U.S. GOVERNMENT PUBLISHING OFFICE

28–601 PDF WASHINGTON : 2018

S. HRG. 115–362 

GRANDPARENTS TO THE RESCUE: 

RAISING GRANDCHILDREN IN THE OPIOID 

CRISIS AND BEYOND 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

WASHINGTON, DC 

MARCH 21, 2017 

Serial No. 115–2 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.govinfo.gov 

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(II) 

SPECIAL COMMITTEE ON AGING 

SUSAN M. COLLINS, Maine, Chairman 

ORRIN G. HATCH, Utah 

JEFF FLAKE, Arizona 

TIM SCOTT, South Carolina 

THOM TILLIS, North Carolina 

BOB CORKER, Tennessee 

RICHARD BURR, North Carolina 

MARCO RUBIO, Florida 

DEB FISCHER, Nebraska 

ROBERT P. CASEY, JR., Pennsylvania 

BILL NELSON, Florida 

SHELDON WHITEHOUSE, Rhode Island 

KIRSTEN E. GILLIBRAND, New York 

RICHARD BLUMENTHAL, Connecticut 

JOE DONNELLY, Indiana 

ELIZABETH WARREN, Massachusetts 

CATHERINE CORTEZ MASTO, Nevada 

KEVIN KELLEY, Majority Staff Director 

KATE MEVIS, Minority Staff Director 

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CONTENTS 

Page 

Opening Statement of Senator Susan M. Collins, Chairman .............................. 1 

Statement of Senator Robert P. Casey, Jr., Ranking Member ............................ 2 

PANEL OF WITNESSES 

Videotape Statement of Ann Sinsheimer and Marvin Sirbu, Grandparents, 

Pittsburgh, Pennsylvania; Linda James, Grandparent, Rochester, New 

York; and Belinda Howard, Grandparent, Fort Walton, Florida ..................... 6 

Jaia Peterson Lent, Deputy Executive Director, Generations United, Washington, DC ............................................................................................................. 7 

Megan L. Dolbin-MacNab, Ph.D., LMFT, Associate Professor, Department 

of Human Development, Director, Marriage and Family Therapy Doctoral 

Program, Faculty Affiliate, Center for Gerontology, Virginia Tech Faculty 

of Health Sciences, Virginia Tech, Blacksburg, Virginia .................................. 9 

Bette Hoxie, Executive Director, Adoptive and Foster Families of Maine and 

the Kinship Program, Orono, Maine .................................................................. 11 

Sharon McDaniel, MPA, Ed.D., President and Chief Executive Officer, A 

Second Chance, Inc., Pittsburgh, Pennsylvania ................................................ 13 

APPENDIX 

PREPARED WITNESS STATEMENTS AND QUESTIONS FOR THE RECORD

Jaia Peterson Lent, Deputy Executive Director, Generations United, Washington, DC ............................................................................................................. 34 

Jaia Peterson Lent Response to Questions for the Record ........................... 38 

Megan L. Dolbin-MacNab, Ph.D., LMFT, Associate Professor, Department 

of Human Development, Director, Marriage and Family Therapy Doctoral 

Program, Faculty Affiliate, Center for Gerontology, Virginia Tech Faculty 

of Health Sciences, Virginia Tech, Blacksburg, Virginia .................................. 40 

Bette Hoxie, Executive Director, Adoptive and Foster Families of Maine and 

the Kinship Program, Orono, Maine .................................................................. 56 

Sharon McDaniel, MPA, Ed.D., President and Chief Executive Officer, A 

Second Chance, Inc., Pittsburgh, Pennsylvania ................................................ 57 

Sharon McDaniel Response to Questions for the Record .............................. 59 

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GRANDPARENTS TO THE RESCUE: 

RAISING GRANDCHILDREN IN THE 

OPIOID CRISIS AND BEYOND 

TUESDAY, MARCH 21, 2017 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:30 p.m., in Room 

SD–562, Dirksen Senate Office Building, Hon. Susan M. Collins 

(Chairman of the Committee) presiding. 

Present: Senators Collins, Fischer, Casey, Gillibrand, Donnelly, 

Warren, and Cortez Masto. 

OPENING STATEMENT OF SENATOR SUSAN M. COLLINS, 

CHAIRMAN 

The CHAIRMAN. The Committee will come to order. 

Good afternoon and welcome. This hearing was originally scheduled for last week, as our witnesses know well, but winter does not 

always cooperate with our Senate schedules. 

I am particularly pleased to welcome today one of the new members of our Committee, Senator Fischer from Nebraska. I was absolutely delighted when I learned she would be joining our Committee, so thank you, Senator, for being here. 

This hearing focuses on an important topic, and I am very 

pleased that we have gathered here to discuss it today. Last year, 

nearly 1,000 babies in Maine—that is about 8 percent of all 

births—were born to women addicted to opioids and other drugs. 

This tragedy afflicts many other states as well as mine. In the 

United States, every 25 minutes a baby is born with an opioid addiction. In this crisis, as in past crises, grandparents are coming to 

the rescue. The Aging Committee is meeting today to recognize the 

grandparents raising grandkids and to explore what can be done to 

assist them as they take on this unanticipated challenge motivated 

by their love of their grandchildren. 

One in five grandparents provides child care regularly to their 

grandchildren. In fact, grandparents who help raise grandkids together with the child’s parents can support healthy aging and be 

a positive experience for all concerned. Today, however, we are focusing on grandparents who are raising their grandchildren alone. 

These ‘‘custodial grandparents’’ are called on to help for a number 

of reasons, including alcohol and drug addiction, physical abuse, incarceration, divorce, financial difficulties, military deployment, and 

even death. In Maine, the number of children being raised solely 

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by their grandparents increased by 24 percent between 2010 and 

2015. 

At a time in life when most seniors are looking forward to enjoying more leisure time, these grandparents have found themselves 

as parents once again. They are waking up in the middle of the 

night to feed babies and planning afternoons around soccer practice, rather than playing golf or volunteering. 

Raising a second family also involves costs they had never anticipated as they budgeted for what was supposed to be their golden 

years. They are tapping into retirement savings, going back to 

work, or staying in the workforce longer just to make ends meet. 

In addition to the financial toll, raising children later in life presents social, emotional, legal, and other challenges. It can be socially difficult to become a full time caregiver as an older adult, 

often isolated from friends. It can be emotionally difficult to go 

from being a grandmother who spoils the kids to becoming the disciplinarian who makes sure that homework is finished. 

At the same time, it can often be emotionally difficult to navigate 

the relationship with the children’s birth parents. The legal challenges are tough. The process of attaining custody is complex, 

lengthy, and costly. Without a proper legal arrangement, routine 

tasks such as enrolling kids in school or obtaining medical care can 

be difficult. 

Becoming a full-time caregiver can also take a toll on the health 

of the grandparent. The new caregiver role challenges both the 

physical, mental, and emotional health of grandparents resulting in 

higher rates of diabetes, heart disease, and depression. 

Despite all of these challenges, when asked if they regret taking 

on the caregiver role, a vast majority of these grandparents answer, ‘‘No.’’ They know that they are making a difference. They are 

providing love, stability, and a home to children who might otherwise have to live with strangers. 

WABI, the CBS television station in Bangor, Maine, recently featured stories of grandparents raising their grandchildren. What 

struck me the most in those stories was that the grandparents are 

not focused on the challenges; instead, they are focused on their 

love for their grandchild. As one put it, ‘‘In the end, it is worth it 

to know that they are happy and safe.’’ 

Throughout history, grandparents have stepped in to provide 

safe and secure homes to their grandchildren, replacing traumatic 

pasts with loving and hopeful futures. The opioid crisis has called 

upon grandparents in epic numbers. We are here today to focus on 

what is being done to help those grandparents who have stepped 

up to help ensure a better life for their children’s children. 

Senator Casey, it is delightful to have you here today, and I call 

upon you for your opening remarks. 

OPENING STATEMENT OF SENATOR ROBERT P. CASEY, JR., 

RANKING MEMBER 

Senator CASEY. Chairman Collins, thank you very much, and 

thanks for getting us started on this important issue. 

I want to thank the Chairman for calling this hearing, and as 

she just indicated, today’s topic is indeed challenging, and that is 

an understatement. It is one that we both see back home, and I 

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think that is true of every member of this Committee. And it is one 

that motivates us when we are here in Washington to try to focus 

on this issue and to tackle the problem. 

Grandparents Ann Sinsheimer and Marvin Sirbu joined me at a 

hearing recently, at a gathering in Pittsburgh, on the opioid problem in the city of Pittsburgh. And as you will hear from them 

shortly, they are raising their grandchildren because their daughter is struggling with an opioid addiction. Ann and Marvin are here 

with us today. Where are they? Oh, I did not see you coming in. 

I am sorry. Ann and Marvin are with us, and, Ann and Marvin, 

we want to first of all express our gratitude to you for being here 

again after having appeared in Pittsburgh and for giving a voice 

to grandparents across the country who are caring for their grandchildren under the hardest of circumstances. 

I also look forward to introducing Dr. Sharon McDaniel from 

Pittsburgh as part of our panel today. I will do that introduction 

a little later, but we are grateful that Dr. McDaniel is here. 

And like the State of Maine, the State of Pennsylvania has been 

hit hard by the opioid epidemic. More than 3,200 Pennsylvanians 

died from drug overdoses just in 2015 alone. That is a 20-percent 

increase over the 2014 total. 

As the Centers for Disease Control and Prevention tell us, the 

majority of these drug overdoses are caused by opioids. The reality 

is that opioid addiction is devastating the lives of individuals with 

addiction. It is also putting a strain on our health care system, law 

enforcement, and communities across the country as well. 

It is also taking a toll on families. Too often, moms and dads are 

falling victim to the epidemic, and grandparents are stepping in to 

care for the children. That is one of the reasons why the number 

of children being raised by grandparents is on the rise. In Pennsylvania, 103,000 children—103,000 children—are in the care of their 

grandparents or other relatives. Experts point to opioids as the 

major driver of that growth, and any parent will tell you that raising a child is rewarding indeed, and it is fulfilling. But it is also 

a major challenge. 

For grandparents, it can dramatically alter their life plans, as 

Senator Collins noted. They postpone retirement. They keep working longer to be able to afford clothes, child care, and food. Some 

deplete their nest eggs and retirement savings to finance these new 

costs. Many are isolated from their social networks. 

Raising children of a parent struggling with addiction presents 

additional challenges for grandparents. Often, they spend time in 

court struggling to sort out custody. Frequently, they need to learn 

the special education system to get their grandchildren the supports that they need. 

Children of addicted parents have often experienced trauma and 

have been exposed to violence and drug use, so grandparents must 

address a child’s mental health needs. And they may need to help 

the child navigate their relationship with the parent who is still 

using opioids. 

All of this can be overwhelming when you expected the next 

phase of your life to be retirement, and it takes a tool on the grandparents’ physical and mental health. These are all significant challenges for the grandparents, but, of course, most grandparents say 

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that it is all worth it to have the peace of mind knowing that their 

grandchildren are safe. Grandparents stepping up to take on the 

role of primary caretaker of their grandchildren deserve our support. They should not feel isolated and unaware or unsure of where 

to turn for help. 

There are supports like the National Family Caregiver Support 

Program, which is under the Older Americans Act. This program 

helps ‘‘grandfamilies’’—a new term—by providing caregivers counseling and respite care. With grandfamilies on the rise, ensuring 

adequate federal funding is critical. 

There is also the modest child-only TANF funding that families 

can access, Temporary Assistance for Needy Families. But there is 

not a go-to place for older Americans facing this situation, and with 

more and more seniors taking on this role, we need to be thinking 

about how to better serve them. 

That is why I would like to work with Chairman Collins and others on legislation to create a one-stop shop for everyone trying to 

help grandparents raising their grandchildren to help make their 

job a little bit easier. 

We also need to continue to expand access to treatment. I am 

pleased, like we all are, that we provided $1 billion in funding to 

states over the next two years to combat the opioid epidemic as 

part of the 21st Century Cures bill at the end of the year. That is 

the good news. 

The bad news? This funding and other funding like it will be undermined if the Affordable Care Act is repealed. Just that repeal 

alone would remove at least $5.5 billion annually from the treatment of those with mental health and substance use disorders. So 

$5.5 billion could be gone even though the $1 billion was added at 

the end of last year. We cannot allow that to happen. 

At the height of this epidemic, we cannot lose ground on health 

care coverage. It is too important to every generation—grandparent, parent, and child. So I am committed to fight to ensure 

that we maintain these vital programs that today help older Americans and grandparents who are raising their grandchildren. 

Today’s hearing will help us learn from past experiences, including issues faced by grandparents affected by the crack cocaine epidemic in the 1980s and 1990s. We cannot arrest our way out of the 

opioid epidemic, and treatment matters, good treatment matters, so 

that grandparents can be grandparents, and grandchildren can 

once again be grandchildren. 

I look forward to hearing from our witnesses about how we can 

do that important task. Thanks very much. 

The CHAIRMAN. Thank you very much, Senator. 

Now we will turn to our witnesses. First, we will hear, by video, 

from grandparents who are raising their grandchildren. As Senator 

Casey has already previewed, two members of our audience today 

are featured also in the video. Drs. Ann Sinsheimer and Marvin 

Sirbu from Pittsburgh, Pennsylvania, will tell their story. Mrs. 

Linda James will share her story from Rochester, New York. And, 

last, we will hear from Mrs. Belinda Howard, who is from Fort 

Walton, Florida. 

Next we will hear from our panel that is right in front of us, and 

that includes Jaia Lent. Ms. Lent is the deputy executive director 

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of Generations United. She leads work for the National Center on 

Grandfamilies. That was a new phrase for me also. 

We will then hear testimony from Dr. Megan Dolbin-MacNab, an 

associate professor of human development at Virginia Tech. She is 

also director of the Marriage and Family Therapy Doctoral Program. 

We will next, I am delighted to say, hear from one of my constituents, Bette Hoxie. Mrs. Hoxie is the executive director of Adoptive and Foster Families of Maine and the Kinship Program. Adoptive and Foster Families of Maine provides important services to 

grandparents, including kinship training, licensing and legal support, material support, and respite care. Mrs. Hoxie does tremendous work to support grandfamilies in Maine. I would note that I 

recognized her with the Angels in Adoption Award in 2004, and I 

am delighted that she has joined us today. She has personally 

raised some 19 children, which is truly extraordinary, and she is 

still at it. 

I will now turn to our Ranking Member to introduce our final 

witness on this panel, Dr. Sharon McDaniel. 

