U.S. GOVERNMENT PUBLISHING OFFICE

28–602 PDF WASHINGTON : 2018

S. HRG. 115–363 

AGING WITHOUT COMMUNITY: THE 

CONSEQUENCES OF ISOLATION AND LONELINESS 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

WASHINGTON, DC 

APRIL 27, 2017 

Serial No. 115–4 

Printed for the use of the Special Committee on Aging 

( 

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

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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 

Julianne Holt–Lunstad, Ph.D., Professor of Psychology and Neuroscience, 

Brigham Young University .................................................................................. 5 

Lenard W. Kaye, D.S.W., Ph.D., Director, Center on Aging, and Professor, 

School of Social Work, University of Maine ....................................................... 7 

W. Mark Clark, M.S.W., President and Chief Executive Officer, Pima Council 

on Aging ................................................................................................................ 9 

Rick Creech, Educational Consultant, Pennsylvania Training and Technical 

Assistance Network .............................................................................................. 11 

APPENDIX 

PREPARED WITNESS STATEMENTS

Julianne Holt–Lunstad, Ph.D., Professor of Psychology and Neuroscience, 

Brigham Young University .................................................................................. 30 

Lenard W. Kaye, D.S.W., Ph.D., Director, Center on Aging, and Professor, 

School of Social Work, University of Maine ....................................................... 38 

W. Mark Clark, M.S.W., President and Chief Executive Officer, Pima Council 

on Aging ................................................................................................................ 40 

Rick Creech, Educational Consultant, Pennsylvania Training and Technical 

Assistance Network .............................................................................................. 45 

ADDITIONAL STATEMENTS FOR THE RECORD

Chelsea Conaboy, Freelance Writer, The Agenda–Politico article, They’re Out 

There–If We Can Find Them ............................................................................... 50 

Dhruv Khullar, M.D., M.P.P., Massachusetts General Hospital and Harvard 

Medical School, New York Times Op-Ed, How Social Isolation Is Killing 

Us .......................................................................................................................... 52 

Meals on Wheels, Statement for the Record ......................................................... 54 

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AGING WITHOUT COMMUNITY: THE 

CONSEQUENCES OF ISOLATION 

AND LONELINESS 

THURSDAY, APRIL 27, 2017 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Washington, DC. 

The Committee met, pursuant to notice, at 9:48 a.m., in Room 

SD–430, Dirksen Senate Office Building, Hon. Susan M. Collins 

(Chairman of the Committee) presiding. 

Present: Senators Collins, Flake, Tillis, Fischer, Casey, Nelson, 

Gillibrand, Donnelly, Warren, and Cortez Masto. 

OPENING STATEMENT OF SENATOR SUSAN M. COLLINS, 

CHAIRMAN 

The CHAIRMAN. The Committee will come to order. 

Good morning. Today we are shining a light on a growing phenomenon: the consequences of isolation and loneliness on older 

Americans who are aging without a strong sense of community. 

This is the first of a two-part series. In our next hearing, we will 

explore solutions that reconnect older people to communities. 

One survey to assess isolation among seniors asks this question: 

If you had good news or an interesting story to tell, do you know 

someone with whom you could share it? Increasingly, older Americans are answering this question not with the name of a relative 

or a friend, but with the name of their cat or their dog. While studies have shown that pets can help to alleviate loneliness, they 

should not be an individual’s only social contact. In fact, the science 

is clear that isolation and loneliness are dangerous to the health 

of our seniors. Having friends is as important for good health and 

well-being as food and water. 

Isolation and loneliness can result in negative mental, behavioral, and physical health outcomes. Seniors who are lonely have a 

45 percent greater risk of dying. They have a 59 percent greater 

risk of functional decline, causing deterioration in their mobility 

and ability to perform daily tasks. Isolation and loneliness are associated with higher rates of heart disease; a weakened immune 

system; more depression and anxiety; dementia, including Alzheimer’s disease; and nursing home admissions. Prolonged isolation 

is comparable to smoking 15 cigarettes a day. I must say that was 

a statistic that really hit home to me. 

Older Americans who are isolated or lonely are also more susceptible to financial scams and elder abuse. Last Congress, we uncovAGING-SDG-5 with DISTILLER

2 

ered the tragic story of a 77-year-old man from Maine who turned 

to the Internet for companionship. Lured by scam artists, he ended 

up in a European prison as a convicted drug smuggler. Without the 

persistent work of this Committee and diplomatic negotiations, he 

would still be there today. The plight of this man and thousands 

of seniors in his shoes could have been avoided had he and others 

not been so susceptible due to their desire for simple companionship. 

A number of risk factors for isolation and loneliness are age related—including widowhood, chronic health conditions, and mobility impairments. The size of one’s social network also decreases 

with age. I have heard seniors in my state compare this phenomenon to ‘‘watching the world die before you,’’ as they lose more 

and more of their friends. 

Maine is the oldest state in median age, is aging the fastest, and 

is among the most rural. An epidemic of loneliness and isolation is 

growing, and we face major challenges. Those who live in Maine 

year round can be left isolated. Winter can keep them indoors for 

long stretches, homes are often far apart, and transportation is 

often a barrier. 

Established programs such as Meals on Wheels are reaching seniors in important ways. For many, Meals on Wheels is not just 

about food. It is about social sustenance, also. Seniors look forward 

to greeting the driver and having a bit of conversation. That is why 

I am concerned that the administration’s proposed budget cuts 

would affect programs like this one and many others that help 

keep our seniors connected. If you look at it, those cuts are really 

penny wise and pound foolish, because in the end they are going 

to cause more hospitalizations, more nursing home admissions, and 

poorer health outcomes. 

The fact is the consequences of isolation and loneliness are severe: negative health outcomes, higher health care costs, and even 

death. The root problem is one that we can solve—by helping seniors keep connected with communities. Just as we did when we 

made a national commitment to cut smoking rates in this country, 

we should explore approaches to reducing isolation and loneliness. 

Each has a real impact on the health and well-being of our seniors. 

I am now pleased to turn to our Ranking Member, Senator 

Casey, for his opening statement. Before I do so, however, I want 

to extend my thanks to our witnesses for being so flexible on this 

hearing. It seemed that every time it was scheduled, we had something intervene, most recently the briefing at the White House yesterday on North Korea. So I very much appreciate your staying 

over and being with us today. 

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

RANKING MEMBER 

Senator CASEY. Chairman Collins, thank you very much for calling this hearing and for your opening statement. 

We, of course, want to begin a process today of examining both 

social isolation and loneliness. And as the chairman mentioned, 

this will be a two-part hearing series. Today we will focus on loneliness and social isolation, and in two weeks, we will be able to examine more macro solutions, focusing on livable communities. 

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Taken together, these hearings will provide the Committee with 

the opportunity to examine the full scope of an issue facing seniors 

as well as others across the country. 

One of the most searing reminders of this came from a New York 

Times op-ed back in December by Dr. Khullar from Harvard Medical School and Massachusetts General Hospital, entitled ‘‘How Social Isolation Is Killing Us’’. He was talking about an individual 

that he knew would be dying, and the individual knew they were 

dying, he said—and this is the doctor speaking—‘‘for me the sadness of his death was surpassed only by the sadness of his solitude.’’ And I think that sums it up. 

We hope that this hearing, and the series of two hearings, will 

inform our engagement on other matters as well that may be coming before the Senate, like the President’s budget request or potentially an infrastructure package. 

You might be asking how those two are related. Well, let me explain. 

Back in March, like a lot of parts of the country, my hometown 

of Scranton, in Lackawanna County, was hit hard by a last gasp 

of winter with a terrible blizzard. Meals on Wheels, of course, in 

that moment became even more important. The blizzard did not 

stop Meals on Wheels in northeastern Pennsylvania. One of the 

drivers that I met with a couple of days after he had been out in 

that snowstorm went to a home in Lackawanna County to drop off 

a weekly supply of meals. Upon arrival, the driver heard the homeowner calling out for help. This individual had fallen into a snow 

bank wearing shorts and just a T-shirt. He had fallen after going 

outside. That Meals on Wheels driver saved that man’s life that 

day. There is no doubt about it. 

And when it comes to not only Meals on Wheels but also other 

programs, but especially a program like Meals on Wheels, I think 

the administration’s cuts to that program are misguided, to say the 

least. 

I believe that Democrats and Republicans can agree on issues 

like that. We have a great deal to work together on to address our 

Nation’s infrastructure in addition to that so that we have improved accessibility. This would include improving signage that 

makes it easier to read. It also includes constructing curb cut-outs 

so those who are aging or have disabilities can continue to get 

around in their communities; and, finally, enhancing access to technology and broadband so that those in rural communities can stay 

connected to their loved ones. 

I would say parenthetically another story that I read in Politico 

talking about loneliness and isolation in rural America is recommended reading for all of us. 

So improvements like the ones I just mentioned will help individuals venture outside of their homes and into their communities 

with success, as well as stay connected to those who are most important in their lives. 

So I look forward to the hearing and discussing the pressing 

issues with our witnesses today, who I thank, as well as the Chair, 

for being here and for rearranging your schedules. 

Chairman Collins, I am also told in the audience today we also 

have the Acting Director of the Administration on Community LivAGING-SDG-5 with DISTILLER

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ing at the Department of Health and Human Services, Bob Williams. We want to acknowledge his presence as well. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you. We will now turn to our panel of witnesses. 

First I would like to introduce Dr. Julianne Holt-Lunstad. Dr. 

Holt-Lunstad is a professor of psychology at Brigham Young University in Utah and studies the influence of social relationships on 

long-term health. Her work has been nationally and internationally 

recognized. 

Next we are going to be very fortunate to hear from one of my 

constituents, Dr. Lenard Kaye. I first met Dr. Kaye some 17 years 

ago. He is a professor of social work and director of the Center on 

Aging at the University of Maine. He is also the director of the Encore Leadership Corps, a statewide adult volunteer program that 

involves older residents in community service. He, too, is a nationally recognized leader in the field of health care and aging, and I 

am delighted that he could be here to join us today. 

I would like to next turn to my colleague Senator Flake to introduce Mr. Mark Clark. 

Senator FLAKE. Thank you, Madam Chair, and thank you for 

being here. And I just wanted to personally welcome Mr. Clark, an 

Arizonan traveling here to discuss this important issue of isolation 

and innovative programs that your organization has developed to 

help combat the issue. Mr. Clark currently serves as president and 

chief executive officer of the Pima Council on Aging as well as 

grass-roots coordinator for the National Association of Area Agencies on Aging. He has extensive experience in administrative advocacy and policy experience working for a variety of community 

service organizations in Tucson. He has also served as a faculty associate with Pima Community College’s Social Services Program 

and ASU’s School of Social Work. 

Welcome, Mr. Clark. Thank you for coming from Arizona. I am 

also glad that there is a fellow BYU alumni on the panel as well. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you, Senator Flake. 

And now I want to once again turn to our Ranking Member, Senator Casey, to introduce the final witness on this panel. 

Senator CASEY. Thank you, Madam Chair. I am pleased to introduce Rick Creech from Harrisburg, Pennsylvania. Rick, I am going 

to use some of your own words to describe you. I hope that is okay. 

Rick, in your book you refer to yourself as a ‘‘unicorn,’’ and I 

know we will hear more about that. But we are grateful that you 

are here, and I do not think I could have come up with a single 

word like that. But I have also read your work. And I had an opportunity to meet with Rick today, and I have to say his spirit is 

inspiring and even magical, your ability to communicate. And we 

know that your cerebral palsy does not define you. Instead, you 

have defined cerebral palsy in your own way. 

Early on in life, Rick relied upon an alphabet board made of 

wood to communicate. Today, using his powered wheelchair and 

augmentive communication devices, Rick works at the Pennsylvania Training and Technical Assistance Network in Harrisburg. 

He is an educational consultant providing training and technical 

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assistance on assistive technology and augmentive communication 

and assists schools, providers, parents, and administrators about 

how technology can promote inclusion. He is an author, and he is 

also a poet. 

Rick, I am certain that throughout your life people have secondguessed your ability. I am sure after today they will have a different point of view. This panel is excited to hear your story and 

hear how you have defied the skeptics and wound up here before 

the Special Committee on Aging discussing, among other things, 

how technology has enabled you to remain actively engaged in your 

community and how your work helps to combat loneliness and social isolation in others. 

Rick, thanks for being here. 

The CHAIRMAN. Thank you very much, Senator Casey. 

We will now turn to our witnesses, starting with Dr. HoltLunstad. 

STATEMENT OF JULIANNE HOLT–LUNSTAD, PH.D., PROFESSOR OF PSYCHOLOGY AND NEUROSCIENCE, BRIGHAM 

YOUNG UNIVERSITY 

Ms. HOLT-LUNSTAD. Thank you, Chairman Collins, Senator 

Casey, and members of the Committee, for your interest in social 

isolation and loneliness and for the opportunity for me to present 

testimony today. My name is Julianne Holt-Lunstad. I am a professor of psychology and neuroscience at Brigham Young University, and my research focuses on the influence our social relationships have on our physical health outcomes. In my remarks today, 

I will be talking about the public health relevance of social isolation and loneliness, including data on prevalence rates, health and 

mortality risk, and potential risk factors. 

Being connected to others socially is widely considered a fundamental human need—crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human 

contact fail to thrive and often die. And, indeed, social isolation and 

solitary confinement has been used as a form of punishment. Yet 

an increasing portion of the U.S. population now experiences isolation regularly. 

