home, maybe in a care management-type mode, 

what are the things that you can find solutions for? What can’t 

you? And now they have become our drivers. 

Then the individual help with a person becomes much more of 

an individual process: What is that person facing? And that is the 

person-centeredness of today’s world, just hearing what they view 

their barriers are rather than trying to craft a pigeon hole for 

them. 

Mr. GUTHRIE. Exactly. Thank you. 

CEWDOCROOM with DISTILLER

57 

And, Mrs. Niese, in your testimony you talked about you have 

flexibility to collaborate with businesses, corporations, and K–12. 

Could you give an example of a collaboration—or one or two—that 

has worked and been successful? 

Mrs. NIESE. Well, the collaboration with the local nursing homes, 

where we can offer exercise programs with the certified P.T.s— 

physical therapists and occupational therapists. Other things that 

we do—again, people realize the market of the baby boomers hitting 60 and 65 and they are a whole new client base. And so we 

have many organizations—home health care agencies, pharmaceuticals, all of that are wanting to educate on their programs and 

services. We are not letting them sell. 

But in order for them to provide that education, we are asking 

them to contribute and support. Maybe they are going to sponsor 

one of our events so that we can have seniors there who could otherwise not afford to participate in cholesterol screenings and that. 

So they are underwriting services that older adults who don’t have 

the financial means can actually participate in. 

Mr. GUTHRIE. Well, thanks. 

That leads to Ms. O’Shaughnessy. In your testimony, you mentioned that participants in Title III are encouraged to make voluntary contributions for services they receive and states may implement cost-sharing policies for certain services. Do you know how 

many states have implemented cost-sharing policies and how successful they have been? 

Ms. O’Shaughnessy. Well, from the latest survey information 

that we have, about 16 states have, you know, formal, written costsharing policies, and when states cost-share they—generally they 

are for the more high-cost individualized services like home care, 

personal care, adult day care. I think why have more states not 

done—established cost-sharing policies? So, voluntary contributions 

are a part of the Act. I mean, people do contribute on a voluntary 

basis, generally generating income through the nutrition programs. 

Mr. GUTHRIE. Do people contribute for their own service, or could 

it be, like, you could have a pharmaceutical contribute to the program and have access to educate on their— 

Ms. O’Shaughnessy. Yes, you could have, I think, you know, as 

witnessed by some of the other speakers today, that, you know, 

they are seeking out businesses to help contribute toward services 

that are provided in the community. 

With respect to the cost-sharing, some states have found it very 

administratively difficult, because even if you have cost-sharing 

policies, the law says that you cannot deny services if someone cannot contribute. So it becomes sort of a catch-22: You might have the 

policy, but if someone cannot contribute, will not contribute, you 

still have to provide the service, especially if they are in the greatest social and economic need. So it becomes a little bit of an administrative difficulty. 

Mr. GUTHRIE. Thank you. Thanks for those answers. 

My time is expired. I yield back. 

Chairwoman Foxx. Thank you. 

Mr. Thompson, you are recognized for five minutes. 

Mr. THOMPSON. Madam Chair, thanks for this hearing. 

Thank you to the witnesses for being here. 

CEWDOCROOM with DISTILLER

58 

As someone who has spent basically almost 30 years working 

with older adults—started out as a certified therapeutic recreation 

specialist, rehab services manager, and I guess somewhat out of 

self-defense, a licensed nursing home administrator towards the 

end of my career. You know, meeting the needs of older adults— 

and I think thankfully today, with science and lifestyle, we—most 

older adults, my observation, age with dignity and independence in 

place. But for those who don’t, because of health, illness issues, it 

is important to have these services that you all are in one way or 

another connected with. 

And so, Ms. O’Shaughnessy—or Ms. O’Shaughnessy—I wanted 

to—as the committee begins to reauthorize the Older Americans 

Act, you know, what key principles should guide us how we review 

and reform programs serving older Americans? 

Ms. O’Shaughnessy. I think you have heard from other witnesses 

today in terms of maintaining the flexibility that the Act currently 

has. The decentralized structure of the Act is somewhat elegant in 

the sense that you have agencies that have feet on the ground, ears 

on the ground, hands on the ground to provide and to develop services for older people. 