Senator CASEY. Chairman Collins, thank you. 

Dr. Sharon McDaniel is the founder, president, and chief executive officer of A Second Chance in Pittsburgh, Pennsylvania. Dr. 

McDaniel is an alumna of foster care herself and was raised by relatives. She founded A Second Chance, which is a nonprofit that 

provides services to 800 families a day through kinship care in both 

Pittsburgh and Philadelphia, our two largest cities in the State. A 

Second Chance’s mission is to provide a safe and nurturing environment to children who are being cared for by their relatives. It 

also works to prevent the cycle of drug and alcohol abuse and provide children in need with kinship placement. Dr. McDaniel is also 

a member of the Casey Family Programs Board of Trustees. No relation to me, but a great organization, great foundation. 

Clearly, Dr. McDaniel’s work and that of A Second Chance is invaluable to the people of Pennsylvania, so I am glad she is here 

with us today, and I look forward to her testimony. 

I mentioned Ann and Marvin, as the Chairman did. They will be 

in the video. They will not be giving testimony, but they are here. 

So they are here in more ways than one, both in the video and in 

person. We are grateful they drove from Pittsburgh to be here. And 

as I mentioned, they have taken on this task of raising two granddaughters as a result of their mom’s struggle with drug addiction. 

So they have made great sacrifices not only to be here but, of 

course, the larger sacrifice they have taken on. So thanks very 

much. 

The CHAIRMAN. Thank you, Senator. 

I would now direct your attention to the screens where we will 

hear the testimony of individual grandparents. 

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VIDEOTAPE STATEMENT OF ANN SINSHEIMER AND MARVIN 

SIRBU, GRANDPARENTS, PITTSBURGH, PENNSYLVANIA; 

LINDA JAMES, GRANDPARENT, ROCHESTER, NEW YORK; 

AND BELINDA HOWARD, GRANDPARENT, FORT WALTON, 

FLORIDA 

Ms. SINSHEIMER. Hi. We are Ann and Marvin, and we are caring 

for our two granddaughters, ages 8 and 5. 

Mr. SIRBU. Well, I have a daughter who has been struggling with 

drug addiction for a dozen years. Well, I am 71. I had been thinking about when I would retire, but now I am thinking it is going 

to be later than I originally thought. I need health insurance for 

my oldest granddaughter, and I can get that through my employer 

if I continue working. And my expenditures are more than anticipated, and so it seems prudent to continue working a little longer. 

I have colleagues with young kids, but they are much younger 

than I am, and the people who I have associated with all my career 

are now themselves empty nesters. They are talking about their 

grandchildren, but only for occasional visits. And so it is a little 

awkward. The people I would normally socialize with do not want 

to talk about young kids anymore. And the people with young kids 

are in a different stage of life than we are. So it is a bit awkward. 

Ms. SINSHEIMER. Yeah. It is hard to go out. It is hard to make 

plans to travel, like we were thinking about, and I guess sometimes 

I feel like it is a little lonely. I feel a little—I mean, I know I 

should not, but I feel a little ashamed about our situation. It is not 

like something you want to bring up at dinner when you are actually going out with your friends. So we are in such a different 

world from our peers. 

Ms. JAMES. I am Linda James, and I have raised two of my 

grandchildren. I became a primary caregiver of my grandchildren 

in 1987 when my granddaughter was born in a crack house. Two 

years later, I went to Baltimore, Maryland, to pick up my grandson. Well, I started a support group because I felt that the kinship 

caregivers needed that emotional support. And they also needed 

tools to help them in raising their grandkids, tools such as how to 

navigate the special education system because a lot of children 

whose parents have been affected by drugs have some learning disabilities. So these grandparents need to know how to navigate their 

special education system. 

They also need to know how to take some of the old things that 

they have learned when they was growing up and applying some 

of the new things that we are now doing to really help their grandchild and to really understand their grandchild. Well, the skills 

that I found most helpful was really just good parenting skills and 

good common sense. 

Ms. HOWARD. Hi. My name is Belinda Howard, and I am from 

Fort Walton Beach, Florida, and I am raising our grandson, Logan. 

He is seven years old. So we rescue the children from foster care, 

and they have been in our home ever since. 

We are back in the public school system, and that is a big challenge. I thought I was done with that. So, financially, for my husband and me it is a challenge. You know, there is baseball equipment and basketball equipment and school lunches and just the 

time and, you know, not having that time frame where we feel like 

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we were going to be empty nesters, and we are not. So that is a 

huge challenge. 

Being a part of an online support group through the Addict’s 

Mom, called ‘‘Grandparent to Grandparent,’’ I want to say we are 

at 2,900 members strong, and it is good to have online support. But 

if we could have people-to-people support, you know, something on 

the ground, groups that we could go to, people that we could touch 

and help and, you know, encourage each other, that would be huge, 

you know, to just be able to know that there are other grandparents out there, you know, for whatever reason, struggling to 

take care of their grandkids. 

The most positive thing from this situation—because my husband and I have four children and three of them are addicts, we 

have eight grandchildren, and I want to say the most positive thing 

about everything is that our—our grandchildren think we’re super 

heroes. They think that their Gammy and Pop-Pop can do everything. 

[End of videotape.] 

The CHAIRMAN. Well, I think the grandparents who are raising 

grandchildren are super heroes. I think she said it very, very well, 

and that is something all of us can admire. 

We are now going to start with testimony from our panel, and, 

Ms. Lent, we will begin with you. 

STATEMENT OF JAIA PETERSON LENT, DEPUTY EXECUTIVE 

DIRECTOR, GENERATIONS UNITED, WASHINGTON, DC 

Ms. LENT. Thank you, Chairwoman Collins, Ranking Member 

Casey, and members of the Committee, for your leadership in holding this hearing on the important role of grandparents in providing 

safe and stable homes to children and the sharp increase in this 

trend attributed to the opioid crisis. 

For almost 20 years, Generations United’s National Center on 

Grandfamilies has been a leading voice for issues affecting families 

headed by grandparents and other relatives. 

Today’s grandparents provide a continuum of care from part- or 

full-time child care to raising a grandchild. My testimony will focus 

on grandparents and other relatives raising children, also known 

as ‘‘grandfamilies.’’ 

According to the U.S. census, more than 2.6 million grandparents 

report they are responsible for their grandchildren. And there are 

many kinds of grandfamilies. Some grandparents are raising children inside the formal foster care system as licensed or unlicensed 

kinship foster parents. Others have no involvement or support from 

the child welfare system. And while the challenges these families 

face are varied and complex, they are united by one common factor: 

they believe beyond a shadow of a doubt in the importance of family. They believe that children fare better when they are raised in 

a family, not a system, and they are right. Yet we cannot ignore 

the fact that they often step in at great personal sacrifice, impacting their own health, family relationships, and financial well-being. 

My testimony focuses in four areas: the impact of the opioid epidemic on grandparents; the critical role grandfamilies play in helping the children thrive; the importance of supportive services to 

help grandfamilies succeed; and the valuable role that the National 

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Family Caregiver Support Program can play in responding to the 

crisis. 

After years of decline, the overall numbers of children in foster 

care are on the rise. Child welfare systems are increasingly looking 

to grandparents and other relatives to care for children as they face 

shortages of foster parents to meet the growing need. And unlike 

parents or foster parents who plan for months or even years to care 

for a child, these grandparents usually step into their role unexpectedly. Some may have received a call in the middle of the night 

telling them to come and pick up their grandchildren or they will 

end up in foster care. Suddenly, they are forced to navigate complex systems to help meet the challenges of the children who come 

into their care, often after experiencing significant trauma. 

Taking on the unexpected expense of a child can be especially 

devastating to caregivers living on fixed incomes. Countless 

grandfamilies report spending down their retirement savings to address the health, mental health, food and clothing needs of the children, or to pay expenses from seeking legal custody of the children. 

And while grandparents have been called upon to raise children 

for many reasons over the years, the current opioid and heroin epidemic is overwhelming many families and child welfare systems. 

One grandparent shined a light on the impact when she said, 

‘‘For my 50th birthday, I got a two-year old. My story is not unique. 

The opioid epidemic has devastated communities all over the country. It does not discriminate against age, race, or gender. It affects 

all of us.’’ 

In 2014, more than a third of all children who were removed 

from their homes because of parental alcohol or drug use were 

placed with relatives. And although the child welfare system relies 

heavily on relatives, for every child being raised inside the foster 

care system with a relative, there are 20 children being raised in 

grandfamilies outside of the foster care system. And those that 

raise children outside of the system usually struggle with even less 

support. 

Despite the challenges facing grandfamilies, children fare well in 

the care of relatives. Compared to children in non-relative care, 

they have more stability, are less likely to run away, are more likely to report feeling loved. When children cannot remain with their 

parents, research shows that placing children in grandfamilies reinforces stability, safety, well-being, and a child’s sense of identity, 

reduces trauma, helps keep brothers and sisters together, honors 

family and cultural ties, and it increases the likelihood of having 

a permanent home. 

A young person may age out of a system, but they never age out 

of a family. 

Families face challenges that can be addressed through key supports such as information and referral services like Kinship Navigator Programs and support groups; physical and mental health 

care, including Medicaid; affordable legal services; lifespan respite 

care; financial supports such as Temporary Assistance for Needy 

Families and Social Security. And, finally, the National Family 

Caregiver Support Program can also play a valuable role in helping 

to respond to the crisis. 

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Current law gives states the option to use up to 10 percent of 

their National Family Caregiver Support Program dollars to serve 

grandfamilies, yet only seven states use the full 10 percent to serve 

the families; however, those who do, report a significant impact. 

A full list of Generations United’s recommendations are included 

in my written testimony, including the importance of quality health 

and mental health care, financial, legal, and social supports, and 

child welfare reform. 

In closing, no matter the circumstances, every child deserves the 

roots and connection to the rich soil of family that nourish their 

growth and prosperity. Grandfamilies provide just that. 

The CHAIRMAN. Thank you very much for your testimony, Ms. 

Lent. I was struck by your line when you said that you can age out 

of foster care, but that you cannot age out of a family. That really 

sums up why this hearing is so important, so thank you for being 

here. 

Next we are going to hear from Dr. Dolbin-MacNab. Please proceed. 

STATEMENT OF MEGAN L. DOLBIN–MacNAB, PH.D., LMFT, ASSOCIATE PROFESSOR, DEPARTMENT OF HUMAN DEVELOPMENT, DIRECTOR, MARRIAGE AND FAMILY THERAPY DOCTORAL PROGRAM, FACULTY AFFILIATE, CENTER FOR GERONTOLOGY, VIRGINIA TECH FACULTY OF HEALTH 

SCIENCES, VIRGINIA TECH, BLACKSBURG, VIRGINIA 

Dr. DOLBIN-MACNAB. Good afternoon, Chairman Collins, Ranking Member Casey, and distinguished members of the Committee. 

Thank you for the opportunity to testify before you today on this 

very important issue. I am Dr. Megan Dolbin-MacNab. I am an associate professor in the Department of Human Development and director of the Marriage and Family Therapy Doctoral Program at 

Virginia Tech. I have been researching grandfamilies for approximately 20 years. Today, I will provide testimony regarding the 

findings from scientific research on grandfamilies. The testimony I 

provide today reflects my professional views and experiences and 

not those of Virginia Tech. 

As Ms. Lent noted, in the United States, approximately 2.6 million grandparents are primarily responsible for the care of their 

grandchildren. These grandparents play key roles in ensuring the 

safety and stability of 2.5 million or three percent of all U.S. children. 

The majority of grandparents raising their grandchildren are 

women, married, working, and younger than age 60. That said, 

census data suggest that grandparents raising grandchildren are 

disproportionately more likely to be divorced or widowed, less educated, and living in poverty. They are also disproportionately represented among racial and ethnic minority groups, though rates are 

increasing among white, non-Hispanic grandparents. 

Grandparents assume responsibility for their grandchildren in 

response to a variety of intersecting parental difficulties, including 

abuse and neglect, incarceration, physical and mental illness, and 

adolescent pregnancy. Of particular relevance to today’s hearing, 

parental substance abuse has long been noted as one of the most 

common reasons that grandparents raise their grandchildren. BeAGING-SDG-5 with DISTILLER

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yond parental difficulties, however, grandfamilies also develop in 

response to economic instability, cultural traditions of grandparent 

involvement, and familism. 

Raising a grandchild impacts all aspects of a grandparent’s life. 

According to the research literature, commonly reported stressors 

include economic distress, legal difficulties, inadequate housing, 

strained family relationships, and social isolation. The demands of 

parenting may be particularly stressful for grandparents because 

their grandchildren often experience significant emotional, behavioral, and physical difficulties. These difficulties have been associated with grandchildren’s histories of trauma and other adverse 

circumstances. 

Research has documented that the collective stressors experienced by grandparents raising grandchildren can negatively impact 

both their physical and mental health. 

In terms of mental health, studies consistently demonstrate that 

grandparents experience significant levels of depression, at rates 

that are higher than those within the general population. 

With regard to physical health, early research suggested that 

grandparents experience compromised physical health, dissatisfaction with their health, and functional limitations. More recent research, however, suggests that grandparents’ adverse health outcomes may have less to do with raising their grandchildren, per se, 

and are more likely to be reflective of risk factors such as poverty 

or preexisting health conditions. Still, studies consistently find that 

grandparents raising grandchildren experience a variety of serious 

chronic health conditions and often engage in a variety of risky 

health behaviors. This is particularly concerning given evidence 

that grandparents often forgo preventative health care as a result 

of putting their grandchildren’s needs ahead of their own. 

While the scientific research has illuminated the many stressors 

and adverse outcomes experienced by grandparents raising grandchildren, not all grandparents experience these negative outcomes, 

and many are resilient in the face of significant adversity. In fact, 

the experience of raising grandchildren is not entirely negative. 

The emotional connections that grandparents form with their 

grandchildren are highly rewarding, as is the chance to provide 

their grandchildren with better opportunities in life. 

In light of this information, researchers are increasingly examining grandparent resilience or the ability to positively adapt in the 

face of adversity. Studies have found that resilient grandparents 

have social support and demonstrate optimism, active coping, resourcefulness, and a sense of empowerment. Increasingly, researchers are developing and testing promising interventions that promote grandparent resilience and reduce adverse outcomes. Improving the quality of the larger environments in which grandparents 

are embedded is also important for promoting resilience. 

Support services play a critical role in reducing adverse outcomes 

and promoting resilience in grandparents raising grandchildren. 