It is estimated that more than 8 million older adults are affected 

by isolation. However, if we consider social connection more comprehensively, this includes the extent to which relationships are 

present, can be relied upon, and one’s satisfaction with them. And 

if we consider this, the prevalence of adults in the United States 

may be—or the prevalence of this may be much larger. So, for instance, a quarter of the population and 28 percent of older adults 

live alone, and over half the U.S. adult population is unmarried. 

Three in ten marriages are severely distressed, and the majority of 

adults do not participate in social groups. More than a third of 

older adults experience frequent and intense loneliness. 

There is also evidence that isolation or social disconnection is increasing. For instance, the average size of social networks has declined by one-third, and social networks have become less diverse. 

Census data also shows trends of decreasing marriage rates, fewer 

children per household, and increased childlessness and living 

alone. 

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Taken together with an increasing aging population, smaller 

families and greater mobility reduces the ability to draw upon familial support in times of need and in older age. 

To estimate the prevalence—or the influence that this has on the 

risk for premature mortality, my colleagues and I have conducted 

two meta-analyses. We first examined the social connections, including a variety of indicators. Cumulative evidence from 148 studies revealed that greater social connection is associated with a 50 

percent reduced risk of early death. 

The second focused specifically on social deficits, including social 

isolation, loneliness, and living alone. Cumulative evidence from 70 

different studies, including over 3.4 million participants, indicates 

that each of these have significant and independent effects on mortality risk. 

To contextualize this cumulative data on social connections relative to other leading health indicators, we created Figure 1 (page 

37) to benchmark the magnitude of the effect on overall mortality 

risk. Despite some variation across social indicators, there is a consistent and significant effect on mortality risk, and the magnitude 

is comparable and in many cases exceeds that of other well-accepted risk factors, including smoking up to 15 cigarettes per day, obesity, and air pollution. 

As seen in Figure 2 (page 36), prevalence rates or the proportion 

of the population affected are also comparable with other risk factors that receive considerable attention. 

Social isolation has also been linked to a variety of mental and 

physical health outcomes. For example, those who are isolated are 

at increased risk for depression, cognitive decline, and dementia. 

Social relationships influence health-related behaviors such as 

medication and treatment adherence and have a direct influence on 

health-related physiology such as blood pressure, neuro-endocrine 

and immune functioning, increasing the likelihood of the development and progression of a variety of chronic illnesses. 

Risk factors include living alone, being unmarried, no participation in social groups, fewer friends, and strained relationships. Retirement and physical impairments, including reduced mobility and 

hearing loss, may also increase the risk for social isolation. 

Why is it important among older adults? Chronic exposure to either protective or risk factors are more pronounced as individuals 

age; therefore, we are more likely to see the effects of lacking social 

connection in older adults. Further, there are a number of important life transitions among older adults that reduce social connection. These include retirement, widowhood, children leaving home, 

and age-related health problems. 

Given the incidence of loneliness is known to increase with age 

and social networks shrink with age, the prevalence of loneliness 

is estimated to increase with increased population aging. 

In conclusion, the World Health Organization explicitly recognizes the importance of social connections, and many nations 

around the world now suggest that we are facing a loneliness epidemic. The scientific evidence is clear that social isolation poses a 

significant risk to both older adults and public health more generally. The challenge we face now is what to do about it. 

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I am very pleased to see that the Committee has recognized and 

is bringing attention to this important issue, and I am happy to assist in advancing an agenda to address social isolation and loneliness among older adults. 

Thank you again for the opportunity to comment, and I welcome 

your questions. 

The CHAIRMAN. Thank you very much. 

Dr. Kaye. 

STATEMENT OF LENARD W. KAYE, D.S.W., PH.D., DIRECTOR, 

CENTER ON AGING, AND PROFESSOR, SCHOOL OF SOCIAL 

WORK, UNIVERSITY OF MAINE 

Mr. KAYE. Chairperson Collins, Ranking Member Casey, and 

members of the Senate Special Committee, thank you so much for 

inviting me to be here today. I appreciate it. And I also applaud 

your willingness to be addressing what is a very, very troubling 

issue but, unfortunately, an under-recognized issue of the day, and 

that is social isolation. 

As director of the Center on Aging at the University of Maine, 

it has become clear to me that aging Mainers across the oldest and 

the most rural state in the Nation are a stoic and fiercely independent lot. But like millions of their counterparts in other rural 

states, they may be losing the battle when it comes to protecting 

themselves against the devastating consequences of isolated living 

and loneliness. 

The fact is social isolation is a silent killer, and it is lethal in its 

impacts. More Americans are dying of isolation and loneliness than 

ever before. The prevalence, in fact, may be as high as 43 percent 

if you break out certain subgroups of older adults who are at particularly high risk. And let me remind you that risk is high as well 

for caregivers of older adults given that when they engage in elder 

caregiving, as if it were a career, it can become a very, very isolating experience. 

Perhaps that is why multiple national social work associations 

have identified social isolation as one of 12 grand challenges to societal well-being and why AARP, NIH, and, as you heard, the WHO 

have also recognized that social isolation requires it be placed on 

a high-priority list of concerns. 

I will only add a couple of risk factors that perhaps were not 

mentioned as much as they might be. One would be facing critical 

life transitions in the lives of older adults, and I am referring to 

divorce, death of a spouse, an abrupt retirement, a health crisis, 

and even children moving out and away from under the roof in 

which older adults live. 

Also, I want to highlight the lack of instrumental supports, and 

here I am talking about the absence of Internet, of available transportation, even of telephones in the case of some older adults who 

live in extremely rural and even frontier communities. 

The importance of having a social support network cannot be 

overstated in this discussion. Family, friends, and neighbors—what 

we call ‘‘informal supports’’—and professional caregivers together 

provide not only social support, but please know they are socially 

influential; they create a buffer against stress; they increase one’s 

access to resources; they can even stimulate the immune system of 

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older adults. Social interaction, like a breakthrough medication or 

balanced low-fat diet, extends life. 

Solutions to preventing social isolation and loneliness are presenting themselves both locally and nationally and need not be excessively costly. Many of them simply require that we mobilize 

local citizens and existing community organizations. 

At the local level, combating social isolation entails bringing the 

older adult either out into the community or bringing the community to them. Area Agencies on Aging remain one of the first lines 

of defense, and I will tell you, the University of Maine, in partnership with the Eastern Area Agency on Aging, is supporting, for example, a student-led program called ‘‘Project Generations’’ that 

brings college students into the homes of older adults for friendly 

visiting and lending a helping hand. Programs like this offer students the opportunity to interact with elders and for older adults 

to serve as role models for those younger people as they grow older 

themselves. 

In at least one Maine community—namely, Augusta—postal 

service workers are trained to ask questions of homebound older 

adults and to check in on them and ensure their well-being. Doctors, too, if they so choose, are able to screen for social isolation 

during routine doctor’s appointments. These solutions are often 

called ‘‘sentinel approaches,’’ and they provide gatekeepers—gatekeepers who offer an extra set of eyes and ears in the community 

to identify and address social isolation. 

Many communities have begun to organize programs as well 

where volunteers and law enforcement officers provide regular calls 

and wellness checks to older adults who are known to be frail or 

homebound. One example is in Franklin County, which sends sheriff’s deputies to regularly check on older adults to not only help reduce their risk of falling victim to a scam, but also to increase their 

social contact and ultimately well-being. 

Creative housing solutions like co-housing where older adults live 

with younger adults can also help to combat social isolation and 

help create a sense of purpose among both the young and old. 

If you add to that the availability of smart technologies in those 

homes, you can further enable regular communication and contact 

between older adults and the outside world. 

Remember also that information empowers people and that local 

informational clearinghouses that keep older adults informed of 

services, entitlements, and benefits, and other programs available 

to them and their family caregivers, enables them to more easily 

stay connected with the world around them. 

Several federal programs add to the support infrastructure available, and I am referring here to the Meals on Wheels Program. 

That network reaches 800,000 homebound older adults across the 

Nation. They provide not only home-delivered meals, they also provide socialization. And the Senior Companion Program—part of the 

national network of Senior Corps programs—pairs older adult volunteers with homebound older adults in their communities for ongoing socialization and support. 

We also know there are ways to prevent social isolation before 

it even occurs, and here I am referring to the importance of encouraging older adults to be involved as volunteers in their commuAGING-SDG-5 with DISTILLER

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nities through churches and civic groups, which can be important 

avenues for ensuring that they stay healthy but also feel vital and 

needed by the communities in which they live. Programs like 

RSVP, another Senior Corps program, and Senior Colleges, of 

which Maine is proud to say we have 17 such lifelong learning programs, offer older adults opportunities to meet people and have a 

purpose. 

Older adults residing in small towns and rural communities may 

be especially vulnerable to the dangers of isolated living, but such 

communities, with relatively modest levels of local and federal support, can be mobilized to take action against what, in fact, is the 

lethal threat to their well-being. 

Thank you. 

The CHAIRMAN. Thank you very much, Dr. Kaye. 

Mr. Clark. 

STATEMENT OF W. MARK CLARK, M.S.W., PRESIDENT AND 

CHIEF EXECUTIVE OFFICER, PIMA COUNCIL ON AGING 

Mr. CLARK. Good morning. Thank you, Chairman Collins, Ranking Member Casey, and members of the Aging Committee, for your 

interest in this topic and the opportunity to testify today. 

As Senator Flake noted, I have the honor of serving as president 

and chief executive officer of Pima Council On Aging, the Area 

Agency on Aging serving Pima County, Arizona, since 1976. Area 

Agencies on Aging, of which there are 622 across the country, were 

created by the Older Americans Act in 1973. We serve as local 

planning, development, and delivery systems, providing home and 

community-based services to older adults so that they may age successfully with maximum health, independence, and dignity. 

Pima County is roughly the size of the State of Vermont, and one 

in four of our residents is age 60 or older. But the fastest-growing 

segment of our population is people 85 years of age and older, up 

35 percent in the past decade. 

Every four years, we collect information about the issues of most 

concern to older adults. Nearly 2,300 people completed our survey 

last fall, almost half of whom lived alone. The ability to continue 

to live independently in one’s own home was a significant concern 

of nearly 67 percent of responses. Other indicators of isolation, 

such as loss of a spouse, depression, and anxiety, also appeared as 

significant issues. Social isolation itself was cited as a concern by 

46 percent of responses. 

While aging at home is cited as a top priority by a majority of 

older people and doing so has both emotional and economic benefits, it can also lead to isolation. And so meal delivery drivers or 

direct care workers who come into the home to drop off lunch or 

assist with giving a bath, changing linens, or shopping can become 

a social network. Such regular contact can help stave off the depression and ill health effects that accompany isolation. In fact, 

these Older Americans Act home and community-based programs 

were intentionally designed to meet those socialization needs, as 

well as other needs, including safety, independence, and nutrition. 

As we have heard, the causes of social isolation are many. What 

we witness happening is isolation even in the midst of community. 

Long-time residents often have no connection to the younger famiAGING-SDG-5 with DISTILLER

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lies in their neighborhoods. People retiring from other states move 

to communities like ours and leave behind their families, friends, 

and support systems. We have become in a very real sense communities where the garage door is the front door, and many come and 

go without ever seeing neighbors except through the car window. 

Other challenges include isolation from the community by language or cultural barriers as well as by fear. Many older people do 

not reach out for assistance for fear of losing their ability to remain 

in their homes. Changes to mobility, cognitive ability, or health status can cause an individual to hold back from previously enjoyed 

social activities. Older adults in rural areas who can no longer 

drive are at incredible risk of physical and social isolation unless 

transportation options are available. And as has been noted, acting 

as a caregiver can itself also be isolating. 

Reaching out to all older people with messages that resonate and 

suggestions they will embrace is critical. That is why we participated in last year’s ‘‘Expand Your Circles: Prevent Isolation and 

Loneliness As You Age’’ campaign, a national effort of the Federal 

Eldercare Locator to boost public awareness and education of social 

isolation among seniors. 

While PCOA will continue to tackle the problems as best we can 

at home in Pima County, we offer several policy recommendations 

for consideration by Congress and the administration. 

First, public education needs to be increased. Current national 

efforts to raise awareness, assessment, and remedy should be 

strengthened and new interventions developed so that we can elevate the issue with more older adults and their families. In tandem 

with national campaigns, local communities like ours and the aging 

and community groups that serve them need effective messages 

and resources to deploy at the ground level. 

We also believe that all Older Americans Act programs should be 

increased in fiscal year 2018. We urge you to pay particular attention to the Older Americans Act Title III B Supportive Services, 

which provides flexible funding for a range of services from inhome supports to transportation, as sequestration has eroded III B 

funding to levels not seen since before fiscal year 2002. 

Programs that get older adults engaged in serving the community help reduce social isolation for both volunteers and those they 

serve, and we support funding the Corporation for National and 

Community Service’s Senior Corps programs. 

Transportation is one of the most pressing needs for all older 

adults who are trying to remain at home and in the community, 

so we need more investment in affordable, accessible transportation 

options. 

We also need to create livable communities for all ages. Although 

there is much that individuals can and should do to maximize their 

independence as they age, public policymakers make critical decisions about issues such as transportation systems, housing opportunities, and land-use regulations that affect whether older adults 

can live successfully and productively at home and in their communities. 

Finally, the problem of social isolation can be reduced with better 

coordination between acute health care systems, such as hospitals, 

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doctor’s offices, and managed care organizations, and the social and 

human services systems of which Area Agencies are a key part. 