I think you might want to be careful about adding any new requirements in this time of fiscal constraint. We may have some 

issues in terms of if you add new requirements on an already burdened network, which is trying to serve the needs of the growing 

elderly population, it becomes very difficult. 

I think that one might look at some evaluations that the Administration on Aging is conducting now. They have some results from 

various component parts of the network, so I think you might want 

to look at some of the evaluative information that is coming out of 

there—out of the administration. 

Also, I think that—some people have mentioned it, too—I think 

that, you know, we have to think about new ways of garnering resources, so making state and area agencies, or at least area agencies, more entrepreneurial, looking at being trained on business 

outlooks, and I think that the administration has taken the step 

by awarding to the National Association of Area Agencies on Aging 

a grant so that they can help area agencies become more competitive, and to garner, you know, outside, private sector resources, as 

someone just mentioned. I think those are the kinds of things you 

might want to look at. 

The other areas, I think, that—the administration has even suggested this, that you might want to look at ways to increase efficiency and performance across the board, and by perhaps having 

incentive grants for high-performing agencies that might, you 

know, have a little competition going on, but reward people for 

doing, you know good things and—on evidence-based research. I 

think those are the kinds of things I would suggest maybe looking 

at. 

Mr. THOMPSON. Thank you. 

Speaking of evidence-based research, one of my certifications in 

the past had to do with working with individuals with disturbing 

behaviors—dementia, such as Alzheimer’s. And this is my observation, and so I was curious to just get an affirmation whether I am 

right or wrong—and I am okay either way because people tell me 

CEWDOCROOM with DISTILLER

59 

every day that I am right and wrong on the same issue, actually— 

but how significant an issue is the increasing evidence and prevalence of disturbing behaviors related to dementia, such as Alzheimer’s—and obviously there are other disorders in that family— 

for this older adult reauthorization, compared to even just in 2006, 

and what should we consider to address this rising incidence and 

the impact on individuals and families? 

I don’t have much time but we will start with Mrs. Kellogg, and 

then when we don’t get if, if you would submit in writing that 

would be great. I appreciate it. 

Mrs. KELLOGG. I was thinking of the other representative’s comments about his family and involvement. When we put out an education or a seminar in our community saying, ‘‘You and Your Aging 

Parent,’’ it is flooded every time. 

And when that happens, I think we just need to help people be 

aware and not be so afraid of the disease, and recognize the reality 

so that they can take preventative steps to live life even with the 

disease, as well as people, because they are sometimes fearful to 

come forward, miss the tips—and the benefit of each other. We are 

doing a lot with creating confident caregivers, evidence-based caregiver training that focuses on dementia, and the ‘‘aha’’ moments 

among participants that they are not alone and they can still live 

life, and how do you manage this? I think that is a critical task 

for us all. 

Mr. THOMPSON. Thank you, Madam Chair. 

Chairwoman Foxx. Thank you, Mr. Thompson. 

I would now like to welcome to the committee our distinguished 

colleague from New York, Congressman Gibson. Without objection, 

Congressman Gibson will be permitted to participate in our hearing today. 

I hear no objection, so I recognize Mr. Gibson for five minutes. 

Mr. GIBSON. Well thanks, Madam Chair. 

And I thank the ranking member and all the members of the distinguished committee here. 

I thank the panelists for their tremendous testimony today. 

The resources, the support programs that come with the Older 

Americans Act, critical to my district. And it is a very popular program. In fact, really the only criticism I hear about the program 

is the name of the Act, and I wonder—but it may be something to 

think about going forward. 

But, you know, as I have worked the issues across the 11 counties in upstate New York, and listening to seniors, seniors’ advocates, family members, and caregivers, and then meeting with the 

directors of the Office of the Aging in my area, it was clear to me 

that we needed to push for this reauthorization that puts the programs at risk without the authorization. 

So, and I worked with my colleagues, Betty McCollum, Tom 

Reed, and we have authored and introduced H.R. 3850, which is a 

5-year reauthorization of the Older Americans Act. And that is why 

I greatly appreciate the Chair allowing me to be here today. Our 

staffs have been working together. 