Unfortunately, research findings suggest that grandparents underutilize these services due to ineligibility, difficulty navigating multiple agencies, and an inability to pay. Other barriers to accessing 

support include a lack of awareness of available services and even 

negative interactions with practitioners. Addressing these barriers 

AGING-SDG-5 with DISTILLER

11 

requires a truly ecological approach to intervention that attends to 

individual level factors as well as macro level factors, including increased availability of services and more flexible eligibility guidelines. 

Grandparents raising grandchildren are important resources to 

their families and communities. Despite the challenges they experience, grandparents are highly resilient and deeply committed to 

giving their grandchildren the best lives possible. Supporting them 

means supporting some of our Nation’s most vulnerable families. 

Thank you for the opportunity to appear before you today. I look 

forward to responding to your questions. 

The CHAIRMAN. Thank you so much for your excellent testimony. 

Ms. Hoxie. 

STATEMENT OF BETTE HOXIE, EXECUTIVE DIRECTOR, ADOPTIVE AND FOSTER FAMILIES OF MAINE AND THE KINSHIP 

PROGRAM, ORONO, MAINE 

Ms. HOXIE. Good afternoon, Chairman Collins, Ranking Member 

Casey, and members of the Special Committee on Aging. My name 

is Bette Hoxie, and I am honored to speak with you today regarding both my professional and personal experiences with this topic. 

I am first and foremost a mother, grandmother, and great-grandmother. I raised my grandson since his infancy, and he will soon 

be 18 years old and graduating from high school and on to study 

conservation law enforcement. I have to add, a few months ago he 

originally said, ‘‘I think I will do social work,’’ and I am thinking, 

‘‘Oh, please, no.’’ But I did not say that. 

[Laughter.] 

Ms. HOXIE. I just said, ‘‘Do whatever you want,’’ and luckily he 

changed his mind. 

I am also the executive director of Adoptive and Foster Families 

of Maine and the Kinship Program. It is comparable to what others 

were talking about with regard to the Navigator Program, although 

we serve all three components, both foster, adoptive, and kinship. 

The aspects of kinship care or grandfamilies are closely replicated 

to the Navigator Program. 

Like so many other states, as you have already heard, Maine is 

severely affected by the opioid crisis that permeates our Nation and 

its vulnerable families. More and more infants are being born to 

mothers who are using opioids while pregnant. These births are 

taking a toll on a population of caring people who would, if they 

could, simply love their grandchildren, spoil them, and send them 

home to be raised and nurtured by their parents. However, obviously, for many families that is no longer an option. Instead, the 

grandparents are becoming the primary caretakers. 

The organization that I work for, Adoptive and Foster Families 

of Maine, works with an amazing team of professionals throughout 

the state to support these grandparents, who, in most cases, were 

never expecting to parent again, at least not in this way. They may 

not have a spare bed at home or clothing. They may need a crib. 

There are a number of different material goods that they will not 

have access to. So one of the things that our organization does on 

a very easy level is to collect new and gently used items, including 

the beds and furniture and clothing and make them accessible to 

AGING-SDG-5 with DISTILLER

12 

the families. When we do not have them immediately at one of our 

offices, we put it on our list serve, and Maine’s families are amazingly generous and kind, and they frequently fill that void within 

a few days. 

We also help the families as they are going through and navigating the licensing process to become foster parents for their 

grandchildren. And depending on where they are in time and 

space, we may also be helping them to work through the probate 

court system where some will get guardianship because the Department of Health and Human Services is not involved. 

For example, when they are going through the licensing process, 

as Senator Collins indicated, this is sometimes a very lengthy process, and it can be costly. Many of the homes in Maine are older 

homes and the windows are not egress, therefore, they will not 

pass the foster care licensing standard and that can be a barrier. 

One of the things our office has been able to do in some instances 

is to get donations of windows that are the right size or get volunteers who are willing to help install the windows, anything to try 

to bring some of these totally unexpected costs down. 

The organization provides specific support groups, and this is 

huge for the families. Being able to talk with others who are walking the walk and talking the talk just helps to make you feel like 

you are more a part of things. It diminishes some of the isolation 

that the other two presenters have talked about. And also at those 

meetings, we have the children come as well, so we provide child 

care, and that also helps them to feel like, ‘‘Wow, I am not the only 

one being raised by my grandmother,’’ or ‘‘my grandfather,’’ whatever the case is, and they feel less isolated themselves. 

Another benefit of those support groups is that although many 

people think of respite care as something that should last days or 

even weeks, for many of us—and I will include myself in this number—15 minutes to spend in the bathroom or go to the library to 

pick out a new book or even have time to read that book is huge. 

So at these support group meetings, for an hour and a half or two 

hours, they are engaging with other adults and feeling like that is 

a form of respite, and the children are in other rooms taking part 

in activities and sharing their own experiences. 

Something else that we are able to do is we rely on—you know, 

it is not a one-stop shop. Adoptive and Foster Families of Maine 

is a very small organization. Even though we have an office in 

Orono and one in Saco, we only have a staff of seven throughout 

the state, and two of them—three, actually, if I count myself—are 

what we consider kinship specialists, but the others have a variety 

of other designated positions. So we try really hard to provide those 

families with training, and we do a statewide training conference 

annually. And for the first 20 families, kinship or grandparents, 

who are unlicensed, we provide them with the cost-free registration, and if they are traveling more than 60 or 70 miles, we may 

also pay for their overnight stay at the hotel because that is just 

so important for them to have those opportunities to both learn and 

to network. 

I mentioned earlier that I raised my grandson. Well, today I am 

raising a 19-month-old little boy. He is not biologically related to 

me, but he is still part of my family. When I agreed to raise my 

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13 

grandson nearly 18 years ago, I imagined, ‘‘Will I still be walking 

upright and be able to march with him as he marches down the 

aisle?’’ Just a few months away, I guess I will succeed in that. But 

now I am looking at being past 70 and at a little boy who is yet 

to be two years old, and my thinking is: Am I the right person? I 

love him, he loves me. We love his family. We are hoping for good 

things. But it is still a question. And, you know, his mom is struggling with this crisis, this world of the opioids, and, you know, I 

have no idea. I cannot see into the future what that will be for her. 

I know she loves her son, and that is huge. And I hope she loves 

herself enough to get the help she needs. 

But that is part of why I really want to talk with all of you 

today, is to think about the ways that we can help this whole dynamic. We cannot do anything in isolation. It cannot be just the 

child. It cannot be just the parents. It cannot be just the grandparents. It has to be an active networking to provide supports to 

all concerned and not the least of which is mental health care. 

Funds to meet the barriers for these families can be huge. Just 

traveling back and forth to the doctor with the children is an unexpected cost, never mind things like child care, which most of us 

need—clothing and diapers—all of these things are added to families who had expected to be retired by now. 

So I would just look to all of you because I think that it is great 

that the families can rely on organizations like Adoptive and Foster 

Families of Maine and individuals like all of us here who care. But 

as a Nation, we also need to step forward and say yes, you can rely 

on individual organizations, but you can also rely on your country 

because you are doing extraordinary work, keeping your family together as a family and, moreover, keeping those children safe. 

So I thank you for recognizing this important issue. I appreciate 

the opportunity to share just a little bit of what is happening in 

Maine, both in terms of what works—and there are some things 

that work—and what continues to be challenging. And I hope that 

I can respond to any questions and be useful as you work to support grandparents raising grandchildren who have been affected by 

the opioid crisis. 

Thank you. 

The CHAIRMAN. Thank you so much for your very compelling testimony. You truly are one of those super heroes that we have heard 

about. 

And last but certainly not least, we will hear from Dr. McDaniel. 

Thank you for being here. 

STATEMENT OF SHARON McDANIEL, MPA, ED.D., PRESIDENT 

AND CHIEF EXECUTIVE OFFICER, A SECOND CHANCE, INC., 

PITTSBURGH, PENNSYLVANIA 

Ms. MCDANIEL. Thank you. Chairman Collins, Ranking Member 

Casey, and members of the Committee, good afternoon. I greet you 

by saying ‘‘Kasserian Ingera.’’ ‘‘Kasserian Ingera.’’ ‘‘How are the 

children?’’ The Masai Warriors of Africa go from village to village 

asking, ‘‘How are the children?’’ And so today you are asking, ‘‘How 

are the grandfamilies and the children?’’ And I thank you. 

I am Sharon McDaniel, President and CEO of A Second Chance, 

Incorporated, a leader in kinship foster care and support services 

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14 

in Pennsylvania. I am also on the Board of Trustees of Casey Family Programs, the largest national foundation dedicated to the safety, permanency, and well-being of children in the foster care system. 

Since 1994, A Second Chance has serviced over 21,000 children 

throughout the two largest counties—Philadelphia and Allegheny 

County–-in Pennsylvania. 

Each day the dedicated staff of A Second Chance services over 

1,800 children. We have a mantra at A Second Chance that says, 

‘‘Every child touched by A Second Chance has a right to be safe 

and must thrive.’’ We do not treat our children as if they are in 

foster care but, rather, simply with family. 

So who are the children? They range from newborns to 21 years 

old. Fifty-six percent of the children in our Philadelphia office are 

under the age of five. This is an 11 percent increase in two years 

due to the opioid crisis. Forty-eight percent of the children in our 

Pittsburgh office are under the age of five. They are all enrolled in 

CHIP. They receive Medicaid support. They are from urban and 

rural communities and 82 percent of our kids have entered care because of neglect which is often associated with parental substance 

abuse. 

Our caregivers, 65 percent of them are maternal grandparents. 

Forty percent of all of our caregivers are single, female heads of 

household. Sixty-seven percent are over the age of 55, and they are 

often low-income. Our parents are single moms (82 percent of 

them). They are low-income, and they have a GED. 

It is critically important to know that kinship families are resilient and do not lose value in crisis. I am profoundly humbled and 

appreciative to be able to share with you a couple of stories where 

grandfamilies have stepped up and stepped in, and I will start with 

my own. You see me. 

From the time that I was two years old, I was placed in the care 

of my fictive kin. They were not related by blood, but related by 

the heart. They were members of my father’s village. Following the 

tragic death of my mother, my father sunk into a deep depression 

and attempted to drink his way out of the problem. And he realized 

that he did not want this life for his young children. 

I witnessed, and was central to, the personal sacrifices that my 

grandparents had to make for us. And in the book that I gave you 

all, I tell my entire story, so I hope you get a chance to read it. 

Today, I am reminded of a grandmother who I met a year ago. 

She was 62 years old, and she had a successful career at Verizon 

when she was suddenly asked to care for her five grandchildren 

due to her daughter-in-law’s opioid addiction. The family made 

these arrangements outside of the child welfare system. Unfortunately, due to the lack of supports, this grandmother ended up losing her job, and she and her grandchildren had to rely on TANF 

child-only payments to support her financially. The provisions outlined in Families First could have helped this grandmom. Thankfully, her faith community stepped in. The grandmother said to me, 

‘‘Though I may not have much, I have my grandchildren. They are 

with me and not in the system, and we are going to be all right.’’ 

Grandfamilies inside and outside of the child welfare system 

need support. For those inside the system, they need to be seen as 

AGING-SDG-5 with DISTILLER

15 

an asset and not a problem. Grandfamilies already deal with feelings of isolation and guilt, but they must be treated with the dignity and respect that they deserve. 

Grandfamilies outside the system need the same supports as 

those offered inside—navigator programs, support groups, financial 

support, and mental health counseling. 

As a Nation, where would we be without grandfamilies? They 

make unparalleled sacrifices because they value keeping their families together. 

In closing, my Grandma’s Hands Support Group participants told 

me to tell you this: ‘‘We do what we do because we love our grandchildren and our families. We need your help and cannot do what 

we do without your love, support, and suspended judgment of those 

we interact with each day. Treat us as if we were your own grandchildren.’’ 

Thank you for the opportunity to present to you today. 

The CHAIRMAN. Thank you so much for your terrific testimony. 

Ms. Hoxie, I am going to start with you, not surprisingly. You 

told me earlier when we were talking about your grandson whom 

you raised from when he was just an infant, and he is now 18 and 

on the verge of graduating from high school, as you shared with us. 

And he is a handsome young man, too, I might add. You mentioned 

in your testimony that you are now approaching 70—— 

Ms. HOXIE. I am past 70. 

The CHAIRMAN. Or past 70, and I know from our previous interactions that you have raised some 19 children over the years. Now 

you are taking on the role of mother once again of a toddler. Tell 

us what motivates you. 

Ms. HOXIE. Well, I think it is what we have all talked about. It 

is about keeping family together. He thinks of me as his grandmother, and our family is his family. And so, you know, I have a 

real passion for making sure that that family stays as intact as it 

is possible. And I cannot see the—I do not know what the future 

brings, but I know definitely that we are his family. 

The CHAIRMAN. Well, I think he is very lucky. 

Ms. HOXIE. Well, when he is not wrecking my house, I think I 

am pretty lucky, too. 

[Laughter.] 

The CHAIRMAN. You talked about the services that the organization for which you work which helps not only kinship, it provides 

programs for adoptive and foster and kinship families, and you 

mentioned the importance of support groups and respite care and 

how critical that is. Maine is a large rural state where people often 

live in very small communities. How do you cope with the barriers 

of providing services in a state as large and rural as ours is? 

Ms. HOXIE. For some things, you know, we have had a lot of support between different staff at the Department of Health and 

Human Services and other—you know, like where some of us from 

the staff is constantly on the road, so we have learned to rendezvous with folks who will say, ‘‘Okay. We are going to be at the 

Clinton exit in 20 minutes. Can we stop by and drop off what you 

have requested?’’ So sometimes it is as simple as that. 

With regard to support groups, we have 26 around the state, and 

for a small state, that is a lot. 

AGING-SDG-5 with DISTILLER

16 

The CHAIRMAN. That is indeed. 

Ms. HOXIE. But it still does not come close to meeting all the 

needs, so we have developed a mentor program so people can be 

on the phone and responding and helping them work through 

whatever the issues are. Again, it is not 100 percent, but it is a 

lot better than it could be. 

The CHAIRMAN. And that must be particularly important when 

you are dealing with children who have special needs. 

Ms. HOXIE. Absolutely. And then, you know, a lot of my staff 

have professional expertise in that topic, but we also take advantage of a program called Maine Parent Federation, which is another statewide organization that really provides support to all 

families that may have a child with special educational needs. And 

as you know, because so many of these children have been prenatally exposed to drugs and alcohol, a lot of them have a lot of 

issues educationally. Some would happen perhaps just because of 

the climate, the atmosphere that they were originally raised in. 

But many of them are prenatally exposed, and their brains are 

really compromised, unfortunately. 