Thank you again for the opportunity. I look forward to answering 

questions. 

The CHAIRMAN. Thank you, Mr. Clark. 

Mr. Creech. 

STATEMENT OF RICK CREECH, EDUCATIONAL CONSULTANT, 

PENNSYLVANIA TRAINING AND TECHNICAL ASSISTANCE 

NETWORK 

Mr. CREECH. Chairwoman Collins, Ranking Member Casey, and 

other members of the Committee, thank you for inviting me to 

speak today. 

There can be no social engagement with others without interactive communication. 

As someone who was born with cerebral palsy and was without 

the ability to speak in the accepted way, I grew up lonely and isolated—except for my parents and grandmothers. It was not until 

I received my first vocal output communication device that people 

began to realize that they could speak to me and I could speak to 

them—well, at least, some people did. 

I was born in 1954 in Smithfield, North Carolina. Back then babies like I was were not expected to live, and if we did live, we 

were not expected to be out in public, we were not expected to be 

educated, and we were certainly not expected to become independent adults. However, I had extraordinary parents who trusted 

in God, and not in all the doctors, the therapists, the social workers 

who said I would never do that, or that, or certainly not that. 

My father told me once—and I never forgot this—that he wanted 

me to learn math so that I would be able to manage my own 

money. He wanted me to read so that I would be able to read and 

understand anything that someone might write about me and what 

should be done to and for me. And he wanted me to be able to communicate so that I could have control over my life. 

My parents presumed competence in my ability to learn to do 

those things. They insisted that I learn. Boy, did they push me. 

When it came to teachers, I would always prefer to have my mother because with her I could slack some. With my father, the Baptist 

preacher, there was no way I could slack. He was more demanding 

than God was with Moses. 

[Laughter.] 

Mr. CREECH. However, they taught me that I was competent. I 

was competent enough to go beyond their goals—and their 

dreams—for me. This is what great parents, great teachers, and 

great schools do. 

Supporting individuals who need to use AAC is not simple. The 

person may want to communicate; however, the person will have 

to be taught how to use an augmentative and alternative communication device for his or her expressive communication. The vocalimpaired person will not know how, what, when, or why to express 

thoughts, feelings, ideas without being encouraged, without being 

pushed. 

I am speaking from experience. Initiating a conversation and carrying on a conversation is the hardest thing I do in life. To put it 

AGING-SDG-5 with DISTILLER

12 

simply, I am no good at chit-chatting. I believe that there is an optimal age to learn communication skills, that age being as young 

as possible. However, I was 28 when I got my first voice output 

communication device, and although I still have deficits, I can expressively communicate my ideas in conversations. 

I had to work extremely hard, and I work long hours to learn to 

communicate with an AAC device. I used to read passages from the 

Bible and newspapers aloud to practice with my AAC device. My 

point is that we cannot provide a person with assistive technology 

or AAC and expect people to use it. 

I recently got the Amazon Echo to help me to control the lights 

in the house. Sometimes I am ready to throw Alexa out the window, and I will not tell you the names my wife has called the thing. 

Amazon Echo is simple compared to AAC devices. I started telling 

people many years ago that assistive technology without training 

is not assistive. 

Even today, as proficient as I am with my AAC device, I cannot 

talk to some people because they are too much in a hurry or too 

caught up in my Accent1400, saying things such as, ‘‘What can you 

say?’’ ‘‘Can you say my name?’’ or they are hollering at me as if I 

am deaf, saying, ‘‘it—is—good—to—meet—you. What—are—you— 

doing?’’ I get tempted to reply, ‘‘Talking to an idiot.’’ 

[Laughter.] 

Mr. CREECH. But my parents taught me that if you cannot say 

something nice, say nothing at all, so I do not. 

As I get older, I feel my body slowing down. My bones snap, 

crackle, and pop—like Rice Krispies. My muscles hurt. Right now, 

I have my best friend and my protector, my wife, but she is almost 

my age and has a bad back, arthritis, and diabetes. I know that 

I might not always have my wife by my side. One day I will probably be in the care of a minimum wage worker, who will have 24 

other patients all requiring less time and care than I. The only way 

I have to individualize myself to my caretakers will be through my 

ability to communicate with them so that they will be able to see 

me as a person rather than just another patient. 

Of course, if that does not work, I could always call one of my 

three 250-pound sons and say, ‘‘Son, I need help.’’ 

I would like to thank the Committee on Aging for giving me this 

opportunity to speak here, although I do not think I am that old. 

I would like to thank the Association of Assistive Technology Programs for sponsoring my trip here. Before I started working for 

Pennsylvania Training and Technical Assistance Network, I 

worked with Pennsylvania Initiative on Assistive Technology. I 

started PIAT’s Short Term Loan of assistive technology to adults 

nearly 30 years ago, so maybe I am that old. 

The communication device I use, the Accent1400, costs in the 

neighborhood of $10,000. It is one of the more sophisticated AAC 

devices. However, even simpler augmented communication devices 

with speech output cannot be found for less than $5,000. The AAC 

devices with eye tracking so that people can speak with them using 

only their eyes cost in the neighborhood of $20,000. 

All of my assistive technology, my AAC device, my van converted 

for a powered wheelchair passenger, my smart home equipment, 

my powered wheelchair all cost upward of $200,000. Still, ladies 

AGING-SDG-5 with DISTILLER

13 

and gentlemen, that is cheap compared with a lifetime of taking 

care of me in a nursing facility. 

For my work at PaTTAN, Pennsylvania Training and Technical 

Assistance Network, I help manage its Assistive Technology ShortTerm Loan Program that provides assistive technology to school 

therapists and teachers statewide to try with their students. Each 

year the Pennsylvania Department of Education generously provides around a third of a million dollars for equipment. To a poor 

North Carolina country boy, that sounds like a lot, but we have 

constant waiting lists of students, and at the end of every school 

year, there are requests that I have to cancel or delay until the 

next school year because we do not have enough inventory to meet 

the requests. These students need appropriate assistive technology 

to receive education so that they can grow to be productive and 

independent adults who can be social members of our society. 

I want to leave the Committee with this thought: Living without 

being able to communicate is like being behind four glass walls. 

You are able to see others and people can see you, but you are ignored, or worse, talked down to, until you stop remembering who 

you are and why you are important. 

The CHAIRMAN. Mr. Creech, forgive me for interrupting you. I 

have to go cast a vote just across the hall. I will be right back. You 

can continue while I am gone because Senator Tillis is going to 

take over temporarily as the Chair of the Committee. Senator 

Casey may have to go and cast that vote also, but I did not want 

you to think I was one of those idiots that you talk to. 

[Laughter.] 

The CHAIRMAN. Or that I was disrespectful. And I will return 

very quickly. Thank you. 

Senator TILLIS. [Presiding.] You can continue, Mr. Creech. 

Mr. CREECH. I have finished. 

Senator TILLIS. Well, I hope I did not cut you off, but I am from 

North Carolina, and it is nice to see another North Carolinian here 

before us. Welcome. 

I will, acting in the chair, defer to Senator Casey for the first 

questions. 

Senator CASEY. Well, thanks very much. I want to thank our 

panel. And, Rick Creech, thank you in particular. I am, of course, 

showing deference to Pennsylvania. I am sure the other witnesses 

will grant me that privilege, at least for part of the hearing. 

Rick, I will start with you. You mention in your testimony that 

your assistive technology keeps you connected to others, that it 

combats isolation and allows you to interact with those around you. 

You also tell us that for you your technology costs about $200,000, 

which is quite an investment. So here is my question. 

First of all, how do you pay for your technology, and what would 

life be like without it? That is one question. And maybe I will continue on so we have it all in one. And since you work with so many 

other people who need assistive technology to keep them connected, 

how should the Federal Government be supporting the costs of assistive technology so that others may stay connected for their communities and live independently? 

Mr. CREECH. My employer’s insurance paid for my powered 

wheelchair and my Accent1400, my communication device. That is 

AGING-SDG-5 with DISTILLER

14 

one reason that I am not planning on retiring anytime soon, that 

and the mortgage on my house. 

The Office of Vocational Rehabilitation in Pennsylvania helped 

pay for my van conversion. The Office of Vocational Rehabilitation 

only will help pay if I am working or I wanted to work, another 

reason I am not retiring anytime soon. 

My personal care aide, who is not technology but certainly is assistive, is subsidized by a state program. My smart home technology I am paying for piece by piece. 

One of the biggest breakdowns is in transportation. Too often 

paratransit buses are unreliable. I have been told that drivers can 

be rude, although I have never experienced that myself. What I 

have experienced are vans being late or not coming; being taken on 

a 90-minute ride when where I needed to go was 10 minutes from 

my home; my powered wheelchair not being fastened down properly. I absolutely love this one. My van breaks down, so paratransit 

is called. Someone tells my wife that I cannot use paratransit because I am not registered. You have to register every 6 months. If 

you do not, you are dropped from registered users. I guess they figure you are dead. 

So my wife says, ‘‘How can I re-register?’’ They say first I will 

have to get a doctor’s note saying that I need paratransit. Then I 

will have to go down to the paratransit office in person to get a 

photo ID. My wife stopped them right there and asked, ‘‘How about 

if I rent a U–Haul trailer, load my husband and his powered 

wheelchair in it, and drop him off at your front door?’’ They replied, 

‘‘Oh, no, you cannot do that. It takes 4 to 6 weeks to process his 

registration and put him on the schedule.’’ My wife hung up. 

So the short answer to your question: Get us decent and reliable 

transportation. 

Senator CASEY. Rick, thank you very much for your answers. 

I will yield back to Senator Collins, the Chair. 

The CHAIRMAN. [Presiding.] Thank you very much, and I want to 

thank Senator Tillis for taking over the gavel. How did it feel? 

Senator TILLIS. It was a tough job. 

[Laughter.] 

The CHAIRMAN. Dr. Holt-Lunstad, I understand that you flew 

here directly from a conference in Germany—for which I want to 

thank you for making that kind of effort to be with us. I am curious 

whether you find that there is a difference between other countries 

and our country when it comes to issues related to isolation and 

loneliness among our seniors. 

Ms. HOLT-LUNSTAD. Thank you. That is a very good question. So 

there are a couple of different ways in which we can approach that. 

First I will mention that when we look at actual data from the 

meta-analysis that we conducted on risk for mortality, we did not 

find significant differences across country of origin. However, I 

should mention that most of the data comes from Western nations, 

and there is less data from developing nations. 

However, we also know that there are some similarities in terms 

of other nations that have also in essence called for a loneliness 

epidemic, so nations such as Germany, the U.K., Australia, North 

America, and Europe have all reported similar trends and are considering efforts to alleviate this. 

AGING-SDG-5 with DISTILLER

15 

Another way to consider this, though, is also some of the different norms across nations. So in Western nations, we tend to 

value independence. Other nations and cultures tend to value 

collectiveness and being part of a group. And our national value on 

independence to some extent may come at our detriment in terms 

of desire for connecting in older age and the desire for independence; and that perhaps if we can change some of the national dialogue around the value of interdependence and relying upon others 

as well as being someone to be relied upon, that could be a potential solution that we could strive for. 

The CHAIRMAN. Thank you. 

Dr. Kaye, you made a very interesting point, and I am reminded 

of it by the testimony we have just heard about people wanting to 

be independent. Your point focused on the caregivers and that we 

have in our state fiercely independent seniors, and it is not at all 

uncommon to find a spouse in her 80s taking care of her husband 

who may be in his 90s, living down at the end of a rural road in 

an old, big farmhouse, and their children have moved away, their 

friends have died, they no longer are well enough to go to church 

each week, and they really are cut off. 

Could you talk a little bit more about the impact on caregivers 

and what we could do to try to assist the caregiver who may end 

up being just as isolated as the person for whom she is caring? 

Mr. KAYE. That is a crucially important question, Senator Collins. The fact is America’s families and friends and neighbors— 

again, what we call the ‘‘informal support network’’—are unsung 

heroes. These are the very individuals who provide the lion’s share 

of care in this country. It is not doctors or nurses or social workers. 

They provide supplemental assistance. But 80 percent or more of 

care in this country, and certainly in Maine, is provided by primarily family members, and they, as I said, are at risk of living 

isolated lives. They are also likely to be less healthy than members 

of the general population. They themselves are aging. They themselves are struggling with chronic illnesses and know that the burden they feel when it comes to caregiving is multidimensional. And 

so it is not just a burden on them physically. It is also a burden 

on them socially and emotionally and financially. 

And so caregiving is dangerous business, especially for those who 

are involved in it literally for years at a time. For them it becomes 

a career. And for all too many of them, it is their second or third 

career, because they are also employed. And so they are caught between a rock and a hard place. They need to hold down employment and at the same time manage the responsibilities of caring 

for a spouse or a grandparent or other member of the family. 

So caregivers need as much of our attention and support through 

a comprehensive network of benefits and entitlements and programs as older adults themselves. 

The CHAIRMAN. Thank you. Senator Tammy Baldwin and I have 

a bill that we have introduced known as the ‘‘Raise Family Caregivers Act,’’ which we hope we will be able to get through this session of Congress. 

Mr. KAYE. I am aware of that bill, and what is very inviting and 

attractive about it, in my view, in particular, is that it addresses 

this comprehensively and it aims to establish a national infrastrucAGING-SDG-5 with DISTILLER

16 

ture, and it realizes that caregiving needs responses that are 

broad-ranging, from information to respite care to training and 

preparation to assessment. And that bill appears to recognize all 

such needs. 