I also want to mention some of the organizations, I think, that 

were instrumental in authoring the reauthorization: AARP, the National Association of Area Agencies on Aging, the National Council 

CEWDOCROOM with DISTILLER

60 

on Aging, the Meals on Wheels Association of America, Experience 

Works—and that is, you know, the work that they do in our district 

I think is critically important, and I think important for generations working together. So many seniors who have just remarkable 

wisdom and the desire to impart that on younger Americans, and 

I think this is a great program that helps with that—Easter Seals. 

And so all these advocacy groups working with my colleagues 

and I to get this reauthorization. And so I look forward to what I 

hope is a fruitful set of hearings so that we can get to this reauthorization. 

And, you know, I had one question for Mrs. Niese, and it is really 

based on our experiences in upstate New York. I am curious to 

hear your best practices of how you deal with this challenge. 

I have a county on the western trace of my district—Delaware 

County. The village is Sidney, and Sidney sits right on the western 

edge, and it—you know, within a rock’s throw you are in Chenango 

County. And the orbit within 10 miles or so pulls everyone to Sidney, but it is a different county. 

And so we have had a challenge because there is a wonderful 

senior center right in Sidney and they service people in another 

county, and so they find a way. They have voluntary contributions. 

But it has been a bit challenging for the administration of the program. 

I am curious to know, do you have similar challenges, and what 

you have done about it? 

Mrs. NIESE. I certainly do, and a large part of that is because we 

are a bedroom community of Lucas County, Toledo, Ohio, and we 

have many people who live in Lucas County who come across into 

Wood County to one of the senior centers there. We also, in our 

southern part of our county, have folks coming in from Hancock 

County for programs and services. 

Because of the Older Americans Act funds coming in, my governing board, our county commissioners allow for that. They are 

treated as everyone else. So it doesn’t matter where you are coming 

from. You are a U.S. citizen, it is Older American Act dollars, you 

are welcome to come in. 

Now, since the majority of our funds are raised through our senior services levy, there are different call centers associated. If someone wants a newsletter and they are out of county, they pay more. 

If someone wants to—well, we cannot do medical escort for someone out of county. But if they want to go on a trip or an activity 

they are welcome to come into the site and then they can participate as a county resident. 

So you have to work together. 

Mr. GIBSON. Yes. So the flexibility in the Act, I think, is highlighted— 

Mrs. NIESE. Flexibility is phenomenal. 

Mr. GIBSON. Yes. Well, thank you. And thank you again for all 

your great work and leadership. 

And, Madam Chair, I will yield back the balance of my time. 

Thank you. 

Chairwoman Foxx. We like guests like you who yield back the 

balance of their time. Thank you. 

CEWDOCROOM with DISTILLER

61 

Well, I want to thank all of the members of the panel who are 

here today, and because I am chairing and am here the entire 

panel I usually wait till last to ask my questions. And when that 

happens most of my questions get asked ahead of time, but you 

have prompted some issues and some questions for me. 

I appreciated, Ms. O’Shaughnessy, your talking about the fact 

that there are some efforts being made to make the programs more 

efficient and to measure performance and to do evidence-based research. 

All of you have mentioned the fact that funds are scarce, and 

people here know that I am a big proponent of accountability and 

efficiency and effectiveness. 

This is a program that, it appears, has done a good job of 

leveraging local and state money. It can be, I believe, a model program for the federal government to be involved. 

So I would like to ask—and you don’t have to go into great detail, 

and I am hoping you will give me some information in writing, so 

I am not asking for great detail here. I would like to give Ms. 

O’Shaughnessy and Mrs. Kellogg, Mrs. Niese some—an opportunity 

to quickly answer. 

How are ways that you are measuring efficiency, client outcomes, 

and how services are targeted to the most vulnerable of the populations? And can we export these metrics to programs that aren’t 

using them now? How can we do that? And how can we set up a 

program of reward to help those who aren’t doing the kinds of 

things that should be done based on evidence-based research? 

So, Ms. O’Shaughnessy, if you could very quickly respond? 