The CHAIRMAN. I really worry about those babies and what is 

going to happen to them later on as the effect of that prenatal exposure becomes evident, although I know we are doing a much better job and have developed expertise in helping those little children. 

Ms. HOXIE. Exactly. 

The CHAIRMAN. Ms. Lent, the Kinship Care Programs are a great 

example of what can happen when agencies collaborate effectively. 

When I considered the role of the Aging Network in helping grandparents, I was surprised to learn that some states are not expending the maximum allowable amount of their National Family Caregiver Support Program funds. In fact—and correct me if I am 

wrong—but I think you said only seven states were using the program fully. Why do you think that is? 

Ms. LENT. Sure. So the National Family Caregiver Support Program allows ten percent of the dollars from that program to be 

used to serve grandfamilies. The program is designed for all types 

of family caregivers, but up to ten percent can be used for these 

families. And what we find is that states need to learn from each 

other about this issue and effective programs to serve the families. 

So when the program was first enacted, we put together some information to do some resource and information sharing between 

states about effective uses of the funds. It is not a lot of money, 

but we have seen some really creative and effective use of these 

dollars from putting together legal guides to operating support 

groups, to information and referral services, to money for bunk 

beds when there is an emergency. 

So we really see a need to elevate those practices and share information about effective use of these funds so that the Area Agencies on Aging can understand the population better—it is not a 

population that they are traditionally thinking of serving—to educate them more on the special needs of the population and creative 

and effective ways to serve them. 

The CHAIRMAN. Thank you. 

Senator Casey? 

AGING-SDG-5 with DISTILLER

17 

Senator CASEY. Thank you very much, Madam Chair, and I want 

to, first of all, thank the panel for bringing your testimony here 

and your experience, your expertise, and even your passion. I will 

start with Dr. McDaniel. 

We know that—we have some sense, I should say, not all of us 

know for sure, but even someone who is not living through this 

challenge knows the burden that folks are carrying. And one of the 

issues is can that grandparent or grandparents, can they access resources or information to help them, especially initially when they 

know they have to take on a significant new assignment? And I 

guess I would ask you, what can we do to be helpful in providing 

more opportunities to create what I called earlier a ‘‘one-stop shop’’ 

or one place for people to go? Is that simply aggregating existing 

services or opportunities? Or is that something where we have to 

create a new model or a new paradigm? 

Ms. MCDANIEL. Thank you, Senator, for the question. I think 

Jaia talked earlier about how we can think differently about places 

like senior centers in a different way. There are many community 

resources, but it really is about the way in which communities operate are currently in categorical places, so senior funding does not 

cross over the child welfare funding. So how do we create an integrated approach where, if a grandma has a child that is inside the 

child welfare system or not, that if she shows up at a senior center 

that she is able to get all the supports that she needs for that 

young person. An integrated model is what’s needed in every community in America. I think that would go a long way. 

We need to also normalize. We talk about grandfamilies living in 

isolation. Grandfamilies—and I am a grandmom—need to know 

they are not alone in this fight, in this crisis. We need to be able 

to think about public service announcements where families live, 

work, and play; about having flyers and information and letting 

them know that we are here with then. 

Senator CASEY. One issue that has arisen is access to mental 

health services. Tell us about that, if you could, if there are any 

barriers. What do you know about that? 

Ms. MCDANIEL. The young people I serve are all eligible. In fact, 

we enroll them in CHIP and Medicaid. But for grandfamilies who 

are outside of the child welfare system, it can be extremely difficult. They go to a TANF office. They are asked a host of questions 

that they may not even understand or know, and the process becomes very cumbersome. 

We need to streamline the language and the process so that 

when grandfamilies show up at these offices, they know what they 

are being asked. I think if we do something like that will help 

grandfamilies know that there are supports available. There are 

kids who have had traumatic experiences. We need to address their 

trauma because, otherwise, we are going to continue to create another generation of young people who have gone untreated. 

Senator CASEY. And I know that your work brings you in contact 

with the health care system on a regular basis, and I know that 

is not what you do most of your days making recommendations 

about how to improve health care. But do you have any suggestions 

that we should focus on, especially now where we have the attenAGING-SDG-5 with DISTILLER

18 

tion of the Nation on the question of health care? Anything you 

would recommend there? 

Ms. MCDANIEL. Children need health care. I just want to share 

a story with you briefly. Two weeks ago, I had to work with a family to bury a two-year old child. That child was taken to the hospital, but did not receive appropriate treatment, and the child died 

of pneumonia. 

If she did not have health care, what would have happened? She 

showed up with Medicaid. We need to make sure that families have 

the health care that they need and also that our systems are responsive to our children. 

Senator CASEY. I appreciate that. I will wait for the second 

round. 

The CHAIRMAN. Thank you. 

Senator Cortez Masto, nice to see you. 

Senator CORTEZ MASTO. Thank you, Madam Chair, and thank 

you for having this panel on this important topic. 

I am the former Attorney General of Nevada and I bring that up 

because I spent eight years addressing this specific issue. I drafted 

legislation and worked to pass it through the legislature to form a 

substance abuse working group that I chaired. I additionally created a drug-endangered children’s unit in my office to address this 

issue. Moreover, I have been very vocal about the opioid abuse occurring in the State of Nevada and across the country that we see 

has just taken control, unfortunately, of many of our lives. 

And so I have a number of questions for you because I think 

many of them are topics that we still need to address but we are 

too afraid sometimes to bring forward. So let me just give you an 

example. 

In the State of Nevada, to get substance abuse treatment, because there is very little of it, you have to commit a crime, and you 

get priority for that. 

Now, with that said, the Affordable Care Act has brought additional resources for treatment—mental health treatment, substance 

abuse treatment—and there is talk about repealing it. I have concerns about how that is going to impact our communities. Particularly, I am concerned about those who are, unfortunately, going 

down the path of substance abuse and those who must take care 

of their children. 

I am curious. Does anybody have any thoughts on the impact 

that taking away treatment, particularly for opioids, is going to 

have across this country on the individuals who need it, whether 

they are children or adults? 

Ms. LENT. I am happy to speak to that. What I can say is that 

health care is critically important to these families. In particular, 

Sharon spoke to the fact that she works with many families inside 

the system. We are also familiar with the needs of families that are 

operating outside of the child welfare system, so they have no one 

place to go for information and support. However, when they do access some information about what they can qualify for, usually the 

one thing that they can access is Medicaid for the children, and 

that is critically important. 

AGING-SDG-5 with DISTILLER

19 

And you also have families that may be too proud to access any 

cash assistance or help, but they know that they cannot afford the 

medical care for children, so they find that critically important. 

Actually, there was just a comment—Washington Post commentator Michelle Singletary just did a story last week talking about 

Big Mama, who she pulls a lot of her financial advice from, and she 

specifically—she was raised by her grandmother, Big Mama, and 

she said, ‘‘Big Mama was too proud to accept money, but she knew 

she did not make enough to get treatment and medicine that we 

all needed.’’ So she learned from her. This is a person who is very 

savvy with dollars, but she needed the medical support, and it was 

critical to her family. 

So Medicaid in particular is a critical foundation for these families, and we would not want anything to tear away at that critical 

program. 

Senator CORTEZ MASTO. And I appreciate that comment. 

The other piece I see missing, and that we typically do not fund, 

is education awareness. To me, that is the first step in prevention, 

and it never gets funded. I had to fight for $1 million out of my 

legislature just to engage in an education awareness piece on the 

threat of methamphetamine abuse, and that was the only time that 

we had ever put money into education awareness. I am concerned 

that we are still going down that path with opioids, and, Dr. 

McDaniel, you talked about it. It is about the education piece. It 

is about talking about it. It is about making sure there are dollars 

going to communities to teach them about what is happening with 

this opioid crisis. 

I am interested also, Dr. McDaniel, on your thoughts on that, 

along with how we have an impact on our rural communities. In 

Nevada, we have rural communities that are challenged just to 

have resources or access to health care and mental health needs. 

I am curious about your thoughts on how we can work together to 

improve that at a federal level and provide the assistance that is 

necessary. 

Ms. MCDANIEL. Right. I would think about us going back to funding the Kinship Navigator Programs. Those programs work in rural 

and urban communities, so we have to make them available. 

And the other piece that I wanted to go back to is the education 

component. If we do not have the necessary treatment, we will also 

see children languishing in foster care because families will not be 

able to get the treatment to remediate the issues. We already have 

over 400,000 children in the foster care system. You will see that 

number go up if families do not receive treatment because they 

cannot go back home, they cannot be returned, if they have not addressed their drug and alcohol addiction. 

We need to make sure that the educational content addresses 

treatment as well as what could happen in child welfare. 

Senator CORTEZ MASTO. Thank you. And I know my time is up. 

I just want to say, though, about what you are doing with respect 

to caregivers, that both the stress level and support out there are 

crucial to our communities in helping address this issue. And if 

there is a way that we can, Madam Chair, figure out how we can 

provide additional support to the caregivers as well, I am supAGING-SDG-5 with DISTILLER

20 

portive of it, and I think it is something we should be looking to 

do. Thank you. 

The CHAIRMAN. Thank you very much. 

Senator Donnelly? 

Senator DONNELLY. Thank you, Madam Chair. 

Before I begin my questioning, I want to first share the story of 

a woman from Indianapolis named Theresa Short. Theresa is a 

grandmother who is currently raising her grandson because her 

son suffers from an opioid addiction. She faces many of the same 

challenges that have been highlighted in this hearing here today. 

When describing the difficulties of raising a grandchild outside 

the formal foster system due to the opioid epidemic and the challenges of accessing necessary resources for her grandson, Theresa 

wrote, ‘‘I could not get his medical records because I had no legal 

guardianship. I had to buy him new school supplies, new clothes 

and everything else a boy might need. As a grandparent, I had to 

do this alone with no support. The odds were stacked against my 

grandson and against me as a grandparent. Without having legal 

guardianship of my grandson, it made it difficult to reach out for 

help and to provide services to our family. My grandson is hurting, 

and many times he feels like he is already an adult. His childhood 

was taken. The things he has gone through are not easy, and trying to regain those relationships with his parents has been a process. Our grandchildren need to have access to counseling, and 

grandparents need to help change the cycle, and they need help to 

do that.’’ 

Theresa’s story is shared by too many families in my home State 

of Indiana and across our country. I want to thank all of you for 

the work you do to address this issue and for taking the time to 

testify here today. 

Ms. Lent, I would like to ask you, as Theresa noted in her story, 

many children impacted by the opioid epidemic need access to 

counseling and mental health services. You mentioned in your testimony that Medicaid plays a critical role in providing health care 

to grandfamilies. In your view, how would grandfamilies be affected and impacted by the attempt to cut Medicaid spending by 

$880 billion in the American Health Care Act? 

Ms. LENT. Again, Medicaid is a critical source of support for 

these families. To some families, it is the only federal program or 

support that they do tap into, are aware of, and get access to. So 

it is important for the children. Children that are impacted by the 

opioid epidemic, if their parents are struggling with addiction and 

they have trauma in their history, they certainly need to get some 

support early on to make sure that they do not fall prey to a similar path. And having access to health care and stable support of 

a loving caregiver are two critical factors in ensuring that they, 

contribute and grow up to be healthy, thriving adults. And Medicaid in so many of these families is a critical part of that picture. 

Senator DONNELLY. Thank you. 

Dr. McDaniel, you shared your organization immediately seeks to 

enroll children in CHIP in order to assess their medical needs. In 

your experience, are there sufficient counseling services available 

to children? And how essential is CHIP in connecting children to 

the counseling services that are available? 

AGING-SDG-5 with DISTILLER

21 

Ms. MCDANIEL. Thank you for the questions, and let me answer 

the first one. In terms of the services available for children relative 

to trauma-informed care, absolutely no. There are not enough providers to address their needs because it is a specific way in which 

children need to be engaged when it is trauma-informed. There are 

not enough providers in that space. 

But in terms of CHIP, absolutely. Every child needs Medicaid. 

They need to be enrolled, even in the interim of finding that trauma-informed therapist or counselor. There needs to be someone 

who can support that young person. So, absolutely, CHIP is necessary. 

Senator DONNELLY. Thank you. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you, Senator. 

Dr. Dolbin-MacNab, research findings suggest that being a custodial grandparent is particularly taxing on those grandparents who 

are raising children without the presence of any parent. I was interested and heartened to learn from you that some of the negative 

outcomes that you mentioned can be avoided or turned around by 

those grandparents who are more resilient. But my question to you 

is this: Is resilience an innate quality that people have? Or is it 

something that can be learned? 

Dr. DOLBIN-MACNAB. Thank you for that question. Your question 

underscores a significant point of discussion and debate among 

those who study resilience. What we think is that characteristics 

associated with resilience, including coping skills, benefit finding, 

and seeing the good things in a challenging situation—those are 

skills that can be trained and developed. I have a colleague at Case 

Western Reserve University, Dr. Carol Musil, who does wonderful 

work. Dr. Musil and her colleagues provide resourcefulness training to grandparents raising grandchildren, and this training has 

shown very promising results related to reducing grandparents’ depression and stress, and improving their quality of life. 

There may be people who are more resilient than others, but 

many aspects of resilience are skills that can be taught. Also, we 

can improve grandparents’ resilience by improving the quality of 

the environments in which grandparents are living. Providing 

grandparents with some of the supports that we have all been talking about today can help promote resilience as well. 

The CHAIRMAN. Thank you. 

Dr. McDaniel, we have also talked about the financial strain that 

many grandparents experience when they assume this unexpected 

role later in life. As you mentioned, these grandparents often spend 

their own money on housing and school supplies and food—expenses that they had no reason to include when they were doing 

their budgets for their older years. 

How often do you see grandparents drawing on their retirement 

savings or even returning back to work in order to have sufficient 

funds to care for their grandchildren? 

Ms. MCDANIEL. It happens every day for the 7.6 million children 

that we talked about, caregivers are caring for those young people 

outside of the child welfare system, and are doing whatever it 

takes to make it. As you heard earlier, we know that grandparents 

are often on limited incomes or poor. So what are they tapping into 

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22 

if they are already poor? So we see them going back into the workforce. We see them staying longer. 

So I think one of the recommendations that I would make, we 

need to do something in the industry in terms of looking at employers. What are employers doing when it comes to grandfamilies who 

are staying longer in the workforce? Are we being sympathetic? Are 

we ensuring that child care is available? The very same things we 

did when the Family and Medical Leave Act first took place. We 

need to think about how that is transferred and how that is translated to grandfamilies who are working longer. 