The CHAIRMAN. Thank you. 

Senator Tillis? 

Senator TILLIS. Thank you, Madam Chairman. 

Mr. Creech, again, thank you. I am from North Carolina. I am 

from a different part of the state, but I thank you for being here. 

Mr. Clark, you mentioned Senior Corps earlier. As I understand 

Senior Corps, it is primarily focused on 55 and over adults getting 

engaged in the community, more or less engaging them, but the 

focus is on a younger population, foster parenting and other kinds 

of programs. Is that program or other programs out there focused 

on engaging seniors to engage with other seniors? 

Mr. CLARK. Chairman Collins, Senator Tillis, the Senior Corps 

programs, in fact, do focus, several of them, on older adults. The 

RSVP program, the historic Retired and Senior Volunteer Program, 

the Senior Companion Program, which I referenced in my written 

material, is a program where low-income older adults are actually 

placed and stipended, but placed with specific older adults who 

have support needs. And so there is a commonality between those 

two folks who work very closely together. 

So, yes, in fact, the Corporation for National and Community 

Service programs do a lot of good for older adults. 

Senator TILLIS. Mr. Kaye, I think you alluded in your opening 

comments to some use of technology. My mother is 84 years old. 

If it is on C–SPAN, she is probably watching this right now. My 

father passed away 20 years ago. She is also one of the most politically astute people that I know. But we got her engaged in something as simple as Facebook probably 10 years ago, and it has had 

a remarkable impact on her feeling engaged in our daily lives. 

Sometimes, when somebody engages me on my Facebook page, she 

engages a little bit too much. 

[Laughter.] 

Senator TILLIS. She still takes care of her kids. But, you know, 

to what extent are best practices arising to where we are 

leveraging—you know, there are bad parts to the Internet, but 

there are a lot of good uses to connect people when geography— 

particularly in my case, six kids spread out all over the Southeast, 

the few that live near her. But are there best practices out there 

or states that are doing, you know, particularly better than others 

that were instructive? 

Mr. KAYE. I am so delighted, Senator Tillis, that you raised the 

technology question. We in Maine take that very seriously, and I 

am pretty proud to tell you the University of Maine system has a 

major aging initiative underway, and I am thinking of other universities—I know for a fact in other states as well—who have identified and recruited scientists and researchers who are aiming to 

put devices and products that enable older adults to age in place 

and stay connected and advance those products on the fast track 

and get them commercialized and available. But what we do know 

is our best practices need to accompany that process, that the best 

AGING-SDG-5 with DISTILLER

17 

technology is going to be that which is responsive to the needs of 

the consumer. 

We in Maine think that means what we have called ‘‘engaging 

older adults in co-design functions’’—that is asking consumers how 

that product or that device needs to be styled, what design should 

it reflect, how much should it cost, where should it be available for 

purchase, what should the user interface look like; that is, is it easily utilized and taken advantage of by older adults. 

And so principles of co-design are driving the research we are 

doing at the University of Maine in our aim to put that technology 

into the homes on as fast a track as possible. 

Senator TILLIS. I absolutely believe—I have become just obsessed 

with making sure seniors that I interact with spend a moment to 

go on Facebook—they probably have family members on there—to 

expose them to this interaction tool. And I think the more that we 

use these tools to connect people maybe first through the network, 

that it will naturally foster relationships that may result in actual 

touch and presence, which is also very important. So I would be interested in getting any feedback you have on the program in Maine 

or any other states. 

Dr. Holt-Lunstad, I am going to ask my last question of you. The 

health impacts of isolation and loneliness I think are very compelling. Do you know of any research out there that is focused on programs that have affected or maybe bent the curve in a positive direction and, if so, whether or not we have tried to dollarize them? 

I think one of the things that we need to do—and I kind of pound 

this in a number of our hearings here, or focus on it—is that we 

need to understand that, on the one hand, this is a good thing to 

do for someone who is isolated, but at the same time, it is also, I 

think, a fiscally sound investment of dollars because it reduces cost 

of health and other bad outcomes, whether it is illnesses or similar 

things that tend to cost more if we do not invest. 

Is there any research out there or information you can point me 

to on the subject? 

Ms. HOLT-LUNSTAD. Thank you. Yes, so I want to briefly mention 

one thing about the technology, and then I will also talk about effectiveness as well as costs. 

One thing that we need to have some caution about in terms of 

technology is that we need to recognize that it can be a tool to 

bring people together—— 

Senator TILLIS. And it can become isolating. 

Ms. HOLT-LUNSTAD. Absolutely. And we really need to do more 

research on this and determine to what extent that this can facilitate social connection versus bringing people apart. 

Senator TILLIS. That is why I made the point of also using technology and knowledge of who you are interacting with in close 

proximity to ultimately get them to the point to where there is a 

human connection or a connection with someone else. That is why 

I asked the question earlier. 

Ms. HOLT-LUNSTAD. Right, and there are some that are certainly 

very concerned about particularly younger generations that will be 

our future aging adults, and thus reducing the ability to connect 

face to face and may substitute connections, potentially leading to 

AGING-SDG-5 with DISTILLER

18 

greater isolation. And so certainly more attention needs to be paid 

to that. 

In terms of effectiveness, my colleagues and I, we are currently 

working on another meta-analysis looking at interventions and 

their effectiveness in terms of reducing risk for mortality. This is 

currently still in progress, so we do not—this is not published yet. 

But what I can tell you from the preliminary data is that the data 

is mixed. There are some interventions that are effective, and there 

are others that are not effective. And so we do need to be careful 

and not assume that any kind of intervention will be effective. 

Senator TILLIS. That information—and I have gone way over, but 

that information is critically important because it is instructive to 

the extent that the federal government gets involved in funding or 

promoting any programs that you are going to be—you are naturally inclined to do it because of the subject matter, but we want 

to make sure that we are putting the limited dollars into the ones 

that have the most empirically based—positive results empirically 

based so that we—we are going to continue to struggle to have 

enough money even for the good ones. What we do not want to do 

is spread it out, and I think at the expense of drilling down on ones 

that can produce more transformative results. 

Thank you, Madam Chair, for indulging me for going over. And 

my mother is watching. Hey, Mom. 

[Laughter.] 

The CHAIRMAN. Thank you very much. 

Senator Cortez Masto? 

Senator CORTEZ MASTO. Thank you. 

Thank you all for being here, and this is such an important topic. 

I am so happy we are having this conversation. I am from the 

State of Nevada and have worked most of my career fighting 

against neglect and exploitation for many in our senior community. 

And just recently, when I was home over the break, I had the opportunity to deliver a meal with a Meals on Wheels driver. I had 

an incredible conversation, not only with the Catholic Charities 

who provides the programs in Nevada for Meals on Wheels, but 

also with the driver, as well as the senior who was the recipient. 

And one thing I did learn—and we are talking about this now— 

is it addresses and helps with the issue of social isolation and more 

particularly, medical needs. The driver that I was riding with actually responded to a medical need of a senior who had fallen. Thank 

goodness he showed up that morning with the meal and was able 

to help that individual. 

I am curious—and I do not think we have heard it yet today— 

are your thoughts on pets and animals, to address isolation. Is this 

something that we should be looking at as well. I know many of 

the seniors that this gentleman talks with and delivers Meals on 

Wheels to, have animals that they treat just like their children. 

And then, more importantly, I think we should be funding programs like this at the front end. I do not support any cuts to any 

funding for Meals on Wheels or any senior programs, because I 

think in the long-term it saves dollars for Medicaid, medical care 

costs, things that we would be looking at had we not had these 

front-end programs. 

AGING-SDG-5 with DISTILLER

19 

I’d like your thoughts with respect to animals and isolation, and 

front-end programs. How we save money, which is really what they 

say, penny wise, pound foolish, if we are going to go down this path 

of cutting the funding. 

Mr. KAYE. I would like to begin, if I may. There is no doubt 

about it that the availability of pets and companion animals makes 

an enormous difference in the lives of older adults. In my experience, in fact, it is those programs that may be the most popular 

and most utilized programs offered in the community through Area 

Agencies on Aging. Pets are known to reduce the blood pressure 

and calm anxiety in older adults. In fact, more than a few pets are 

far more popular than many relatives when it comes—— 

[Laughter.] 

Mr. KAYE. [continuing]. To providing support for older adults in 

the community. There is no question about it. There is a natural 

tie and connection when animals are brought into assisted living 

facilities and nursing homes. There is an immediate response. It is 

visceral, it is observable. Older adults are immediately engaged, 

and it makes it clear and drives home the point for me that that 

should be among the arsenal of programmatic responses that we 

offer in fighting against social isolation. 

Mr. CLARK. Madam Chairman, if I might also, Senator Cortez 

Masto, absolutely, pets are important. One of the issues that we 

hear about from our Meals on Wheels drivers is the concern that 

sometimes our meal recipients are actually feeding their meals to 

their pets or sharing their meals with their pets. And so we are actually working with local pet stores and securing pet food donations 

with our animal welfare organizations in the community and actually exploring ways that we may be able—you know, with the 

health requirements and everything, that we may be able to deliver 

some pet food at the same time we are delivering lunch. So it is 

definitely an issue that we are concerned about. 

We also are working with our older adults between our social 

service agencies and our animal welfare agency to try to develop 

a notification system, sort of an end-of-life-care plan for my pets, 

not when the pets die but what is going to happen with my pet 

when I die. And so through end-of-life-care planning processes, we 

are working on that as well. 

Senator CORTEZ MASTO. Thank you, and I am glad you brought 

that up because recognizing that many of the seniors are giving 

their food to their pets, the program that I was able to ride along 

with started obtaining pet food to also give to the seniors, and then 

the driver has little treats that he gives to the animals when he 

shows up to deliver the food as well. So I appreciate that. Thank 

you so much. 

The CHAIRMAN. Thank you. 

Senator Warren? 

Senator WARREN. Thank you, Madam Chair. 

It is hard to maintain social relationships when you cannot communicate very well, and a big reason that older adults have trouble 

communicating is hearing loss. When people cannot hear, they do 

not just drop out of a conversation in a noisy restaurant. They 

often drop out of social life altogether. Research shows that seniors 

with hearing loss are more likely to experience loneliness and they 

AGING-SDG-5 with DISTILLER

20 

score higher on measures of social isolation, meaning, for example, 

reporting that they do not have any close friends, not having anyone to talk over problems with if they face a difficult situation. And 

this is a really big deal on the numbers. More than two-thirds of 

people in their 70s have hearing loss, and that figure jumps to 90 

percent of people over the age of 80. 

So, Dr. Kaye, in your experience studying healthy aging, does untreated hearing loss play a role in people’s ability to stay active and 

engaged in their communities? 

Mr. KAYE. Of course it does. Senator Warren, it is a critical 

issue. Sensory impairment is a frequent and commonplace chronic 

impairment, and I would argue that hearing loss may be the most 

crucial sensory impairment because, as you said, it cuts off the 

ability of one individual to communicate with another. And the fact 

is not only is it untreated, but initially it is undiagnosed. As I understand it, over 9 million individuals over 65 suffer from hearing 

loss, and my understanding is some three out of five of them have 

not had it treated, which means they are not taking advantage of 

the rapid advance in the quality and the efficacy of hearing aids. 

Senator WARREN. So let us talk about that for a second, because 

there is the good news. The good news is we can treat hearing loss, 

and hearing aid technology has just gotten better and better and 

better. The bad news is that the vast majority of people with hearing loss, more than 80 percent according to the estimates I have 

read, are not using hearing aids, and one of the principal reasons 

is they cannot afford them. Out-of-pocket costs for a single hearing 

aid average more than $2,000, and most people do not need one, 

they need two. 

So the question becomes: Why are hearing aids so expensive? 

And the reason in part is because state and federal regulations restrict this market. They limit competition and channel all of the 

business to licensed hearing aid dispensers, even though evidence 

shows that with some oversight from the FDA, hearing aids could 

be made directly available to consumers in a way that is safe, effective, and far less costly. 

So, Dr. Kaye, let me ask you this one: The National Academies 

of Science, Engineering, and Medicine have recommended changing 

regulations to permit over-the-counter sales of hearing aids to 

bring down prices dramatically. Do you think this would make a 

difference for seniors, and particularly for seniors in rural areas 

who are closed out of markets more often? 

Mr. KAYE. My knee-jerk reaction is that any policy that makes 

devices, technologies, programs, services more readily available is 

to be applauded. 

Senator WARREN. Good. 

Mr. KAYE. In rural communities, lack of access is a major issue. 

Lack of affordability, of course, is as well. 

Senator WARREN. Good. Thank you. And if I could ask, Mr. 

Creech, you do not use hearing aids, but you do use technology to 

help you communicate. Could you just say a brief word about the 

importance of access to technology so that you can stay engaged 

with your friends and colleagues? 

Mr. CREECH. If I did not have access to technology, I would be 

in a nursing home in my pajamas, being pushed in a manual 

AGING-SDG-5 with DISTILLER

21 

wheelchair in front of a television until my brain turned to mush 

that not even zombies would eat. 

[Laughter.] 

Senator WARREN. Thank you, Mr. Creech. 

Mr. CREECH. Assistive technology has to be affordable, and it is 

not. 

Senator WARREN. Yes. 