Ms. O’Shaughnessy. I do think that, you know, performance 

standards are a good thing, and at this moment I don’t believe that 

there are performance standards. It is very difficult in the social 

service world to have performance standards, but I think that you 

can have a goal and objectives—excuse me. 

So I do think that, you know, as you mentioned, working on evidence-based research is absolutely very important, and perhaps, 

you know, developing the performance standards and having technical assistance to state and area agencies to make sure that those 

standards are being used. You can’t really cut off their funding if 

they don’t do it, but you can have, as you mentioned, an incentive 

program, perhaps, to offer the high-performing agencies in order 

for them to compete for additional funds. I do think that is an option you may want to consider. 

Chairwoman Foxx. Thank you. 

Mrs. Kellogg? 

Mrs. KELLOGG. Yes. Obviously one measure, by shifting almost 

everything we do to evidence-based practice is kind of copping out 

to one degree, but building on our research to make sure that you 

are only doing evidence-based practice. When I talked about the 

person-centered contracting, it did raise our impact analysis significantly because you actually order a service based on a need and 

then follow up to see if that exact service did the need or not, so 

that is a very direct measure for us. 

I do believe that there is a body in—somewhat in the academic 

community studying performance standards for satisfaction and 

empowerment-type issues. People, if they truly know—they have 

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overturned every rock and understand their situation in life, it does 

bring peace. And how to measure that in today’s world is a toughy, 

so I am glad there are people smarter than I am tackling it. 

But I do think that becomes a standard when you are talking 

about programs that at one point are serving people with very severe needs that you do not expect to get better. 

Chairwoman Foxx. Mrs. Niese? 

Mrs. NIESE. One of the things that we have established internally is that all of our locations have a set of standards that we 

have developed that they have to adhere to so that residents 

throughout our service area are receiving equitable services. That 

is very important to us. 

Another thing that we have done is we have collapsed administrative costs, in that we have staff at our central office that are 

shared at all seven of those senior centers. And so we have two 

R.N.s and one MSW on staff. Those three ladies are running 

around this county at all the seven senior centers and are being as 

efficient as possible working one-on-one with those seniors, going 

into the homes for assessments, helping with home repairs. 

So again, sometimes we have to step back and look at our own 

administrative operations and maybe have an economy of scale by 

readdressing that. 

Chairwoman Foxx. Thank you very much. 

I want to thank our distinguished panel of witnesses for taking 

the time to testify before the subcommittee today. 

Mr. Tierney, do you have some closing remarks? 

Mr. TIERNEY. Just very brief, and to echo your comments, I want 

to thank all of the witnesses for their testimony. It is refreshing 

to see all of us be able to come together on an issue and in a matter that I think obviously reflects the concern that members of Congress have. 

And thank you for adding your insight into it. It will be very useful as we move forward. 

Thank you. 

Chairwoman Foxx. Thank you. 

And as you all said, and others have said here today, we know 

that we have scarce resources. However, we know the population— 

the elderly population—is growing. There is just some givens there 

that we have. 

But I think the—you have raised some really important points 

today that we need to pay a lot more attention to, and that is to 

getting out the information to which programs are effective, and to 

making sure that the hard-earned taxpayer dollars are being spent 

as efficiently and effectively as they can be. We do want to take 

care of our elderly, and it is important that we do so in the best 

manner possible. 

So I will look forward to looking at some of the research that has 

been done and talking to folks who are doing more research, and 

hopefully seeing people go in the direction that will help us set up 

guidelines, set up performance measures that would help the 

money be spent better. 

And I applaud all of you, particularly those of you working at the 

local community to deliver the services, for making stone soup, as 

we said before, taking scarce resources and putting them together, 

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because I do think that this is an example of good partnerships at 

the local level. So thank you all very much for being here today 

and getting us started on this discussion. 

There being no further business, the subcommittee stands adjourned. 

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[Questions submitted for the record and their responses follow:] 

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[Mrs. O’Shaughnessy’s response to questions submitted follows:] 

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[Whereupon, at 11:37 a.m., the subcommittee was adjourned.] 

Æ 

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