In the child welfare system, however, grandfamilies who go 

through the process of foster care, they receive the same dollars 

and support that a foster parent would receive. But, again, those 

families outside of the system need that same support. 

The CHAIRMAN. You anticipated my next question which I was 

going to ask Ms. Lent about. But, actually, I will ask all of you just 

to go across, and that is, it seems to me we have an unusual situation here. Obviously, it often is best for the child to be with the 

grandparent or be with another family member. And yet unless 

they go through the legal process, in most states they are not going 

to get the financial assistance they would receive if they were ‘‘just 

foster parents.’’ 

Now, I know many foster parents in Maine, and they do an extraordinary job. They do get some assistance financially that many 

of these grandfamilies do not get. So is that correct? Is my understanding correct? And if so, do you have suggestions for what we 

might be able to do? Ms. Lent. 

Ms. LENT. Sure. So there is a continuum of arrangements that 

we see with grandparents raising grandchildren. On the one side, 

there would be those that go through the full licensing process, get 

the windows up to the exact requirements, have the right number 

of bedrooms, and go through that extensive process. And when they 

go through that process, the vast majority of those families would 

get the licensing rate that a traditional foster parent would be. But 

that is a small portion of all of the families. 

There are also those that can be in unlicensed foster care, so it 

is sort of an interim role where they may or may not get some 

amount of money, but it is not going to be the same amount as the 

fully licensed family. 

And then on the other end of the spectrum, there are those that 

just step in and keep the children from even making contact with 

the child welfare system. And by stepping in, in advance, and making sure that the child is safe and never even needs to make contact with the child welfare system, in a sense they are penalized, 

and they get almost no support. So that is the challenge that we 

have. 

Of course, we believe that we should be supporting families with 

what they need, not based on what circumstances ultimately 

brought the children into the relative’s care. So we need to find a 

way that we present them with their full range of options, talk 

about the advantages and disadvantages of each, and make sure 

they get the support that they need. 

The CHAIRMAN. Thank you. 

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23 

Dr. DOLBIN-MACNAB. One of the things that I have heard is that 

many grandparents are afraid of the child welfare system. They are 

afraid that their grandchildren will be taken away from them. 

They are afraid that siblings will be separated. Whether or not that 

is the case, that is a fear that they have, and they often experience 

a sense of stigma related to being involved in the child welfare system. Some of the grandparents that I have worked with were involved with the child welfare system when they were parents with 

their own children. 

One of the things to consider is how can we raise awareness 

among child welfare professionals and educate grandparents so 

that these systems can better support grandparents and so that 

these systems are not perceived by grandparents as being an adversarial environment and experience. 

The CHAIRMAN. Ms. Hoxie? 

Ms. HOXIE. Well, I would like to share just a quick story. I have 

been working with a grandmother who has a very medically fragile 

baby that was placed with her because of her daughter’s use of 

opioids, and she travels 240 miles twice a week to get the baby 

medical treatment, and at least once from Maine, Downeast Maine, 

to Boston once every 4 to 6 weeks. 

When she took the baby, it was with the fact that it was a safety 

plan. The Department of Health and Human Services had intervened, but they opted not to take the child into custody and left 

her with her grandmother. The grandmother was working. She had 

a reasonably good job. But because of the baby’s incredible medical 

needs, she took family leave in the beginning. She went on to take 

leave without pay. During that time she really fell behind, and she 

was in danger of losing her vehicle. 

Now, imagine what it would be like to know that is the only way 

that you can get access to medical treatment for that child, and 

there she was about to lose it. We were able to get some help for 

her and get her payments caught up, and she has since gone back 

to work, and she is in the foster care licensing process now, and 

the Department has taken custody. So, eventually, until she is licensed, she will get $10 a day. But in the meantime, there is this 

huge gap. And, interestingly enough—and part of this is—what I 

am getting to is that part of it is creating that awareness throughout the state and within the systems, including the Department of 

Health and Human Services, of how important it is, if you are 

going to take custody, to do it quickly so that the family has just 

even that minimal support. 

In Maine—and I do not know if it is across the country, but in 

Maine, for babies that are medically fragile, that could actually 

succumb to these effects of that fragility, they actually—once they 

are licensed, they are eligible for $60 a day. But here 10 months 

have gone by without them getting anything just because of gaps 

in the system and people not being aware. 

So when we are educating people, we just need to do a better job 

of emphasizing the possibilities and to encourage that those safety 

plans, if you will, do not go longer than the designated 35 days, or 

whatever it is in whatever state, because that will make a huge difference for some families. I mean, obviously, there are many other 

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24 

issues, but that one comes to mind quickly because, you know, I 

felt so badly for this family. 

The CHAIRMAN. Thank you. 

Dr. McDaniel—I know I am way over my time—did you have 

anything you wanted to add? 

Ms. MCDANIEL. I just offer that if we would consider federal 

child welfare finance reform, that initiative would allow us to look 

at how we fund child welfare. In the current system, the child has 

to be abused or neglected in order to receive resources. That should 

not happen. 

The CHAIRMAN. Thank you. 

Senator Casey? 

Senator CASEY. Thank you very much. 

Ms. Lent, I wanted to go back to your written testimony. Despite 

all the challenges that we have outlined or articulated here today, 

it is remarkable when you put on paper that list of positive outcomes that come from relative care, where you say on page 4 of 

your testimony, ‘‘reinforces safety, stability and well-being, reduces 

trauma, reinforces child’s sense of identity, helps keep brothers and 

sisters together, honors family and cultural ties, and increases the 

likelihood of having a permanent home.’’ Really powerful outcomes 

for that child and that family. 

I guess that leads me to one question. You made reference to a 

foster care savings of about $4 billion. Can you tell us about that? 

Ms. LENT. Sure. We know that the vast majority of children 

being raised by grandparents are being raised outside of the foster 

care system, so I talked about those on this end of the continuum 

that step in and keep children out of foster care, so never entering 

the foster care system. 

Well, when you look at the savings from that foster care payment, it is conservatively $4.5 billion a year per year. So there are 

savings that come from that. 

But there are also long-term savings, I would also suggest, because the children fare so well, so much better in the care of relatives, the children have fewer behavioral and mental health issues 

in the long run, so they are more likely to end up being contributing to our communities and our economy in positive ways. 

Senator CASEY. I appreciate that, and it is important for us to 

know that number. 

Dr. McDaniel, you had shared in your testimony the story of the 

grandmother who—let me get your exact words. You said that she 

was a 62-year-old grandmother who ‘‘had a successful career at 

Verizon when she was suddenly asked to care for her five grandchildren due to her daughter-in-law’s opioid addiction.’’ You go on 

to say that she had real trouble and her faith community saved 

her. 

Ms. MCDANIEL. Yes. 

Senator CASEY. Tell me about that example and the reason you 

raise that example in your testimony. What is the point that we 

should take away from that? 

Ms. MCDANIEL. Right. I raise that because she was quite isolated. She did not know about the community resources that were 

available. She had gone to the child welfare system, and they told 

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25 

her, ‘‘Well, because your family made those arrangements first, you 

are not eligible for any support from us.’’ 

So she went to the TANF office, and they said, ‘‘We are going to 

give you TANF and Medicaid and pretty much that is about it’’. If 

she was trying to get child care, she could not get child care, so 

she ended up losing her job. And what I did not add was that she 

was living in a one-bedroom apartment. If she was in the child welfare system, they would have said that was not adequate—‘‘We 

need to move you to a larger place.’’ But she should not have had 

to go to a child welfare office to get that support for the children 

that come in care. 

So Navigator Programs, support programs, programs that are associated with senior centers are the kinds of resources she should 

have been able to go and get the support that she needed, not lose 

her job. She was almost retirement age, but she had to give up all 

those years because she did not have the adequate supports. 

Senator CASEY. I appreciate that. Thank you. 

Ms. MCDANIEL. You are welcome. 

The CHAIRMAN. Senator Warren. 

Senator WARREN. Thank you, Madam Chair, and thank you very 

much for holding this hearing, and thank you, Ranking Member. 

Last week, I was at the Manet Community Health Center in 

Quincy, Massachusetts, and the week before that, I was at Lynn 

Community Health in Lynn, Massachusetts, and talking to physicians and first responders and patients and local officials about 

how this public health care crisis has devastated communities and 

families across our Commonwealth. 

According to the Massachusetts Department of Public Health, an 

estimated 2,000 people in our state died for opiate overdoses just 

last year. And as the Chair and the Ranking Member have noted, 

thousands of children are affected, and many are left in the care 

of their grandparents. And I have seen the data on this that children whose parents struggle with substance abuse disorder are 

about twice as likely to develop the disorder themselves. 

So where I wanted to start this was a variation on the question 

that Senator Casey just asked Dr. McDaniel, and that is about resources and connections. But this one is about when you suspect 

a substance abuse problem. 

Ms. Lent, can I ask you, if grandparents become concerned about 

a grandchild’s substance use, are there good options for them to access treatment or counseling in their own communities, maybe 

through a pediatrician, that grandparents are readily familiar 

with? 

Ms. LENT. So, again, those that are already connected to the 

child welfare system would probably turn to the social worker at 

the child welfare system for that information. But the vast majority 

do not have that resource available to them, so best-case scenario 

they live in a community that has a kinship navigator, where they 

would have a one-stop-shop answer to those questions. But those 

are also not available in most communities right now. We would 

like to see them. 

So I would say the vast majority of families in that case are 

going to look to the physician that they are connected with, probably their child’s pediatrician, so it would be very important that 

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26 

the physician is familiar with issues of substance use and how it 

affects children when they are exposed and when their families are 

dealing with that crisis and to coordinate those services. 

Those that may not even be comfortable talking to their physician are going to look to their peer network, and that is why support groups and other types of services of some of the agencies represented here are really important because that peer-to-peer communication and where to go for support is really critical as well. 

Senator WARREN. I understand that, and I think that is really 

important. 

Did you want to add to that? 

Dr. DOLBIN-MACNAB. Yes, thank you. Related to your question, 

there are some really exciting intervention models. One of those approaches is nicknamed SBIRT, which refers to Screening, Brief 

Intervention, and Referral to Treatment. This approach involves 

training a variety of practitioners, everyone from nurses to physicians, to screen people where they are and to make referrals in 

their communities for substance abuse treatment. I am in a rural 

community, and I think those types of resources are so important 

because people will go to their doctor to talk about what is going 

on, but they may not necessarily access a substance abuse treatment facility. 

Senator WARREN. Right. And, you know, your point gives me a 

chance to talk about one in Boston, but it is the reminder, how 

many different kinds of services may be needed when it is time to 

intervene. The adolescent substance abuse program at Boston Children’s Hospital brings together whole teams of pediatricians, social 

workers, child psychiatrists. They work on screening, they work on 

diagnosis, and they work on treatment for adolescents who have 

substance abuse disorder. And the idea is to do this hopefully at 

a time when they can keep children both at home and in school 

and try to work through these problems. And the program partners 

with pediatric practices throughout the region so that local doctors 

can get engaged in this. 

I take it from your comments, and from everyone nodding their 

heads about this, that this is an important thing for us to expand, 

that this is the kind of thing that we should try to make available 

throughout the country, so someone has got to weigh into this. 

I want to ask another part about this, and that is, when grandparents are trying to get substance use disorder diagnoses and 

treatment, both for their children and for their grandchildren, or 

for either, how important is health care coverage to providing access to preventive screening and to specialty care? Ms. Lent, could 

I ask you about that? 

Ms. LENT. Again, I would say it is critically important. I conveyed earlier that often when they do not have access to other services, they still have access to Medicaid for the children, and so that 

is a critical resource to them, again. But they need to be aware of 

it, so things like Kinship Navigator Programs and resources that 

can connect them to those services are important. But the health 

care is foundational. 

Senator WARREN. Right. And if the cost of health care goes up 

or if Medicaid is sharply cut, what will be the impact? Ms. Hoxie, 

maybe would you like to speak to that? 

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27 

Ms. HOXIE. Well, I can certainly speak on a personal note. 

Senator WARREN. Yes. 

Ms. HOXIE. If I did not have medical coverage for my children, 

I cannot even imagine, you know, what it would be like, and certainly for the families that I work with. 

I can give you one example of a family that lived in a rural area 

in Maine, and the grandmother was caring for her son who was addicted—his child—I do not know where the mother was in all of 

this—and her husband was ill. The son eventually overdosed and 

died, leaving grandmother with, ‘‘Oh, my gosh,’’ you know, ‘‘how do 

I meet the needs, the mental health needs now of this grieving 

child?’’ 

Two weeks later, her husband passed away, so she was, you 

know, looking everywhere to find grief counseling, and in the area 

that she lived in, there was not anything that was going to be 

available for 16 weeks. 

So I do not know if that answers your question, but going without it, you know, was devastating. And they did eventually find 

somebody that would work with them individually. She wanted 

someone that would work with them as a grieving family and with 

a child with some significant mental illness himself at this point. 

Senator WARREN. I appreciate that, and I see you all nodding on 

this. You know, the Affordable Care Act made it possible for many 

families that are struggling with substance abuse to get access to 

the care that they need. And if the mental health and substance 

abuse disorder protections of the ACA are cut out, the estimate is 

that there would be $5 billion in resources taken out of this area, 

which would make it a lot harder for families to get their lives back 

on track. 

So this is something that I appreciate your talking about and a 

reminder of how much we need to do to make sure that we are trying to support families that are struggling with this terrible epidemic. Thank you. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you. 

I want to thank all of our witnesses for testifying today. Your 

testimony was so compelling and educational, not only to the members of this panel, but to those who are watching on C–SPAN and 

to others who will learn about this hearing. 

One of the motivations for holding this hearing was to raise public awareness about the growing prevalence of grandparents raising 

grandchildren, something that has always occurred in society, as 

Dr. McDaniel has made clear, but we are seeing a huge increase 

as a result of the terrible opioid epidemic that is devastating so 

many families in so many communities across our country. 

Through your programs, your advocacy, your research, your service, and your testimony today, you are truly making a difference, 

and I thank each and every one of you for that. 

I thought that I would conclude my comments, before turning to 

my colleague, by quoting on the plus side of what happens when 

a grandparent takes in a grandchild, and this was from an interview of a grandmother who was interviewed on Maine television recently. She put it best when she said, ‘‘When your grandchild looks 

at you and says, ‘I love you more than 500 peanut butter sandAGING-SDG-5 with DISTILLER

28 

wiches,’ then you think to yourself, in the end it is worth it to know 

they are happy and safe. You know, just normal little boys. Maybe 

a little overactive, but a normal little boy.’’ And that really does 

sum it up, and that is the benefit of kinship care. 