Mr. CREECH. I am trying to build a smart home system through 

Amazon Echo and my smartphone. I will be paying $30 a month 

for three years for the phone; the Amazon Echo, $175. The Echo 

Dot, which I will need in every room, is $40 each. A smart thermostat will be $275 plus installation. Smart keyless lock, $250. Smart 

ceiling fans and lights, $400 each. I have not even checked into 

smart televisions and appliances. This wonderful smart home thing 

holds a lot of promise, but just like any other assistive technology, 

people with disabilities cannot afford this amazing technology without funding assistance. The cost of not providing assistive technology would be more than the country could afford in lost productivity, in lost creativity, in lost humanity, and in increased medical 

cost, in increased personal care cost, and in increased cost to family 

members who would have to stay home to care for their loved ones 

instead of being free to work outside of the home. 

Senator WARREN. Thank you very much. It is a powerful statement about the importance of technology. And on hearing aids, I 

just want to say they should not be reserved for the privileged few 

who can afford $5,000 in order to have some assistance. I just want 

to say this is why I have introduced bipartisan legislation with 

Senator Grassley, Senator Isakson, and Senator Hassan that would 

implement the recommendations of the National Academies panel 

and create an FDA-regulated category of safe and effective overthe-counter hearing aids. It has been endorsed by the AARP, by the 

Gerontological Society of America, and by the American Doctors of 

Audiology, a leading group of health practitioners who deal in hearing aids. 

One way to tackle the problem of loneliness and isolation and depression for some older adults is to cut the cost of hearing aids so 

they have a chance to participate in conversations with other people. 

Thank you, Madam Chair, and thank you for letting me have a 

little extra time. 

The CHAIRMAN. Thank you. 

Mr. Clark, when I was listening to your testimony and read your 

written testimony, I was reminded of an important fact, and that 

is that we should not only talk about how we can get services to 

our seniors but also our seniors have a lot to offer, and I do not 

think we should forget that part of the equation. 

I was thinking, when Dr. Kaye was talking about the senior companion program, for example, and also our Senior Colleges in 

Maine, of which there are 17, I think you said, and oftentimes the 

courses for those colleges are taught by people who are retired. So 

you talked about certain programs, the Aetna model, for example, 

that can be useful to change our perception of seniors as solely 

needing service but, rather, looking at the fact that they can serve 

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others, too. And, of course, that is a wonderful way to end isolation 

and loneliness. Could you talk a little bit more about that? 

Mr. CLARK. Well, at Pima Council on Aging, we have been working with older adult volunteers for a number of years. We were one 

of the original RSVP programs. We are not doing that program 

anymore, but we work very collaboratively with the Senior Corps 

program, which is the program that Aetna participated in, which 

is where older adult volunteers are paired—they are actually 

stipended volunteers—with older adults who need some in-home 

assistance, and so they both benefit. 

But I also want to reference the Neighbors Care Alliance, which 

I also mentioned in my testimony. That is a program that PCOA 

began 10, 12 years ago, I think, as part of a compassion connection 

grant, and that really is a collection of neighborhood-based, but 

also faith communities and a couple of social service agencies, volunteer organizations like the one in the neighborhood I live close 

to, the Old Fort Lowell Live-at-Home Program. That program is 

neighbors actually caring for each other, and so they are driving— 

and most of them are older adults who are doing the caring, so 

they are driving people to physician appointments; they may be 

taking people shopping, stopping by for friendly visiting, or maybe 

placing a call, occasionally bringing a meal in if somebody needs 

one on a short-term basis, maybe somebody coming in and changing a light bulb; you know, not so much yard work, maybe once a 

year sort of major cleanup. And then another neighbor allows his 

or her—his, I think—garage to be used as a durable medical equipment lending library, so if somebody has a short-term need for a 

potty chair or a wheelchair they can get it rather than having to 

buy it. 

So we have about 15 of those Neighbors Care Alliance affiliates 

in the community, and they serve thousands of folks. We have a 

little bit of money from our regional transportation authority for 

senior volunteer driving, and so we are able to reimburse their 

driving volunteers on a per mile basis for the driving. And driving 

is a big piece of what those NCA affiliates do, but they do all those 

other things. And so it is a way—we know that people age much 

more healthfully, if I can make up a word, if they stay active and 

involved. And those kind of programs are really helpful in allowing 

people to stay active and involved. 

The CHAIRMAN. Thank you. 

Mr. Creech, first of all, I want to thank you for sharing your 

story. In addition to the technology that has been so important to 

you and it has allowed you to connect with people and communicate, are there other steps that you have taken to overcome isolation? 

Mr. CREECH. The loneliest time in my life was during childhood. 

I had no friends. My outings out of my home was limited to the 

churches my father pastored. My days were spent in my home trying to find ways to fight boredom. I had plenty of toys; with some 

I could actually play. I was always able to bamboozle my parents 

into letting me have a dog or a cat, the same way I bamboozled 

my wife into letting my youngest son have a dog, and we have had 

dogs in the house ever since. There was nothing for me to do except 

watch TV or read books. I found that I much preferred my books 

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over TV. Back then, my communication was limited to the typewriter and an alphabet board. Have you tried to communicate with 

someone who used an alphabet/word board? Most people cannot. 

My experience has been after you finish spelling the third word, 

they forget what was the first word you spelled. You dare not use 

words that have over two syllables else you will completely mess 

up your communication partner’s mind. 

I do not know if you have watched the television show ‘‘Speechless.’’ JJ on that show supposedly uses an alphabet/word board 

with an optical head pointer, and he is able to point to a few 

squares on the board, and his aid comes out with these correct sentences. That is not how it works in the real world, folks. When I 

used an alphabet board, I was lucky to get three simple words together before blowing the other person’s mind. And what teenager 

wants to talk with friends through a grown adult reading over his 

or her shoulder? I am flabbergasted every time I see that in the 

show. 

The CHAIRMAN. Thank you. 

Senator Casey? 

Senator CASEY. Madam Chair, thanks very much. 

Rick, I was thinking as you were giving testimony today and telling your own story, you know, you said in your testimony, ‘‘I am 

no good at chit-chatting.’’ After all this time, Madam Chair, chitchatting is so yesterday, isn’t it? 

[Laughter.] 

Senator CASEY. But I have two final questions, two serious questions that involve, Rick, part of your family’s story. You shared 

with the Committee that your mother has Alzheimer’s disease. The 

Committee recently held a hearing on the topic and continues to 

advocate for medical research funding that will—will one day—lead 

to a cure, for funding to support those who are caring for family 

members with Alzheimer’s. However, the disease can also lead to 

isolation for the individual diagnosed and their family. 

So two questions in one. How has your mother’s diagnosis 

changed your interaction with her? And has it resulted in any feelings of isolation for you? 

Mr. CREECH. This is hard for me to put into words. For 28 years 

my mom was life. She fed, she dressed, she bathed me. For 28 

years, she was the first face I saw in the mornings and the last 

face I saw at nights. Ever since she went to a nursing facility, I 

have not been able to call her on the phone. This afternoon, I will 

be going down to North Carolina to visit mom. I do not know if she 

is going to recognize me. This is the woman who a few years ago 

gave my wife a box full of old papers of everything that I had typed 

since I was 8 years old. I thought, ‘‘OMG, what other potentially 

embarrassing things has she kept?’’ 

[Laughter.] 

Mr. CREECH. This is the woman who during my first year of college, because I had gotten a mouthful of mouth ulcers and could 

not eat, came and stayed in my dorm for a month and nursed me 

back to health so that I would not have to drop out and go back 

home. 

Mom is not here anymore. What lingers is the shell that used to 

contain my precious mother. Mom is gone as certainly as dad is 

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gone. I feel like a captain of a sailing ship after the stars have fallen and the sun will not show itself. All I have is my memory of 

them and the principles they instilled in me to guide me through. 

Senator CASEY. Rick, thank you very much. 

Thank you, Madam Chair. 

The CHAIRMAN. Thank you very much, Senator Casey. 

I want to thank all of our witnesses for being here today, for your 

patience as we maneuvered the time and date of the hearing. To 

my knowledge, this is the first hearing on Capitol Hill to address 

the issue of isolation and loneliness among our seniors, and it is 

such an important issue when you look at the impact on our seniors’ health and well-being. When I learned the startling statistic 

that we heard today from Dr. Holt-Lunstad about the mortality 

risk of isolation and loneliness, something that Dr. Kaye also 

talked about, it tells us that this problem is a serious one and it 

is pervasive, and yet it has received very little attention outside of 

the work done by the experts in the field and in academia. 

So one of my hopes today is that we have raised public awareness of this problem and we can start to explore some of the creative solutions that you all have talked about, whether it is greater 

use of technology or having Meals on Wheels drivers specifically 

check on the health of the seniors or pairing college students and 

seniors, which I love that program, Project Generations, that Dr. 

Kaye has started in Maine, or helping seniors be of service to others as well. As I said, I think it is really important that we remember that this problem can be addressed from both directions in 

many cases. And using the resources that we have, we can come 

up with some creative solutions to reach out and connect seniors 

with communities. ‘‘Connections,’’ it seems to me to be the word, 

whether you are connected with your family, your neighbor, your 

community, your church, your college. That seems to be what helps 

to keep people healthy and strong and increases their well-being. 

So now today we have learned a lot about the problem. We have 

all heard the phrase that it takes a village to raise a child. Well, 

I think the flip side of that is the village can also care for our seniors, and our seniors need to be an integral part of that village. 

So at our next hearing, we are going to look at some of the solutions across the country, and I am very proud that my State of 

Maine is really leading the way. Dr. Kaye, you get a great deal of 

credit for that. 

I want to thank our staff for their hard work, all of our witnesses, and all of the Committee members who are here today. 

Many of them had conflicts so could only be here briefly, but we 

actually had an excellent turnout, and I think that shows that people are very interested in this issue. 

Committee members will have until Friday, May 5th, to submit 

any questions for the record, which we will forward along to you. 

Senator Casey, do you have any closing comments? 

Senator CASEY. Just briefly. Madam Chair, thank you for convening the hearing. I want to thank our witnesses for being with 

us, Rick especially, and we are grateful for your presence here and 

your message. 

Despite the challenge of this issue, isolation and loneliness, we 

know what works. We know that drop-by programs work, whether 

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it is Meals on Wheels or some other program. Group interventions 

work. And we know, of course, that assistive technology works. So 

we are looking forward to more discussion on these issues and are 

grateful to have the opportunity today. Thanks very much. 

The CHAIRMAN. Thank you, and this hearing is now adjourned. 

[Whereupon, at 11:26 a.m., the Committee was adjourned.] 

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APPENDIX 

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Prepared Witness Statements 

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Prepared Statement of Lenard W. Kaye, D.S.W., Ph.D., Director, Center on 

Aging, and Professor, School of Social Work, University of Maine 

Aging Mainers across the oldest and most rural state in the Nation are a stoic 

and fiercely independent lot. But like their millions of counterparts in other rural 

states across the Nation, they may be losing the battle when it comes to protecting 

themselves against the devastating consequences of living a socially isolated and 

lonely life. Let there be no doubt, social isolation is a killer and more Americans 

are living in isolation than ever before. The prevalence may be as high as 43% 

among community dwelling older adults. And, the risk is high as well for caregivers 

of older adults given that caregiving can be a very isolating experience. Perhaps 

that is why the National Association of Social Workers, the World Health Organization, AARP, and the National Institutes of Health, among others, have recognized 

the need to place social isolation on their lists of major challenges and high priority 

threats to societal well-being. It is a perplexing, potentially lethal problem, impeding 

a successful and productive old age. The bad news is that the challenge is perhaps 

greatest for older adults living in small towns and rural communities where individuals are separated geographically, children and grandchildren have often left for the 

bright lights of the big cities, and critical community supports are in short supply. 

I’ve come to realize that stoicism and a fiercely independent spirit can be 

overrated qualities and not always something to aspire to. Not when we learn that 

such individuals are at higher risk of living social isolated and lonely lives which, 

in turn, research confirms, will place them at higher risk of a variety of poor outcomes including disability, high rates of mortality and morbidity, dementias, hospitalizations, falls, not surviving natural disasters, poor health practices, psychological distress, neglect and exploitation, lower self-reported health and well-being, 

and even the common cold. 

Who is at greatest risk? That would be LGBT older adults, those with physical, 

sensory, and functional impairments, who live alone, are 80 years of age and older, 

are geographically isolated, living on limited income, lacking instrumental supports 

(access to transportation, the Internet, telephones, etc.), with poor mental health, 

weak social networks, and facing critical life transitions (i.e., divorce, death of a 

spouse, an abrupt retirement, a health crisis, children moving out, etc.). 

The importance of having available a social network cannot be overstated in 

guarding against social isolation. Family, friends, neighbors, and professional caregivers provide social support, social influence, create a buffer against stress, increase your access to resources, and can even stimulate your immune system. 

Local Solutions That Make a Difference 

Solutions to preventing social isolation and loneliness are presenting themselves 

both locally and nationally and need not be excessively costly. We do, however, need 

to remain vigilant and especially mindful of those conditions that put older adults 

at risk. 

The University of Maine Center on Aging recently gathered 200 professionals and 

community members together at a conference to discuss older adult social isolation. 

Their front-line experience suggests additional factors can increase the risk of social 

isolation including ageist views and stigma about aging, a lack of transportation to 

get older adults out into the community, lack of access to technology which could 

bridge communication gaps with loved ones, poor health, alcoholism, and increasing 

lifespans which mean that many older adults outlive their friends and family. Responding to these challenges, the University of Maine has identified aging research 

as an emerging area of excellence and is especially encouraging its scientists to 

focus on developing user friendly, accessible, and affordable technologies that will 

keep older adults safe, secure, and mobile not only in their homes, but in their communities. 