Federal policies such as the National Family Caregiver Support 

Program continue to serve as a critical resource, but I agree with 

Ms. Lent in that a lot of states do not think of that program as 

a way to help grandparents that are raising grandchildren. There, 

again, I hope that we are raising the awareness of area Agencies 

on Aging, which do such fabulous work, that this is another possible use of the funding. We are going to continue to work together 

to look at what else we can do. 

In the meantime, I think we have an enormous debt of gratitude 

to those grandparents who are opening their homes and their 

hearts to their children’s children. 

Senator Casey? 

Senator CASEY. Madam Chair, thank you, and thank you for having this hearing and convening us. We hope we do not have to have 

future hearings on this topic, but I am afraid we may. 

I did want to reiterate what many of us have been thinking and 

I think some of us have tried to articulate one way or the other, 

and that is the heroic nature of what these individuals, these families are doing. We live in a society which, for not just recently but 

over, unfortunately, many generations, the people that we tend to 

point to as heroes really are not heroes. They are movie stars, athletes or people like that—really are not heroic. Soldiers are heroes, 

of course. People who protect us every day are heroes. And people 

who provide this kind of care and security for their family and in 

a sense our extended family are really heroic. 

To use an old expression, they lead quietly triumphant lives. 

Their names are not in the paper. They are not the subject of a 

claim of notoriety, but they get up every day and take on a more 

difficult task of raising children when they were looking forward to 

a tranquil and restful retirement. 

I do believe that we can come together and do more. I do not 

think the Federal Government is always the place to turn to for a 

new program or a new strategy to deal with the problem. But there 

has to be a way that the Federal Government can be a constructive 

partner in helping states and communities to aggregate services to 

come together. And we had some examples of that and some recommendations today. 

I think we have to make the right decisions the next couple of 

weeks and months on a range of policy matters, especially those relating to ACA and Medicaid especially, and I will be talking more 

about that. But we are grateful that you brought your own stories, 

your own expertise, and your own passion about these issues before 

us today. 

As a Pennsylvanian, I am especially grateful to Dr. McDaniel 

here, and also, Ann and Marvin, we are grateful that you made the 

trip to be with us today. 

But to all of our witnesses, I thank you for doing this, and 

thanks for bringing this information and heightening awareness of 

this challenge. 

The CHAIRMAN. Thank you, Senator Casey. 

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29 

Committee members will have until Friday, March 31st, to submit questions for the record. If we receive some, we will forward 

them on to you. Again, my thank you to all of you for your participation today. 

This hearing is now adjourned. 

[Whereupon, at 4:07 p.m., the Committee was adjourned.] 

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APPENDIX 

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Prepared Witness Statements and Questions 

for the Record 

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1 U.S. Census Bureau, 2015 American Community Survey. 

2 U.S. Census Bureau, 2010 Census. 

3 Annie E. Casey Foundation Kids Count Data Center. 2013–2015 Current Population Survey 

Annual Social and Economic Supplement. 

Prepared Statement of Jaia Peterson Lent, Deputy Executive Director, 

Generations United, Washington, DC 

Generations United is pleased to provide testimony to the Senate Special Committee on Aging. We applaud Chairwoman Collins, Ranking Member Casey, and 

members of the committee for your leadership in holding this hearing on the important role of grandparents and other relatives in providing safe and stable homes to 

children who cannot remain in the care of their parents, and the sharp increase in 

this trend attributed to the opioid crisis. 

Today’s grandparents provide a continuum of care from part- or full-time child 

care to raising a grandchild due to the parent’s death, disability, addiction or military deployment. This testimony will focus on grandparents and other relatives raising children, also known as grandfamilies. 

According to the U.S. Census, more than 2.6 million grandparents report they are 

responsible for their grandchildren.1 About 7.8 million children live in households 

headed by kin—a grandparent, uncle, aunt or other relatives.2 About 2.5 million 

children are living with grandparents, relatives or close family friends without either of their parents in the home.3

There are many kinds of grandfamilies. In some grandparents are raising children 

inside the formal foster care system as licensed or unlicensed kinship foster parents. 

Some have legal custody but no connection or support from the child welfare system. 

Still others are raising the children informally without legal custody or guardianship. While the challenges these families face are varied and complex, they are 

united by one common factor: they believe beyond a shadow of a doubt in the importance of family. They believe children fare better when they are raised in a family, 

not a system, and they are right. Yet we cannot ignore the fact that they often step 

in at great personal sacrifice, impacting their own health, family relationships, retirement plans and financial well-being. These caregivers, and the children they are 

protecting and nurturing, deserve our respect and support. 

My testimony today will focus on four key points: 

• One, the impact of the opioid epidemic on grandparents and other relatives; • Two, the critical role of grandparents and other relative caregivers in helping 

children thrive when their parents are no longer able to care for them; • Three, the importance of supportive services to help grandfamilies succeed; and • Four, the valuable role that the National Family Caregiver Support Program 

and Area Agencies on Aging can play in helping respond to the crisis. 

First, a little about Generations United. Generations United is the only national 

membership organization focused solely on improving the lives of children, youth 

and older people through intergenerational strategies, programs and public policies. 

Since 1986, Generations United has been the catalyst for policies and practices stimulating cooperation and collaboration among generations. We believe that we can 

only be successful in the face of our complex future if generational diversity is regarded as a national asset and fully leveraged. For almost twenty years, Generations United’s National Center on Grandfamilies has been a leading voice for issues 

affecting families headed by grandparents or other relatives and the need for evidence-based practices to support them. 

Impact of the Opioid Epidemic on Grandparents and Other Relatives 

Who are the grandparent caregivers? They are diverse in terms of race, culture, 

income and geography. Thirty-nine percent are over the age of 60 and approximately 58 percent are currently in the workforce. They are more likely to live below 

the poverty line than their peers—21 percent—and 26 percent have a disability. 

They face unique challenges that impact their well-being and their ability to fully 

support and parent their grandchildren. 

Unlike parents or foster parents who plan for months or years to care for a child, 

these grandparents or other relatives usually step into their role unexpectedly. 

Some may have received a call in the middle of the night telling them to come and 

pick up their grandchildren or they will end up in foster care. Suddenly, they are 

forced to navigate complex systems to help meet the physical and cognitive health 

challenges of the children who come into their care, often after experiencing significant trauma. 

Caregivers may struggle with their own mental health issues stemming from feelings of shame, loss or guilt about their adult child’s inability to parent. They may 

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35 

4 Examining the Opioid Epidemic: Challenges and Opportunities: Hearing before the Committee on Finance, Senate, 114th Cong. (2016) (statement of Nancy Young, Ph.D., Director, Children and Family Futures, Inc., Lake Forest, CA). | Kamp, J. & Campo-Flores, A. (2016, January 

11). Parents’ drug abuse strains child-welfare agencies: Growing epidemic puts more children 

into foster care. 5 National Data Archive on Child Abuse and Neglect. (2009–2015). Adoption and Foster Care 

Analysis and Reporting System, Foster Care Files 2008–2014. Retrieved from http:// 

www.ndacan.cornell.edu/datasets/datasets-list-afcars.cfm. 6Quinton, S. (2015, October 9). How heroin is hitting the foster care system. Pew Charitable 

Trusts, Stateline. Retrieved from http://www.pewtrusts.org/en/research-and-analysis/blogs/ 

stateline/2015/10/09/how-heroin-is-hitting-the-foster-care-system. 7 Analysis conducted by Children and Family Futures (CFF) on the public use 2014 Adoption 

and Foster Care Analysis and Reporting System dataset. Estimates based on all children in out 

of home care at some point during Fiscal Year 2014. 

suffer from social isolation and depression because they do not want their peers to 

know about their situation or because their peers are no longer parenting. Caregivers of children whose parents are using drugs may have their stress exacerbated 

by trying to maintain or navigate an ongoing relationship between the child and 

parent, often unaware if the parents are currently using drugs or alcohol and how 

their behavior will impact the child. Relative caregivers are often grieving a host 

of losses, including that of the treasured traditional grandparent role, control over 

their future, financial security or even the ability to go on vacation. 

Taking on the unexpected expense of a child can be especially devastating to caregivers living on fixed incomes. Countless grandfamilies report spending down their 

retirement savings to address the health, mental health, food and clothing needs of 

the children, or to pay legal expenses from seeking legal custody of the children. 

Others turn their retirement savings into college tuition payments. Many older caregivers live in one bedroom apartments or senior housing where children are not welcomed and need to move to larger, more expensive housing. 

While grandparents have been called upon to raise children for many reasons over 

the years, the current opioid and heroin epidemic is overwhelming many families 

and child welfare systems. 

Grandparent Pamela Livengood shined a light on impact when she said, ‘‘For my 

50th birthday, I got a two-year-old. My story isn’t unique. The [opioid] epidemic has 

devastated communities all over the country. It doesn’t discriminate against age, 

race or gender. It affects all of us.’’ 

After years of decline, the overall numbers of children in foster care are on the 

rise. From state to state, experts say the current opioid and heroin epidemic is the 

number one reason for this increase.4 Recent data show the percentage of children 

entering foster care due to parental drug and alcohol use rose from 22 percent to 

nearly 30 percent in just five years.5 This was the largest increase in any reason 

for removal. Some pockets of the country report as high as a 33 percent increase 

in the numbers of children in state custody.6

The current epidemic is hurting our country’s families and stressing many state’s 

child welfare systems. Child welfare systems are increasingly looking to grandparents and other relatives to care for the children as they face shortages of foster 

parents to meet the growing need. In 2014, more than a third of all children who 

were removed from their homes because of parental alcohol and drug use were 

placed with relatives.7

This is not just a child welfare system issue. As one grandmother said, ‘‘Grandparents are doing whatever it takes to bring their grandchildren to safety.’’ 

Although the child welfare system relies heavily on relatives, the number of 

grandparents, uncles, aunts and others who step in to care for children and keep 

them out of foster care far exceeds those raising children inside the system. In fact, 

for every child being raised in foster care (often referred to as ‘‘formal care’’) with 

a relative, there are 20 children living with grandparents or other relatives outside 

of the foster care system, in ‘‘informal care.’’ Often thrown into this caregiving role 

with little or no warning, caregivers frequently do not know about supports and 

services for which they may be eligible. Those raising children outside the system 

usually struggle with even less support. They save our country’s taxpayers more 

than $4 billion a year by raising and keeping children out of foster care. These families deserve our respect and support. 

Impact of Grandparent and Other Relative Caregiving on Child Well-being 

Grandparents and other relative caregivers play a critical role in helping children 

thrive when their parents are no longer able to care for them. 

Despite the challenges facing grandparents and other relatives raising children, 

children fare well in the care of relatives. Compared to children in non-relative care, 

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8Generations United. (2016). Children thrive in grandfamilies. 

they have more stability, are less likely to run away and are more likely to report 

feeling loved. When children cannot remain with their parents, research shows placing children with grandparents or other relatives: 

• Reinforces safety, stability and well-being • Reduces trauma • Reinforces child’s sense of identity • Helps keep brothers and sisters together • Honors family and cultural ties • Increases the likelihood of having a permanent home 8

When explaining why it was so important that he had been raised by his grandparents, Ray Krise, a member of the Skokomish Tribe near Shelton, Washington, 

said, ‘‘If not for being raised by my grandparents, I would not have a cultural identity. I wouldn’t know my family lineage and my son would not bear the name TchaLQad—a name that is 17 generations old . . . [They] helped me develop a real sense 

of pride and belonging.’’ 

Grandfamilies are also more likely to continue to provide a safe haven for a child 

long after they have turned 18 or transitioned out of the foster care system. A young 

person may age out of a system—they never age out of a family. 

Importance of Supportive Services to Help Grandfamilies Succeed 

While many strengths, challenges and needs are shared by these diverse families, 

the level, length and type of supports they need vary. Unfortunately, the degree to 

which these families receive supports and services from the child welfare system is 

often tied largely to the way in which they happen to come into their grandparent, 

aunt, uncle, or other relative’s care, not the needs of the family. 

Grandparents who are able to step in to protect and care for their grandchildren 

and keep them out of the child welfare system are, in a sense, punished for this 

critical and loving act. While services are often still inadequate for caregivers who 

become licensed as foster parents, they are far more likely to receive crucial supports and benefits than those raising children outside foster care. Child welfare programs should do more to prioritize supports for caregivers who keep children out 

of foster care and address barriers to licensing relatives as foster parents when it 

is the best option for the family. Networks of aging services agencies and other community supports can play a critical role in helping these families by coordinating 

with child welfare agencies to provide seamless supportive services to families with 

older caregivers of children who are not getting the full range of supports and services they need from the child welfare system. 

Families commonly face challenges that can be addressed through the provision 

of key supports and services such as: 

Information and Referral Services such as kinship navigator programs that provide a single point of entry for learning about housing, household resources, physical 

and mental health services and financial and legal assistance. 

Physical and Mental Health Care and Services for older caregivers and children 

including Medicaid and Medicare, which have proven to be critical resources to 

grandfamilies. Quality counseling and trauma-informed mental health services have 

been shown to improve outcomes for the caregivers and children. 

Affordable Legal Services so grandfamilies impacted by parental substance use 

disorders, whether inside or outside the foster care system, can access a continuum 

of legal relationship options and understand the differences—both legal and practical—of adoption, guardianship and legal custody. 

Lifespan Respite provides coordinated, community-based respite for family caregivers caring for individuals with special needs of all ages. 

Financial Supports including access to Temporary Assistance for Needy Families 

(TANF)—one of the three primary purposes of which is to support children in the 

care of relatives, Social Security retirement, disability and survivor benefits for both 

the caregivers and for the children, and Supplemental Security Income for low-income caregivers and children who are disabled. 

Valuable Role That the National Family Caregiver Support Program and Area Agencies on Aging Can Play in Helping Respond to the Crisis 

When the National Family Caregiver Support Program (NFCSP) was signed into 

law as part of the Older Americans Act in 2000, Generations United successfully 

advocated that grandparents and other relatives raising children be included to support older Americans not only as those receiving care but also as those giving care. 

Current law gives states the option to use up to 10 percent of state NFCSP dollars 

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to serve grandfamilies in which the caregiver is age 55 or older. According to the 

Administration for Community Living’s Aging Integrated Database (AGID), only 

seven states use nearly the full 10 percent of funds to serve the families. 

Those who do use the funds to serve grandfamilies report significant impact. But 

they are stretching scarce resources elevating the urgency for additional investments to adequately meet the needs of grandfamilies. Examples of successful uses 

of funds range from information and referral services to support groups to legal 

guides and clinics. Families benefiting from services through the aging network report positive experiences and outcomes. They are often more receptive to services 

provided through the aging network, because they have a higher level of comfort 

with those agencies than the child welfare system, which many may fear or distrust. 

Policy Recommendations 

• Protect the Social Services Block Grant (SSBG): SSBG provides critical support 

to states to serve children and older adults in communities, many of whom are 

in grandfamilies, through a range of community-based supportive services such 

as home-based meals, child care and child protective services. This flexible resource allows states to use the funds to meet local needs where they are greatest. • Ensure Access to Quality Health and Medical Care: Ensure that health care reform efforts recognize the critical role that Medicaid plays in providing health 

care coverage to grandfamilies. Health care reform efforts should not prevent 

the children and caregivers in grandfamilies from having access to quality 

health and mental health care, or the ability of parents to access substance 

abuse treatment and prevention services. 

• Promote Services to Grandfamilies Through the Network of Organizations Serving Older Americans: Urge states to maximize use of the National Family Caregiver Support Program (NFCSP) to serve grandfamilies. NFCSP funds may be 

used to provide supportive services to caregivers and children in grandfamilies 

regardless of whether they are involved with the child welfare system or have 

legal custody of the child. Although up to 10 percent of the program’s funds can 

be used for grandfamilies, most states do not make full use of the program to 

help support these families. Policy should support national experts and other 

resources to help educate the aging network about grandfamilies and the most 

effective services to support them. 

• Address Barriers to Licensing Grandparents and Other Relatives as Foster Parents: Adopt the Model Family Foster Home Licensing Standards, which Generations United developed in partnership with the National Association for Regulatory Administration and the American Bar Association Center on Children 

and the Law and with support from the Annie E. Casey Foundation, to eliminate unnecessary barriers that prevent suitable relatives and non-relatives from 

becoming licensed foster parents. 

• Reform Federal Child Welfare Financing to Encourage a Continuum of Tailored 

Services and Supports for Children, Parents and Caregivers in Grandfamilies: 

Allow states to use federal child welfare funds for prevention services for caregivers, parents and children, such as kinship navigator programs, substance 

abuse treatment and prevention services, mental health services and in-home 

supports. 

• Encourage Coordination of Services and Supports Among Temporary Assistance 

for Needy Families (TANF), Child Welfare and Aging Services Agencies: 

Through coordination, leveraging and braiding dollars among these agencies, 

more children and caregivers can be served. 

• Ensure Grandfamilies Can Access Financial Resources to Help Them Meet the 

Children’s Needs Such as TANF, Social Security, and Tax Relief: Access to 

TANF must be improved through a number of concrete policy and program 

steps including eliminating asset tests for caregivers over age 60 so that they 

can have savings for retirement; Social Security retirement, disability and survivor benefits and Supplemental Security Income must be protected and 

strengthened; and tax reform efforts should preserve the ability of 

grandfamilies to qualify for the Earned Income Tax Credit. 

• Provide an Array of Legal Options to Grandfamilies: Ensure that grandfamilies 

have access to a continuum of legal relationship options and understand the differences—both legal and practical—of adoption, guardianship and legal custody. 

As part of this effort, grandfamilies’ access to legal representation and assistance should be improved and expanded. Furthermore, all states should enact 

educational and health care consent laws so that children outside the foster 

care system and without a legal relationship to their caregivers can access education and health care services. 

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1 Ibid. 

2 Centers for Medicare & Medicaid Services, ‘‘CMS Releases Prescriber-Level Medicare Data 

for First Time’’ (April 30, 2016) (online at https://www.cms.gov/Newsroom/ 

MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015–04–30.html). 3Paula Span, ‘‘New Opioid Limits Challenge the Most Pain-Prone,’’ New York Times (June 

6, 2016) (online at: https://www.nytimes.com/2016/06/07/health/opioid-limits-older-patientspain.html). 4 National Institute on Drug Abuse fact sheet (online at: https://www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf). 5 National Institute on Drug Abuse fact sheet (online at: https://www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf). 6 ‘‘Drugs, Brains, and Behavior: The Science of Addiction,’’ National Institute of Drug Abuse 

(July 2014) (online at: https://www.drugabuse.gov/publications/drugs-brains-behavior-scienceaddiction/drug-abuse-addiction). 7See S. 524: Comprehensive Addiction and Recovery Act of 2016 (online at https:// 

www.Congress.gov/bill/114th-congress/senate-bill/524/text). 

• Elevate and Promote Best Practices Through a National Technical Assistance 

Center on Grandfamilies: Create a National Technical Assistance Center on 

Grandfamilies that engages experienced experts to provide a clearinghouse of 

best or promising practices and programs for serving children, parents and caregivers in grandfamilies. This includes guidelines for states to encourage best 

practices to support grandfamilies impacted by parental substance use, including ways to help caregivers meet the children’s needs and support birth parents’ 

access, engagement and success in treatment. The Center can facilitate learning 

across states and provide technical assistance and resources to those who directly work with all three generations in grandfamilies. 

Conclusion 

Stacey Walker, who along with his sister was raised by his grandmother, said, 

‘‘My grandmother already lived in a government housing project, and although her 

salary was enough to keep her afloat, she now had all sorts of expenses . . . any 

young child’s needs, multiplied by two.’’ Stacey’s grandmother sacrificed, scrounged 

and succeeded in raising her grandchildren. Stacey is what we at Generations 

United call a ‘‘grand success.’’ This past November, Stacey was elected the first African American supervisor of the Linn County Iowa Board of Supervisors. After his 

election, Stacey said, ‘‘It’s an honor to be an example of the value of being raised 

in an intergenerational home!’’ 

No matter the circumstances, every child deserves the roots and connection to the 

rich soil of family that nourish their growth and prosperity. 

Thank you for this opportunity to speak. 

Jaia Peterson Lent 

Response to Questions for the Record 

Sentor Elizabeth Warren 

Opioid Epidemic and Partial Fill Policies 

Older patients are frequently prescribed painkillers for chronic pain, or after surgery or other procedures.1 The Center for Medicare and Medicaid Services (CMS) 

reported that generic Vicodin was prescribed to more Medicare beneficiaries than 

any other drug in 2013.2 In 2015, almost 30 percent of Medicare Part D enrollees 

used an opioid prescription.3 If older adults don’t use their entire prescription, these 

pills can remain in the home—and the National Institute on Drug Abuse has estimated that over 70 percent of adults who misuse prescription opioids get the medication from friends or relative.4

As a consequence, efforts to reduce the amount of unused medications in the home 

can be a powerful tool to tackle prescription drug abuse.5 Grandparents raising 

grandchildren as a result of the opioid epidemic may want to keep unused medications out of reach of their adult children still struggling with substance use disorder, 

as well as their grandchildren, who are also at a higher risk of developing substance 

use disorder themselves.6 The Comprehensive Addiction and Recovery Act, passed 

in July 2016, empowers patients to talk to their physicians and pharmacists about 

partially filling their prescription medications in order to reduce the amount of unused opioids available for misuse.7 Instead of picking up their entire prescription 

all at once, patients would be able to take home a few days’ worth of medicine at 

a time, without having to get a new prescription from their physician each time. 

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Question: Do the grandparents you work with express concern about having unused 

prescriptions in their home? 

Response: 

Anecdotally we find grandparents raising grandchildren are conservative in their 

own use of opioid and other pain killers. Most are well aware of the genetic and 

life experiences that their grandchildren face and are thoughtful about keeping their 

medications out of reach of children/youth in their care. 

However, some caregivers report they need to hide their prescriptions particularly 

when family members at risk of or struggling with substance use disorders are visiting. When the prescription is stolen by adult children, teenage grandchildren or 

neighbors, for example, they cannot get more of their needed medication until the 

next month which negatively impacts their own health and comfort. 

Question: Would empowering grandparents to work with their physicians and pharmacists to partially fill their prescriptions—while also ensuring patients needing 

pain medicine receive it—help grandparents keep unused medications out of the 

hands of those struggling with substance use disorder, or those at a high risk of 

developing it? 

Response: 

An option to partially fill prescriptions could be beneficial for grandparents raising grandchildren who have concerns that the medication may be stolen or taken 

by family members struggling with substance use disorders. Furthermore, in the 

event the medication was taken, caregivers would not have to wait a full month to 

refill their needed prescription. It could also help low-income grandparents who are 

unable to cover the cost of the entire medication at one time by breaking down the 

cost throughout the month. 

However, one of the major barriers to health care for grandparent caregivers is 

transportation. Securing transportation to the pharmacy once a month is often a 

hardship. Requiring them to go twice a month would be twice as difficult. Any partial fill policy should be optional and should include strategies to help address barriers related to transportation to secure the medication. 

Question: Are kinship navigator and support groups well-informed about new federal partial-fill policies? 

Response: 

Within our extended network of caregivers and those serving them, the majority 

reported that they were unfamiliar with partial-fill policies. 

Question: What sort of actions can be taken by states, physicians, pharmacists, and 

patient and kinship groups to increase awareness of the new federal partial-fill 

policy so that grandparents and other kinship caregivers can take advantage of 

these options? 

Response: 

Our network of support groups, caregivers and practitioners have expressed an interest and willingness to share information about partial-fill policies through their 

support groups, informational seminars, newsletters, community partner meetings, 

and through their health and wellness programs. 

Question: What other approaches do you think can be taken by states, physicians, 

pharmacists, and patient and kinship groups to reduce the amount of unused prescription medication in circulation? 

Response: 

Recommendations from our grandfamilies networks include: 

• Making available and easily accessible drop off and disposal sites for unused 

medication. 

• For new prescriptions, providing samples to make sure the caregiver can take 

the medicine without side effects or issues before even fully or even partially 

filling a prescription. 

• Prescribing and including insurance coverage of alternative pain management 

approaches such as acupuncture. 

• Providing education literature to support groups and service networks about the 

availability of partial-fill policies, alternative pain management approaches, and 

safe and accessible drop off and disposal options. 

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Prepared Statement of Bette Hoxie, Executive Director, Adoptive and 

Foster Families of Maine and the Kinship Program, Orono, ME 

Good afternoon Chairman Collins, Ranking Member Casey and members of the 

Special Senate Committee on Aging. 

I am honored to speak with you today regarding both my professional and personal experiences with this topic. My name is Bette Hoxie. I am first and foremost 

a mother, grandmother, and great grandmother. I raised my grandson since his infancy. Today he is 17 years old, and he will graduate from high school in June. He 

plans to go into conservation law enforcement after college. 

I am also the executive director of Adoptive and Foster Families of Maine Inc. and 

the Kinship Program. 

Like so many other states, Maine is severely affected by the opioid crisis that permeates our nation and its vulnerable families. More and more infants are being 

born to mothers who are using opioids while pregnant. These births are taking a 

toll on a population of caring people who would—if they could—simply love their 

grandchildren, spoil them, and send them home to be raised and nurtured by their 

parents. But for an all too growing number of families, this is no longer an option. 

Instead, the grandparents have become the primary caretakers. 

Adoptive and Foster Families of Maine and the Kinship Program have a great 

team of professionals working daily to support these grandparents—who, in most 

cases, were never expecting to parent again. They may not have a spare bed at 

home or clothing for the children. In these instances, we are there to help. We collect new and gently used items including beds, furniture, clothing, bedding and 

other material goods, and provide them free to grandparents. If we do not have 

what a grandparent needs in stock, we send out a request to the list serve, and usually receive it within a few days. This office works with over 3,100 kinship families 

statewide—85 percent of the families are grand or great grandparents. One-third of 

the total is licensed as the foster parent to the child/children. 

We also provide licensing and legal education. We guide grandparents on how to 

work through Maine’s Health and Human Services system or gain guardianship 

through the Probate Court system depending on where things are in time and space. 

We walk grandparents through the licensing process, which can be lengthy, complicated, and costly. To attain the license, grandparents must be mentally and physical fit to care for children. We guide grandparents to medical providers in their localities to attain physical and mental health assessments. In some situations we are 

able to use donated funds to support grandparents with the financial costs for filing 

paperwork and or finger printing if they cannot afford it. Their home must also be 

licensed. It must meet certain safety standards, including bedroom space and windows that meet fire codes. Many of the older homes in Maine have small windows 

and do not qualify. We try to work with the grandparents to come up with solutions. 

Our organization provides specific support groups so families can share their stories and get emotional support from others like them who are walking the walk and 

talking the talk! Childcare is provided for children during the meetings so, like their 

caretakers, they are less isolated and can learn that they are not the only child 

being raised by grandparents. These support groups also serve as a mini respite for 

the grandparents for that evening. In rural areas of Maine, where transportation 

is difficult and families are unable to attend the groups, mentors with similar life 

experiences are invited to assist the families by phone. Respite is still a much-needed requirement for the families served and it is very difficult to attain. Frequently 

at the support meetings, families will develop their own respite amongst other members. 

We also provide kinship training. The training explains how DHHS works and 

where to go for support. Relative caregivers participate and share what they needed 

the most when they first started. We provide referrals to appropriate legal guidance 

and mental health services, as well as other resources as needed. For instance, we 

find that many of the grandchildren have special needs, suffer from trauma, or may 

be living with the effects of pre-natal substance abuse. We connect the grandparents 

with resources to help, such as the Maine Autism Society or the Maine Drug Awareness Program. 

One of the most powerful sources of support for grandparents is to meet others 

who are also raising their grandchildren. We organize a statewide conference, which 

brings together grandparents all across the state for education, training, and networking. We provide complimentary registration to the first 20 new grandparents 

to participate and we cover hotel accommodations for those who are coming from 

far away. When the grandparents come together, they feel a sense of solidarity in 

knowing that they are not alone, and they leave with a new set of tools to support 

themselves and their grandchildren on their second parenting journeys. 

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I mentioned earlier that I raised my grandson. Well, today—I am also raising a 

19-month-old boy. He is the nephew of one of my adopted sons. The baby’s biological 

mother is addicted to opioids. When I agreed to raise my grandson nearly 18 years 

ago, I wondered if I’d be able to walk down the aisle at his graduation. Now I find 

myself at 70 plus years of age wondering, ‘‘Am I the right person to take on this 

little boy?’’ I am no stranger to caring for my children. I’m the parent to 19 children 

and 40 grandchildren and 2 great grandchildren. 

I work with families on a daily basis that resembles mine. Helping the families 

understand that our small office is here really helps—despite the fact that they 

know what they are struggling with includes a long tough road ahead. Grandparents need to know that this country supports them as well. Funds to meet the 

basic needs of families taking on a relative’s child needs to be a priority. There are 

barriers in the foster care system but they are small compared to the needs in kinship/grandparent care! 