At the local level, combating social isolation entails bringing the older adult out 

into the community or otherwise bringing the community to them. The University 

of Maine in partnership with the Eastern Area Agency on Aging, is supporting a 

student-led program, Project Generations, that brings college students into the 

homes of local older adults for friendly visiting and lending a helping hand. Programs like this offer students the opportunity to interact with and learn from older 

adults while providing elders with a much needed source of support. 

In at least one Maine community (Augusta), postal service workers are trained 

to ask questions of homebound older adults to check in on them and ensure their 

well-being. Doctors, too, if they choose, are able to screen for social isolation during 

routine doctor’s appointments. These solutions, often termed sentinel approaches, 

provide an extra set of eyes and ears in the community to identify and address social isolation through screening and referral. 

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Many communities have begun to organize programs where volunteers and law 

enforcement officers provide regular calls and wellness checks to older adults who 

are known to be frail, homebound, and isolated. One such program in Franklin 

County, Maine, sends sheriff’s deputies to regularly check in on older adults to not 

only help reduce the risk that an older adult would fall victim to a scam, but also 

to increase social contact and well-being for the older adult. 

Creative housing solutions like co-housing where older adults live with younger 

adults can also help to combat social isolation and help to create a sense of purpose 

among older adults. 

Several federal programs are providing lifelines to older adults who are homebound including the Meals on Wheels Program, a network that reaches over 800,000 

homebound older adults across the Nation, providing not only home-delivered meals 

but also socialization. The Senior Companion Program, (part of the national network 

of Senior Corps programs), pairs older adult volunteers with homebound older 

adults in their communities for ongoing socialization and support. One such Senior 

Companion volunteer shared a story of Mrs. C, a woman whom she visits, and how 

she supported Mrs. C after the death of her husband. The loss of a spouse is a particularly critical time for supporting older adults and ensuring that they do not become shut off from those around them: 

‘‘Mrs. C experienced the loss of her husband after a long terminal illness. 

Having devoted her life to the continuous care of Mr. C, she was left without purpose in her life. Mrs. C had no family in this area and felt completely alone. As her Senior Companion, I was able to assist her through 

arrangements to be made for Mr. C’s cremation and celebration of life. 

Other difficult areas included finances, health, and well-being. It has been 

nearly two years since the passing of Mr. C. With continuous compassion 

and understanding, I have been able to help Mrs. C connect again to the 

world around her. She has made great progress spiritually, emotionally and 

with socialization. As a Senior Companion, I am always at hand for comfort 

and support or simply just to listen.’’ 

We also know there are ways to prevent social isolation before it occurs. Encouraging older adults to be involved in their communities through churches, civic 

groups, and volunteer roles can be important avenues for ensuring that older adults 

stay healthy and connected to the world around them. Programs like Retired and 

Senior Volunteer Program (RSVP) and Senior College offer older adults opportunities for meeting new people and learning new skills. 

Dr. Kelley Strout at the University of Maine has developed a pilot program called 

GROW which sets up garden beds at low-income congregate housing sites. Originally intended to increase the consumption of healthy foods, the program also increased social ties between residents who would not have otherwise interacted and 

formed friendships despite living within the same housing complex. There are numerous examples of programs like this throughout the country that provide an outlet for older adults to naturally connect with others. 

Summary of the State of Current Research 

There is still significant progress to be made in determining what works for helping to reduce social isolation. Lack of rigor in studies of interventions aimed at reducing loneliness make it difficult to evaluate some of these strategies. 

Due to the various life events that can trigger social isolation, from death of a 

significant other, to loss of transportation, to health decline, effective interventions 

will need to be diverse and they will need to be tailored to the personal circumstances of the isolated individual. 

AARP’s Framework for Isolation in Adults Over 50 states that ‘‘Reviews support 

that effective interventions target specific groups, use representative samples of 

their target population, use more than one method of intervention (target more than 

one aspect), allow participants an element of control, include individual participation in intervention planning, and have facilitators who have adequate training and 

resources.’’ 

Other Community-Level Strategies 

The Maine Health Access Foundation has initiated a significant grant program in 

the State of Maine called ‘‘Thriving in Place’’ which supports individuals with chronic conditions and disabilities in remaining in their homes as they age. Although the 

activities being undertaken to support aging-in-place are diverse, reducing isolation 

is a key component of Thriving in Place activities. In a review of Thriving in Place 

initiatives in the state, project evaluators identified promising strategies and lessons 

learned related to reducing isolation that were emerging from these community 

change efforts. These include the importance of developing systems of care whereby 

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people who may have contact with isolated older adults, such as EMTs, Meals on 

Wheels drivers, and other individuals who are knowledgeable enough about community resources and referral processes, can act as gatekeepers and key points of access to supportive services which can reduce isolation and meet other needs. 

Another finding was that services promoting older adult well-being have added 

benefits in reducing social isolation. Examples include morning check-in calls from 

law enforcement programs, which often have a primary stated purpose of ensuring 

physical safety for homebound adults. This finding has been borne out in conversations conducted by the Center on Aging with coordinators of check-in programs who 

have indicated that participants have become less isolated due to these brief daily 

contacts. Additionally, through a research partnership with a local Village to Village 

model organization, At Home Downeast, interviews with volunteer drivers have indicated that volunteer provided rides to health and non-health related destinations 

serve also as an opportunity for members of the Village to receive much need social 

contact. 

AARP’s Age-Friendly community initiative is another community-level strategy 

for supporting aging-in-place and reducing social isolation. Like the Thriving in 

Place initiative, it examines aging-in-place holistically through a framework called 

the ‘‘eight domains’’ that contribute to a livable and age-friendly community including: 

• Outdoor Spaces and Buildings • Transportation • Housing • Social Participation • Respect and Social Inclusion • Communication and Information • Community and Health Services, and • Civic Participation and Employment 

Although all domains have implications for reducing isolation and loneliness, two 

of the eight domains are particularly important: Social Participation, and Respect 

and Social Inclusion. Key elements of these domains that can impact social isolation 

are ensuring accessibility of local gatherings in terms of transportation, affordability, and physical accessibility; ensuring that outreach for events in a community 

are targeted at those at risk of isolation, and combating negative stereotypes of 

aging individuals. 

We should not minimize the lessons learned from the age-friendly community 

movement in terms of what individual towns and communities can be encouraged 

to do to reduce the risk of social isolation among its older citizens, and all its citizens for that matter. The University of Maine Center on Aging recently conducted 

a series of community focus groups with citizens of Bangor, ME and discovered the 

following high priority action steps that can be taken to fight isolation, include: developing and maintaining robust transportation programs geared to meeting the 

needs of older adults, making the community walkable, offering senior center/community center programming, ensuring that outdoor spaces and buildings are accessible, maintaining opportunities for meaningful volunteer and civic engagement, and 

establishing a more comprehensive and timely informational clearinghouse that 

reaches elders and their caregivers with available resources and programs. I’m 

proud to say that Maine leads the Nation in the number of towns and communities 

that have formally joined the age friendly community movement—some 35 of the 

163 such communities across the U.S. 

Older adults residing in small towns and rural communities may be especially 

vulnerable to the dangers of isolated living, but such communities, with modest levels of support, can be mobilized to take action against this threat to well-being in 

later life. 

Prepared Statement of W. Mark Clark, M.S.W., President and CEO, Pima 

Council On Aging 

Good afternoon. Thank you, Chairman Collins, Ranking Member Casey and members of the Aging Committee, for the opportunity to testify today on the problem 

of social isolation and loneliness among older adults. 

My name is W. Mark Clark and I have the honor of serving as President and CEO 

of Pima Council On Aging, the Area Agency on Aging serving Pima County, Arizona. 

Since 1967, Pima Council On Aging (PCOA) has identified the needs of older adults 

in our planning and service area, and responded to those needs with communitybased programs and services. In our role as the Area Agency on Aging for Arizona 

Region II, PCOA has served generations of older adults and their families in comAGING-SDG-5 with DISTILLER

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munities across Pima County, through planning, advocacy and providing and contracting for services. Area Agencies on Aging, of which there are 622 across the 

country, were created by the Older Americans Act in 1973 to serve as the local planning, development and delivery system providing home and community-based services to older adults so that they may age successfully with maximum health, independence and dignity. 

The Aging of Pima County 

Pima County is home to the city of Tucson, the second-largest metro area in Arizona. Because of our mild winters, thriving hospitality industry, natural desert 

beauty and relatively low cost of living, Tucson and other parts of Pima County are 

primary destinations for new retirees and older winter visitors, contributing to it 

being among the fastest aging regions in the Nation. Pima County covers 9,184 

square miles—roughly the size of the State of Vermont—and is home to more than 

248,000 people who are 60 years of age or older. That means one in four County 

residents is age 60 or older today. The population growth among those under 50 

years old has remained stagnant in the last 5 years in the County, while the population in their 60’s grew by 16%. The fastest growing segment of the population 

were people over 85, which has increased by an astonishing 35% in the past decade. 

We are not alone in these remarkable numbers—while Arizona is one of the most 

rapidly aging states, every single state in the Union is growing older as the baby 

boomers age and people live longer. By 2030, one in five Americans will be age 65 

or older. 

PCOA’s Role in the Community 

Pima Council On Aging’s 50 year history of supporting older adults in their homes 

and communities means we are one of the nation’s longest-serving providers of the 

critical home and community-based services that are the mandate of every Area 

Agency on Aging. In fact, we began providing these vital supportive services even 

before Area Agencies on Aging were formally established in the 1973 reauthorization of the Older Americans Act. 

Today this coordinated system of services provides supportive programs including 

home-delivered meals, congregate meals and socialization, transportation, in-home 

care, home repair and adaptations, legal services, evidence-based health promotion 

programs, and assistance for family caregivers. The federal dollars we receive 

through the Older Americans Act are the foundation of this system, as we leverage 

state and local dollars to increase our ability to meet the need and help older adults 

meet their goals of aging at home and in the community, remaining healthy, and 

retaining their independence for as long as possible. To accomplish these lofty goals, 

we work in partnership with approximately two dozen service provider partners to 

provide an array of services, programs and options for older adults, as well their 

caregivers. 

But to stay healthy and to age well, older adults need to remain engaged. The 

home-and-community-based services we offer, such as home-delivered meals through 

the Pima Meals on Wheels program, senior lunch programs, senior center programming and in-home services, increase or maintain self-sufficiency and independence 

and reduce social isolation for the people we serve. In our last fiscal year, PCOA 

delivered just shy of 204,000 meals, utilizing 20 routes to cover metro Tucson—and 

the outlying rural communities where people are at even greater risks for isolation—to nearly 1,500 individuals who are homebound, unable to prepare a nutritious meal because of health or physical limitations and have no one to assist them. 

For many, the driver who delivers their meals may be the only person they see regularly during the week. It is not uncommon for our delivery drivers to find people 

who have been experiencing medical emergencies for a day or longer, and have to 

provide crisis assistance. 

In collaboration with our community partners, PCOA also provides nutrition programs in community settings, and these congregate meals have, since inception, had 

a twin goal of enhancing seniors’ nutrition and encouraging socialization. We served 

nearly 87,000 meals through lunch programs to around 2,000 older adults at our 

network of 13 community and neighborhood-based centers; 91% of them tell us that 

the program gives them someone to talk to each day. The majority of our home-delivered meal clients live alone (67%) and all are frail or disabled. More than half 

(55%) of congregate meal participants live alone, and nearly 30% are frail or disabled. Our home-and-community-based system of services known as the Community 

Services System includes not only these two types of meals programs, but also other 

supports and services that allow people unable to perform basic tasks of daily living 

for themselves to remain living in their own homes. Common in-home services include homemaker services (laundry, cleaning), personal care services (bathing, 

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dressing) and personal safety systems, while community supports include transportation, legal services and caregiver supports. 

Social Isolation Harms Health, Independence 

Data from our local communities tell us that social isolation and related factors 

significantly impact the lives of our older friends and neighbors, which is validated 

by national data and emerging research on the significant negative health effects 

of becoming isolated or lonely. In our role as the Area Agency on Aging, since 1975 

PCOA has conducted the only community needs assessment of its kind to identify 

the needs of older adults age 60 and older. Every three to 4 years, PCOA collects 

information about the issues of most concern to older adults in our communities 

through a written survey, public listening sessions and focus groups with professionals in the field. Through our most recent community needs assessment process 

in the fall of 2016, nearly 2,300 seniors completed surveys in English and in Spanish, with nearly half of those respondents reporting they lived alone. The secondhighest ranking concern for older people in our community, only slightly outranked 

by falls and fear of falling, was being able to continue living independently in their 

own homes. Remaining independent and aging in place was expressed as an issue 

of some or serious concern by nearly 67% of the people we surveyed. Other significant concerns included loss of a spouse, depression, mental health issues and related 

indicators of isolation, as well as social isolation itself, which was specifically cited 

as an issue by 46% of respondents. 

While aging at home is cited as a top priority by a majority of older people, and 

doing so has both emotional and economic benefits, aging in place at home can also 

lead to isolation. As socialization that occurs naturally throughout much of adult life 

through work, raising children, volunteerism, and connection to family wanes in 

one’s life, without opportunities to build new social networks, including having the 

health and mobility to do so, living independently can lead to that person becoming 

nearly entirely isolated over time. And so, Area Agency on Aging funded service providers, such as meal delivery drivers or the direct care workers who come into the 

home to assist with giving a bath, changing linens and shopping, become their social 

network, providing not only services that allow the person to remain in their home, 

but also regular contact that can help to stave off the depression and ill health effects that accompany isolation. 

Yet not every senior needs those particular programs, so how do we do our part 

to combat and respond to social isolation among a broader aging population in our 

community? 

First, we have to understand the causes of the problem. What we as service providers witness happening in our society is isolation even in the midst of community. 

People are aging in place in many of our older neighborhoods, while the composition 

of those neighborhoods has changed to younger families with whom they have no 

connection, so they no longer know their neighbors. Our communities continue to 

see a decades-long influx of retired people from other states who have left behind 

their families, friends, and support systems. Depending on the area they move to, 

the social opportunities that are available, and their ability to navigate the community, they may or may not start rebuilding a social network in their new community. 

Living in gated communities often leads to isolation among a relatively homogeneous group of people. We have turned into communities where the front door is 

the garage door and that for many, especially those without small children, it is possible to come and go without ever seeing neighbors except through the car window. 

We also noted that for some of our longtime retirement communities like Green Valley, a community of about 22,000 people 20 miles outside of Tucson where individuals aged 85 years and older make up more than 10% of the population, those who 

moved there in the early years of their retirements have often outlived their savings 

and their vitality. We hear stories about the fact that since the home owners’ associations maintain the exteriors of the housing units and landscaping, hidden behind 

a facade of normalcy is the despair that exists inside where people simply can’t take 

care of themselves and don’t reach out to others. 

These community patterns and structural challenges contribute greatly to the 

problem of social isolation, but there are other challenges we see regularly too, including seniors isolated from the community by language or culture barriers, as well 

as by fear. Living alone with increasing frailty can be terrifying, and it’s easy for 

these vulnerable older adults to stay inside and resist asking for help. And, given 

the prevalence of elder abuse and the perception of crime and violence, we understand their caution. Many older people don’t reach out for assistance for fear of losing their ability to remain in their homes. 

Finally, we know that there are other risk factors that put some older adults at 

greater risk for having their health compromised by increasing isolation. Changes 

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to mobility, cognitive ability, or health status, which happen frequently in the lives 

of older adults, can cause an individual to hold back from previously enjoyed social 

activities. Older adults in rural areas who can no longer drive are at incredible risk 

of physical, and thus social isolation, unless other transportation options are available. The loss of a spouse or a new, difficult role as a family caregiver may also 

lead to a withdrawing from the community at a time when more engagement is 

needed the most. 

Solutions to Reach and Engage Isolated or At-Risk Seniors 

Reaching out to all older people with messages that resonate and suggestions they 

will embrace is critical. That’s why we participated in last year’s ‘‘Expand Your Circles: Prevent Isolation and Loneliness As You Age’’ campaign, a national effort of 

the Federal Eldercare Locator (Endnote 1) to provide a new consumer awareness 

tool to boost public awareness and education of social isolation among seniors. Funded by the Administration for Community Living and in partnership with AARP 

Foundation and its’ social isolation reduction online platform, Connect2Affect 

(Endnote 2), the National Association of Area Agencies (n4a), which operates the 

ACL-funded Eldercare Locator and of which we are a member, created a simple, 

consumer-friendly brochure on the problem of social isolation, risk factors, negative 

health consequences and a self-assessment checklist. The campaign provided additional materials for aging providers to ensure that the national effort’s leveraged 

media attention was mirrored locally across the country. Like our Area Agency on 

Aging peers around the Nation, we found the new brochure a great tool and resource to raise the issue locally. 

In addition to sharing the resource itself, a member of our staff devoted her 

monthly column in the Arizona Daily Star, the second-largest newspaper in the 

state, to the issue, reaching 200,000 print and online readers with specific tips to 

stay engaged, access supports and services and reduce isolation. We saw a significant boost in calls coming into PCOA the day the story ran and for the next few 

days. 

To supplement and build upon our core Older Americans Act services, Pima Council On Aging developed the Neighbors Care Alliance to encourage neighbors to reach 

out to one another and formally organize volunteers who could provide transportation, friendly visits and calls, meals, and run errands. These include many of the 

top concerns and unmet needs voiced by our community in prior-year surveys of the 

most pressing issues facing older adults. The 15 active Neighbors Care Programs 

and their 120 partners are dedicated to helping their aging neighbors remain independent, safe, and less isolated in their homes for as long as possible. Our communities need to continue to seek innovative, often low-cost, neighborhood-based solutions such as this effort to address the challenges of aging in our society. 

We have seen first-hand how social isolation impacts quality of life and overall 

well-being, and the dramatic effects that breaking down that isolation can have in 

people’s lives. I’m reminded of Edna, a woman in her late 60’s, who lived alone, suffered from multiple chronic health conditions and depression, and received several 

services from us including home-delivered meals, housekeeping help and grocery 

shopping assistance. She rarely left her home. Her concerned case manager suggested that she consider volunteering through the Corporation for National and 

Community Service funded Senior Companion Program, which at the time had recently been brought to Pima County by community partner, Our Family Services. 

Over time, Edna began volunteering to offer companionship to other isolated older 

adults receiving in-home services from us, and within a year, she discontinued most 

of her own services because she simply no longer needed them. She said that going 

to visit with older people in the community every day and a newfound sense of purpose had led her to getting around better and doing more than she had in a long 

time. Edna volunteered as a Senior Companion and benefited from the boost in vitality that social interaction gave her for 8 years, contributing significantly to her 

ability to maintain independent living and her overall quality of life. 

In the course of five decades of service to older people and their families, Pima 

Council On Aging has recognized that social isolation is an issue that not only requires intervention to improve overall health and well-being, it demands prevention, 

as well. Encouraging people as they age to engage in continuing health-related education, volunteerism, and community engagement are critical to reducing systemic 

social isolation in later years. And so, our challenge as a society becomes not only 

continuing to provide and expand critical home and community-based supports and 

services that ensure safety and promote independence like those supported by the 

Older Americans Act, but also to break down systemic barriers to lifelong good physical and mental health and meaningful engagement. It is our role as an Area Agency on Aging to both find ways to reduce social isolation for older people like Edna, 

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forestalling the need for deeper interventions, and to ensure that those interventions are in place and adequate for those who eventually need them. 

Policy Recommendations 

Unfortunately, the problem of social isolation is widespread and knows no race, 

gender, income or geographic boundaries. According to our national association, n4a, 

our fellow Area Agencies on Aging share our concern, our willingness to respond 

and our desire to see greater awareness and resources deployed to address this 

problem that, with a nation that’s aging as fast as ours is, cannot be ignored. 

While PCOA will continue to tackle the problem as best we can at home in Pima 

County, we offer several policy recommendations for consideration by Congress and 

the Administration. 

1. Increase Public Education 

Current national efforts to raise awareness, assessment and remedy should be 

strengthened and new interventions developed. Our agency knows what to look for 

and how to respond, but we don’t have the capacity to serve every older person in 

Pima County. The issue needs to be elevated so that more older adults and their 

families understand that social isolation is a public health issue and should not go 

unaddressed. In tandem with national campaigns, local communities like ours and 

the aging and community groups who serve it need effective messages and resources 

to deploy at the ground level. The Eldercare Locator and Connect2Affect campaigns 

have been extremely helpful but we need more national emphasis on this critical 

issue. 

2. Expand Services that Promote Health, Engagement, Aging at Home and in 

the Community 

As our population ages, it’s essential that life-saving, independence-maintaining 

and isolation-reducing home and community-based services are expanded to meet 

the incredibly growing need. The Older Americans Act’s critical services and supports must grow as we adjust to this age wave. If we don’t meet the need, many 

older Americans will lose their independence and health, resulting in higher costs 

for taxpayers in the form of increased Medicaid nursing home costs and avoidable 

Medicare expenditures. PCOA believes that all Older Americans Act (OAA) 

programs should be increased in FY 2018. OAA Title III B Supportive Services—which provides flexible funding for a range of services from in-home supports 

to transportation—needs particular attention, as sequestration and other budget 

cuts have reduced it to spending levels not seen since before FY 2002, 15 years ago! 

This same title supports Area Agencies on Aging information and referral (I&R) efforts, so that consumers have someone to call for information on and access to aging 

services in that community. While the OAA meals programs of Title III C Nutrition 

have seen restoration from sequestration, much more needs to be done to meet 

growing community need now and in the future. 

As Edna’s story showed, programs that get older adults engaged in serving the 

community help reduce social isolation for both volunteers and those they serve. We 

support funding for the Corporation for National and Community Service’s 

Senior Corps programs, which are specifically designed to engage and serve older 

adults. 

Transportation is one of the most pressing needs for all older adults who are trying to remain at home and in the community—especially those who are isolated, and 

yet it can be difficult to find reliable, accessible, and affordable options to get to the 

doctor, the grocery store, religious services, or social events—all of which are critical 

to staying healthy and independent and prevent isolation. Lawmakers must invest in federal, state and local programs that create a wider array of affordable, accessible transportation options. 

3. Build Livable Communities for All Ages 

As the population of older adults grows so does the desire and need for communities to support people of all ages to ensure that they can grow up and grow old 

with maximum independence, safety, and well-being. Although there is much that 

individuals can and should do to maximize their independence as they age, public 

policymakers make critical decisions about issues such as transportation systems, 

housing opportunities and land-use regulations that affect whether older adults can 

live successfully and productively at home and in their community. That’s why Tucson, through the leadership of Mayor Jonathan Rothschild and Council Member 

Steve Kozachik, recently joined the World Health Organization (WHO)/AARP AgeFriendly Communities List, as the 144th city in the Nation to join; we are currently 

deeply involved in the planning work to make our community even more age-friendly. 

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Federal leadership in livable and sustainable communities is vitally needed, yet 

federal investments in promoting sustainable and livable communities has lagged 

significantly since 2010. In the meantime, states and local governments tasked with 

developing and implementing broad long-term community infrastructure and service 

systems have increasingly recognized the value of ensuring that these systems meet 

the needs of the ever-growing aging population. These community efforts will only 

be cost-effective and efficient if they reflect our aging reality. This means directing 

a portion of any new infrastructure spending to community agencies and nonprofit 

organizations by encouraging states and local governments to embrace livable-communities-for-all-ages principles and make them central to the core work of all government departments. 

The more livable a community is, the easier it will be to prevent isolation among 

older adults. If seniors have appropriate housing options, can get around smoothly 

and safely, are tapped as a resource, and are vital to the life of the community, it 

will do a great deal to prevent social isolation and loneliness. 

4. Create Stronger Connections Between Health Care Systems and Community 

Systems 

The problem of social isolation can also be reduced with better coordination between acute health care systems (hospitals, doctor’s offices, managed care organizations) and the social and human services systems. According to the Robert Wood 

Johnson Foundation, nearly 90 percent of physicians indicated they see their patients’ need for social supports, but unfortunately 80 percent of doctors said they 

do not fully know how to link patients to these networks. Clearly, there is still a 

wide gap to bridge between these very different social services and medical systems, 

and it is imperative that new intersections, partnerships and coordination processes 

are created rather than allowing the medicalization of social services, which will undoubtedly lead to higher costs and reduced consumer satisfaction. 

This list is just a great starting point for a longer list of policy prescriptions that 

this Committee and all of us who care about older adults should develop; we know 

there’s more to be done. 

I thank you for shining a spotlight on this critical issue and for inviting me here 

to share Pima Council On Aging’s perspective, and I look forward to taking any 

questions you may have. 

Endnotes 

1. The Eldercare Locator is the only national information and referral resource to 

provide support to consumers seeking assistance across the spectrum of issues affecting older Americans. The Locator was established and is funded by the U.S. Administration on Aging, part of the Administration for Community Living, and is administered by the National Association of Area Agencies on Aging (n4a). Through 

its National Call Center (1–800–677–1116), which operates 5 days a week from 9 

o’clock a.m. to 8 o’clock p.m. ET, and website (www.eldercare.gov), the Locator 

serves as a trusted gateway for older adults and caregivers searching for information and resources which can be crucial to their health, well-being and independence. 

2. Because the issue of social isolation is so complex, AARP Foundation spearheaded Connect2Affect to seek out solutions. Through research and innovative efforts, the AARP Foundation and its partners are working to create a deeper understanding of loneliness and isolation, draw crucial attention to the issue, and catalyze 

action to end social isolation among older adults. The goal of Connect2Affect is to 

create a network of resources that meets the needs of anyone who is isolated or 

lonely, and that helps build the social connections older adults need to thrive. 

Website www.connect2affect.org. 

Prepared Statement of Rick Creech, Educational Consultant, Pennsylvania 

Training and Technical Assistance Network 

Chairwoman Collins, Ranking Member Casey, and other members of the Committee, thank you for inviting me to speak before you today. 

There can be no social engagement with others without interactive communication. 

As someone who was born with cerebral palsy and was without the ability to 

speak in the accepted way, I grew up lonely and isolated—except for my parents 

and grandmothers. It was not until I received my first vocal output communication 

device that people began to know that they could speak to me and I could speak 

to them, well, at least, some people did. 

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I was born in 1954 in Smithfield, North Carolina. Back then babies like I was 

were not expected to live, and if we did live, we were not expected to be out in public, we were not expected to be educated, and we were certainly not expected to become independent adults. However, I had extraordinary parents who trusted in God, 

and not in all the doctors, the therapists, the social workers who said I would never 

do that, or that, or certainly—not that. 