Many of the grandparents raising grandchildren had planned to be retired. Others 

are younger and still raising children of their own in addition to their grandchildren. Trying to make small or fixed-incomes cover the costs of such things as 

diapers and childcare are often insurmountable obstacles for the families who are 

giving their all to keep our nation’s children within their families of origin and 

above all else safe! 

Thank you for recognizing this important issue. I appreciate the opportunity to 

share just a bit of what is happening in Maine both in terms of what works and 

what continues to be challenging. I hope I can respond to any questions and be useful as you work to support grandparents raising their grandchildren who have been 

affected by the opioid crisis. 

Prepared Statement of Sharon McDaniel, MPA, Ed.D., President and Chief 

Executive Officer, A Second Chance, Inc., Pittsburgh, Pennsylvania 

Chairman Collins, Ranking Member Casey, and Members of the Committee, good 

afternoon and thank you for holding this hearing on the effects of the opioid crisis 

on grandfamilies. As those who place the well-being of children first and foremost, 

I first say to you, ‘‘Kasserian Ingera’’, meaning ‘‘and how are the children?’’ It is 

the greeting of the Masai Warriors of Africa as they move from village to village 

asking about the children, as they know it’s their responsibility to care for their 

young. I share in that same responsibility with all my heart. 

I am Sharon McDaniel, President and CEO of A Second Chance, Inc., a leader 

in the provision of kinship care and support services in Pennsylvania. I am also on 

the Board of Trustees of Casey Family Programs, the largest national foundation 

dedicated exclusively to the safety, permanency, and well-being of children in the 

child welfare system. 

Since 1994, A Second Chance has answered the call in meeting the needs of over 

21,000 children throughout the two largest counties in Pennsylvania (i.e., Philadelphia and Allegheny). From time-to-time, we have also serviced a few of the smaller 

counties. Many of these children and youth were placed in the care of their maternal grandmothers. In fact, over 65 percent of our current children and youth are 

placed in the care of their maternal grandparents; where 40 percent are single female heads of household. 

Each day, the dedicated staff of A Second Chance service over 1,800 children, 

their caregivers, and their birth parents. This does not include the many uncounted 

grandfamilies who are outside of the system and receiving very few supports. 

My eyes have seen a lot throughout my 30-year career in child welfare. I worked 

alongside families through the heartbreak of the crack epidemic in the 90’s. Today, 

the opioid epidemic is bringing children into the system at earlier ages. Through crisis and heartbreak, however, families can still triumph. Families do not lose value 

in crisis. Thus, I am profoundly humbled and appreciative to be able to share with 

you a couple of stories that elevate this conversation from the pages of my notes 

to the imprinted visuals in your heads about the importance of grandfamilies and 

the children that they care for on a daily basis. 

I will start with my own story . . . you see me! From the time that I was 2 years 

old, I was placed in the care of my fictive grandparents; they were not related by 

blood, but related by the heart. They were members of my father’s village. Following 

the tragic death of my mother, my father sunk into a deep depression—which he 

attempted to drink his way out of, and realized that this was not the life that he 

wanted for his young children. Because the system had no real mechanism for kinship care back then, we were placed with my grandparents as foster children. 

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I witnessed, and was central to, all of the personal sacrifices that my grandparents had to make for us, from child care to family support. When we were school 

age, my grandmother used her foster care payments to pay for those extra things 

that would support our educational, cultural and social needs. She only wanted the 

best for us. 

Like my grandparents then, many grandparents want the best for their grandchildren. Today, I am reminded of a grandmother I met last year. She was 62 years 

old and had a successful career at Verizon when she was suddenly asked to care 

for her five grandchildren due to her daughter-in-law’s opioid addiction. The family 

made these arrangements outside of the child welfare system. Today, more than 2.5 

million children are in a similar situation due to their parent’s inability to care for 

them for a variety of reasons. Unfortunately, this grandmother ended up losing her 

job. She and her grandchildren lived in a one-bedroom apartment, had limited financial means and relied on TANF child-only payments. She was unaware of any 

support that could help with her overcrowded living conditions, including any support that the Department of Aging could offer her or her grandchildren. Thankfully, 

it was her faith community that stepped in and partnered with her to fill in the 

gaps when and where needed. The grandmother said to me, ‘‘Though I may not have 

much, my grandchildren are with me and not in the system and we’re gonna be all 

right!’’ Her story is shared by many other grandmothers across the country. 

In Pennsylvania, I have seen a rise in the number of cases referred to us by the 

public child welfare agencies in Philadelphia and, to a lesser extent, Pittsburgh. In 

three years, the caseload in our Philadelphia office has grown from 180 youth to 

over 900 children, many under the age of five. 

In Philadelphia, from 2014 to 2016, there was an 11 percent increase in this age 

group. It is now at a staggering 56 percent. In Pittsburgh, the percentage of children 

under five has been steadier at around 48 percent. Because of the ages of these children and their unknown medical histories, we immediately enroll them in CHIP, as 

we must assess and follow up on their medical needs. It should be noted that over 

90 percent of the children we service are eligible and receive Medicaid support. 

Why the difference between the two largest counties in Pennsylvania? Contributing to this difference is, in part, due to the size of each county. Philadelphia is 

larger and hovers borders with New York and New Jersey. There is a more diverse 

population as well. In Allegheny County, we see an older population. We do, however, know that trends traverse the state. We typically see what happens in the 

eastern part of the state, slowly creep to western Pennsylvania three or so years 

later, as we did with the crack and gang issues. 

Consistent with national trends, the majority of these cases involved parental neglect, which is often associated with drug dependency issues. The opioid epidemic 

is reflected in the national data on children in foster care. After years of declines, 

the number of children in care grew from 378,912 at the end of FFY 2012 to 412,647 

at the end of FFY 2015. State and local child welfare officials attribute this increase 

to the opioid epidemic. Many of these children are being cared for by relatives. Of 

all children in foster care nationally, 29 percent are living with relatives. 

In Allegheny County, 62 percent of children not living with relatives are placed 

in kinship care, and in Philadelphia County, 47 percent are placed in kinship care. 

Grandfamilies, both within and outside the child welfare system, often lack the 

supports and services they need. Unlicensed relative foster parents are typically denied the financial support provided to licensed foster parents. Moreover, the vast 

majority of relative-headed households have no involvement with the child welfare 

system and are often unaware of the services and supports available to them. 

In many areas of the country, particularly rural areas hit hard by the opioid epidemic, those services are few and far between. Grandfamilies affected by the opioid 

epidemic will tell you that they need navigator programs which assist them with 

identifying and accessing available services including mental health services, financial assistance, counseling, support groups, legal assistance, and respite care—all of 

which are essential. Furthermore, these services must be available in urban, as well 

as, rural settings. Too often, transportation, access to services, and child care have 

been cited as barriers to grandfamilies. 

Despite the challenges faced by relative caregivers, research has shown that children experience better outcomes with kin than with non-relative caregivers. These 

outcomes include fewer placement changes, fewer school changes, increased likelihood of achieving permanency, better behavioral health outcomes, increased likelihood of placement with siblings and greater connections to community and culture. 

The best place to touch grandfamilies is where they are isolated. This isolation 

can come physically by way of their neighborhood or lack of transportation. It can 

also come in the form of financial burden. But perhaps the most critical isolation 

comes via the racial and cultural prejudice grandfamilies experience. It is in the 

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1 Ibid. 

2 Centers for Medicare & Medicaid Services, ‘‘CMS Releases Prescriber-Level Medicare Data 

for First Time’’ (April 30, 2016) (online at https://www.cms.gov/Newsroom/ 

MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015–04–30.html). 3Paula Span, ‘‘New Opioid Limits Challenge the Most Pain-Prone,’’ New York Times (June 

6, 2016) (online at: https://www.nytimes.com/2016/06/07/health/opioid-limits-older-patientspain.html). 4 National Institute on Drug Abuse fact sheet (online at: https://www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf). 5 National Institute on Drug Abuse fact sheet (online at: https://www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf). 

ageism they face as caregivers. It is the unrecognized sacrifice they freely give because they value keeping their families together—the families that make up our Nation. What would we do as a Nation right now without grandfamilies? Where would 

those 2.5 million children go? We must not and cannot keep grandfamilies isolated 

any longer. What can be done to support grandparents raising children in the midst 

of this unprecedented crisis? Here are a few of my ideas: 

1. Create a funding mechanism that blends federal child welfare and aging dollars to prevent the need for children to come into care. Let’s get on the front 

end of this issue. Grandfamilies should not have had to lose their jobs to support their grandchildren. 

2. Create more community support centers like the KARE Center in Arizona 

which is supported by Casey Family Programs in partnership with Arizona 

Children’s Association. Additionally, create more holistic community-based kinship care programs like A Second Chance where families and their children can 

go for support services that are needed before removal of children becomes necessary. 

3. Ensure that Senior Centers are equipped to support grandparents raising 

grandchildren with housing vouchers, support groups, counseling and in-home 

services, financial support and respite care. 

4. Create more effective and readily available Drug Treatment Centers that treat 

the entire family. Grandfamilies need to understand how to negotiate the complexities associated with drug addiction and the impact on the children for 

whom they provide care for on a daily basis. 

5. Re-examine the core tenets of the former Families First draft legislation. In 

order for grandfamilies and their grandchildren to receive services without the 

need to enter the child welfare system, flexible finance reform in child welfare 

is necessary and essential. 

As I was preparing my remarks for you today, I decided to consult the real experts and asked grandmothers who were attending a recent Grandma’s Hands Support Group sessions at my organization what they would say to Members of Congress about what they needed. They told me this: 

‘‘We do what we do because we love our grandchildren and our families. We need 

your help and cannot do what we do without the love, support, and suspended judgment of those we interact with each day. Treat us as if we were caring for your own 

grandchildren.’’ 

Thank you Ms. Chairman and Members of the Committee for the opportunity to 

share my thoughts with you today. 

Dr. Sharon McDaniel 

Response to Questions for the Record 

Sentor Elizabeth Warren 

Opioid Epidemic and Partial Fill Policies 

Older patients are frequently prescribed painkillers for chronic pain, or after surgery or other procedures.1 The Center for Medicare and Medicaid Services (CMS) 

reported that generic Vicodin was prescribed to more Medicare beneficiaries than 

any other drug in 2013.2 In 2015, almost 30 percent of Medicare Part D enrollees 

used an opioid prescription.3 If older adults don’t use their entire prescription, these 

pills can remain in the home—and the National Institute on Drug Abuse has estimated that over 70 percent of adults who misuse prescription opioids get the medication from friends or relative.4

As a consequence, efforts to reduce the amount of unused medications in the home 

can be a powerful tool to tackle prescription drug abuse.5 Grandparents raising 

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6 ‘‘Drugs, Brains, and Behavior: The Science of Addiction,’’ National Institute of Drug Abuse 

(July 2014) (online at: https://www.drugabuse.gov/publications/drugs-brains-behavior-scienceaddiction/drug-abuse-addiction). 7See S. 524: Comprehensive Addiction and Recovery Act of 2016 (online at https:// 

www.Congress.gov/bill/114th-congress/senate-bill/524/text). 

grandchildren as a result of the opioid epidemic may want to keep unused medications out of reach of their adult children still struggling with substance use disorder, 

as well as their grandchildren, who are also at a higher risk of developing substance 

use disorder themselves.6 The Comprehensive Addiction and Recovery Act, passed 

in July 2016, empowers patients to talk to their physicians and pharmacists about 

partially filling their prescription medications in order to reduce the amount of unused opioids available for misuse.7 Instead of picking up their entire prescription 

all at once, patients would be able to take home a few days’ worth of medicine at 

a time, without having to get a new prescription from their physician each time. 

Question: Do the grandparents you work with express concern about having unused 

prescriptions in their home? 

Response: 

At a Second Chance, Inc., we have not heard this directly from our grandparents, 

but I believe that they are so overwhelmed with other issues, that have not had 

time to consider this concern. Grandparents need to deal first with the basics including a safe and appropriate sleeping space, getting the child to their original 

school or registering them in a new school and dealing with the trauma of removal. 

Grandparents are also dealing with their own emotions. 

It would be good to have information available in the cases where it could be an 

issue in the household. 

Question: Would empowering grandparents to work with their physicians and pharmacists to partially fill their prescriptions—while also ensuring patients needing 

pain medicine receive it—help grandparents keep unused medications out of the 

hands of those struggling with substance use disorder, or those at a high risk of 

developing it? 

Response: 

This needs to be determined on a case by case basis. Among grandparents who 

are responsible for their grandchildren: 

• 58 percent are still in the workforce 

• 21 percent live below the poverty line 

• 26 percent of them are disabled 

Given these statistics, requiring grandparents to make multiple trips to a pharmacy could add an additional and unnecessary burden to the family route. It would 

depend on ease of access to transportation to the pharmacy, the hours of the pharmacy in relation to the grandparents work schedule and a range of factors. Advising 

grandparents of all their options and helping support their decisions would be the 

best approach. 

Question: Are kinship navigator and support groups well-informed about new federal partial-fill policies? 

Response: 

To my knowledge, kinship navigator programs are not focused on this option because of the wide range of unique issues that must be otherwise addressed. 

Question: What sort of actions can be taken by states, physicians, pharmacists, and 

patient and kinship groups to increase awareness of the new federal partial-fill 

policy so that grandparents and other kinship caregivers can take advantage of 

these options? 

Response: 

Public awareness campaigns and information provided by physicians and pharmacists could be an effective way to provide options for grandparents. Supporting 

and expanding kinship navigators to allow them to provide broader support would 

also help. 

Question: What other approaches do you think can be taken by states, physicians, 

pharmacists, and patient and kinship groups to reduce the amount of unused prescription medication in circulation? 

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Response: 

Grandparents raising their grandchildren have enormous demands on their time 

and their energy, and 39 percent of them are over 60 years old. It is very important 

to have supports that are convenient and accessible. Transportation to pharmacies 

or other prescription drug drop off programs can be a challenge. Allowing grandparents to return unused prescription needs to be convenient and part of their existing routine to be the most effective. 

Another important approach is professional training. We know that research demonstrates the unconscious nature of bias against older caregivers. Given the current 

opioid epidemic and its impact on grandfamilies, we must consider implicit bias 

measures and training because they can illuminate hidden ageism with older caregivers. For instance, we cannot make assumptions that grandparents are not conscious of leaving drugs out in the open due to their age or that there is an automatic 

need for partial-refills regarding seniors. 

Æ 

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