My father told me once, and I never forgot this, that he wanted me to learn math, 

so that I would be able to manage my own money. He wanted me to read, so that 

I would be able to read and understand anything that someone might write about 

me, and what should be done to, and for me. And he wanted me to be able to communicate, so that I could have control over my life. 

My parents presumed competence in my ability to learn to do those things. They 

insisted that I learn. Boy, did they push me. When it came to teachers, I would always prefer to have my mother because with her, I could slack some. With my father, the Baptist preacher, there was no way I could slack. He was more demanding 

than God was with Moses. However, they taught me that I was competent. I was 

competent enough to go beyond their goals—and their dreams—for me. This is what 

great parents, great teachers, and great schools do. 

Supporting individuals who need to use AAC is not simple. The person may want 

to communicate, however, the person will have to be taught how to use an augmentative and alternative communication device for his or her expressive communication. 

The vocal impaired person will not know how, what, when, or why to express 

thoughts, feelings, ideas without being encouraged, without being pushed. 

I am speaking from experience. Initiating a conversation and carrying on a conversation is the hardest thing I do in life. To put it simply, I am no good at chitchatting. I believe that there is an optimal age to learn communication skills. That 

age being as young as possible. However, I was 28 when I got my first voice output 

communication device, and, although I still have deficits, I can expressively communicate my ideas in conversations. 

I had to work extremely hard, and I work long hours to learn to communicate 

with an AAC device. I used to read passages from the Bible and newspapers aloud 

to practice with my AAC device. My point is that we cannot provide a person with 

assistive technology or AAC, and expect people to use it. 

I recently got the Amazon echo to help me to control the lights in the house. 

Sometimes I am ready to throw Alexa out the window, and I will not tell you the 

names my wife has called the thing. Amazon Echo is simple compared to AAC devices. I started telling people many years ago that assistive technology without 

training is not assistive. 

Even today, as proficient as I am with my AAC device, I cannot talk to some people because they are too much in a hurry, or too caught up in my Accent1400, saying things such as, what can you say?, can you say my name?, or they are hollering 

at me as if I’m deaf, saying ‘‘it–is–good–to–meet–you, what–are–you–doing?’’ I get 

tempted to reply, ‘‘talking to an idiot’’, but my parents taught me that if you cannot 

say something nice, say nothing at all, so I don’t. 

As I get older, I feel my body slowing down. My bones snap, crackle and pop— 

like Rice Crispies. My muscles hurt. Right now, I have my best friend and my protector, my wife, but she is almost my age and has a bad back, arthritis, and diabetes. I know that I might not always have my wife by my side. One day I will probably be in the care of a minimum wage worker, who will have 24 other patients 

all requiring less time and care than I. The only way I have to individualize myself 

to my care takers will be through my ability to communicate with them, so that 

they will be able to see me as a person rather than just another patient. 

Of course, if that does not work, I could always call one of my three 250 pound 

sons, and say, son, I need help. 

I would like to thank the Committee on Aging, for giving me this opportunity to 

speak here, although I do not think I am that old. I would like to thank the Association of Assistive Technology Programs for sponsoring my trip here. Before I started 

working for Pennsylvania Training and Technical Assistance Network, I worked 

with Pennsylvania Initiative on Assistive Technology. I started PIAT’s Short Term 

Loan of assistive technology to adults nearly 30 years ago, so, maybe I am that old. 

The communication device I use, the Accent1400, costs in the neighborhood of 

$10,000. It is one of the more sophisticated AAC devices. However, even simpler 

augmented communication devices with speech output cannot be found for less than 

five thousand dollars. The AAC devices with eye tracking, so that people can speak 

with them using only their eyes, cost in the neighborhood of $20,000. 

All of assistive technology, my AAC, my van converted for a powered wheelchair 

passenger, my smart home equipment, all cost upward of $200,000. Still, ladies and 

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gentlemen, that is cheap, compared with a life time, of taking caring of me in a 

nursing facility. 

For my work at PaTTAN, Pennsylvania Training and Technical Assistance Network, I help managed its Short Term Loan of assistive technology program that provides assistive technology to school therapists and teachers statewide, to try with 

their students. Each year the Pennsylvania Department of Education generously 

provides around a third of a million dollars for equipment. To a poor North Carolina 

country boy, that sounds like a lot, but we have constant waiting lists of students, 

and at the end of every year, there are requests that I have to cancel or delay until 

next school year because we don’t have enough inventory to meet the requests. 

These students needs appropriate assistive technology to receive education so that 

they can grow to be productive and independent adults, who can be social members 

of our society. 

I want to leave the committee with this thought. Living without being able to 

communicate, is like being behind four glass walls. You are able to see others, and 

people can see you, but you are ignored, or worse, talked down to, until you stop 

remembering who you are and why you are important. 

Thank you, have a blessed day. 

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(49) 

Additional Statements for the Record 

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Chelsea Conaboy, Freelance Writer 

The Agenda–Politico, 04/12/2017 

They’re Out There–If We Can Find Them 

In rural America, social isolation isn’t just a private woe. It’s increasingly seen as 

a public health crisis, with new ideas for tackling it. 

FRIENDSHIP, Maine—Robin Overlock worries about Elizabeth Brown. That’s his 

job. 

The retired paramedic checks in frequently with Brown, 94, who lives in the same 

farmhouse in rural Maine where she’s lived since 1940, where she raised sheep and 

her four children as well as cared for her own mother for the last two decades of 

her life. The white clapboards have weathered to gray and the barn, the sheep long 

gone, is beginning to collapse in on itself. 

Congestive heart failure and a stroke, plus other consequences of aging, have left 

Brown housebound and largely confined to a recliner, watching TV to pass the time 

or talking by phone with friends or her oldest son, who lives about 100 miles away 

and has health issues of his own. Brown hasn’t seen her son in more than a year, 

she said; her other children are dead or estranged. Overlock, who works for a small 

startup that helps low-income seniors stay in their homes, has become the person 

in her life who monitors her swollen legs for infection. 

As he drives toward Brown’s home, on a finger of land bordering Muscongus Bay, 

Overlock passes houses with logging equipment parked in the driveway or lobster 

traps stacked outside. Some, like Brown’s home, show signs of neglect, and Overlock 

worries that the people who live in them also might be elderly and isolated. 

‘‘They’re out there,’’ he said, pointing out the windshield toward rolling hills that 

lead quickly to the bay and the Atlantic Ocean. ‘‘If we can find them, help them, 

keep them safe . . . ’’ 

Overlock is part of a vanguard of health care workers tackling what researchers 

say is a growing health risk: social isolation. Researchers increasingly are convinced 

that living alone and losing contact with family and friends can be as much a threat 

to people’s health as more physiological factors, like high blood pressure or obesity. 

And the problem is set to get worse in coming decades. Baby boomers, who had 

fewer children than previous generations, are living longer, often with chronic diseases that can reduce their mobility. Family networks that traditionally cared for 

older generations are more dispersed or have unraveled altogether. The trend is already acute in rural regions like those in Maine hard hit by the collapse of the 

paper industry and other manufacturing losses, where young people continue to 

leave for jobs to the South. 

Social isolation is not only unpleasant; it can be deadly. Someone who lacks social 

relationships has the same risk for early death as someone who is severely obese, 

according to a 2015 analysis by researchers at Brigham Young University. The feeling of loneliness, or a person’s perception of being isolated, has been linked to higher 

blood pressure and cognitive decline. Taken together, social isolation and loneliness 

were associated with a 29 percent increased risk for coronary heart disease and a 

32 percent increased risk for stroke, according to another large-scale analysis led 

by researchers at the University of York in Great Britain. 

Just how isolation erodes health is a matter of some speculation. Scientists have 

long thought that interaction with others is beneficial because of ‘‘social control.’’ 

Friends and family members prop each other up, encouraging good behavior and 

healthy habits. When those relationships break down, so can a person’s health. 

But in recent years, research has found that something more is at work: Loneliness, often thought of as a matter of the heart, may actually change the brain. The 

authors of a 2015 paper published in the Annual Review of Psychology theorize that 

chronic loneliness increases activity in a network of glands that control stress responses and create an inflammatory effect that raises the risk for chronic illnesses. 

The reason for this may be a product of evolution. Loneliness may be meant to 

motivate us, when a spouse dies or when we move to a new city, to seek out new 

connections that can sustain us physically and emotionally. But when a person can’t 

act on the feeling in a way that resolves it, loneliness can make people more sensitive to threats and less likely to seek out meaningful relationships for fear of negative consequences. 

‘‘We aren’t, by our evolution, designed to be solitary survivors,’’ said Louise 

Hawkley, who studies social relationships at NORC, an independent research organization at the University of Chicago. ‘‘We need to have others around us.’’ 

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When Sandra Lane, 79, was growing up in Bristol, Maine, where the local newspaper regularly printed the names of people in the hospital so friends and neighbors 

could call, an elderly aunt lived next door. Afraid of thunderstorms, the aunt would 

pull on rubber boots and run to Lane’s family home to wait out each squall. 

Lane now lives with her husband, Russell, 85, a former lighthouse keeper and 

lobsterman disabled by post-traumatic stress disorder and depression, in a home 

they built down a rutted gravel road on a remote pond. More homes have been built 

nearby in the years since, but most are seasonal. When a blizzard comes during the 

quiet winter months, Lane said, she feels so isolated ‘‘I almost go crazy.’’ 

The Lanes, whose son moved back to Maine from Pennsylvania to help care for 

them, are working with Overlock through Access Health, a nonprofit launched this 

year by their longtime doctor, Allan ‘‘Chip’’ Teel, who regularly performed house 

calls before he closed his practice. Now Teel is working with a local hospital group 

to pair video calls from a doctor with home visits and phone calls from people like 

Overlock, who not only checks on medical issues but listens to his patients’ stories, 

takes out their trash, or couriers a broken hearing aid across the state for a speedy 

repair. When he called recently and learned Russell Lane was having hallucinations, he took quick action to get Teel on the phone to adjust his medication. The 

aim of Access Health is to restore some of the attention that a ‘‘country doctor’’ once 

provided, Overlock said, as well as provide a small sense of community. 

Nearly half of Mainers 65 and older—about 46 percent—live alone, slightly higher 

than the national rate, according to 2015 U.S. Census data; fewer than one-third 

lived alone in 1990. Older adults who are lonely are less likely to be married and 

more likely to have annual household income of $25,000 or less, according to a report conducted for the AARP Foundation by Hawkley and others at NORC using 

2010 data. Experts say shifts in family dynamics have compounded other factors 

that are part of rural life that contribute to isolation, including poor public transportation and long travel times to grocery stores, doctors, community centers or even 

neighbors’ homes. 

It used to be that grandparents ‘‘moved into the spare room, and they were there 

until they left—until they died, I’ll be blunt—and that was part of life’s lesson,’’ 

Overlock said. ‘‘In today’s society, we all are busy. We all have careers, and we move 

around.’’ Access Health, he said, is taking ‘‘a step to be a surrogate.’’ 

The reach of Access Health, which will cost about $99 a month per patient when 

the program is fully rolled out, is relatively small. Overlock serves 12 patients now, 

though Teel hopes each of the program’s health advocates eventually will serve up 

to 100 people. The need is great. 

That’s apparent in the hospital emergency department in Augusta, the state capital, where Rob Boudewijn works as a physician’s assistant. About once or twice a 

week, he admits a patient who has no acute diagnosis but who lacks the support 

at home to manage ongoing chronic conditions, such as lung disease and obesity, 

or simple frailty. ‘‘Social admissions,’’ a frowned-upon reality in many hospitals, 

allow social workers time to contact family members or to enroll a patient in support services. Sometimes, Boudewijn said, a patient will come to the emergency department showing signs of dementia. Then they spend time with nurses and doctors, 

just connecting with other people, and their whole disposition changes. 

In those patients, he said, he can see the harmful effects of social isolation. ‘‘Everybody likes to feel worthwhile.’’ 

Oxford County, A paper-making region stretching along much of Maine’s border 

with New Hampshire, was named the state’s least healthy county by a Robert Wood 

Johnson Foundation analysis in 2010. That prompted a broad group of public health 

organizations and community groups to undertake a years-long assessment, looking 

at the root causes of the county’s poor health. They eventually settled not on access 

to healthy food or exercise or even poverty but on something deeper: disconnection, 

a feeling of being undervalued, and social isolation. 

‘‘Everything we have done since then has been with an eye toward . . . reducing 

that root cause,’’ said Jim Douglas, director of Healthy Oxford Hills, a public health 

program of the local hospital that facilitated the process. 

But what to do about it? While research has made progress in identifying the 

problem, solutions remain few and far between. 

Some studies have found that targeted psychotherapy can help people cope with 

loneliness in older age. That is unlikely to be a widely adopted strategy in rural 

communities with limited resources. In the meantime, countless social service agencies are working, much like Overlock, to address the needs of isolated individuals 

by providing in-home support, meal delivery, transportation or group activities. 

However, many lack the resources for rigorous research necessary to persuade policymakers to invest in their work. 

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Oxford has come up with a few local initiatives. A plan to expand community gardens became a means of teaching young people leadership skills. A group concerned 

about the opioid crisis organized a ‘‘recovery rally’’ in one town and put together a 

how-to to help other towns do the same. Others organized community conversations 

about broadband internet access to improve lobbying for its expansion, an important 

step for job growth and the use of telemedicine. 

‘‘It’s a very long-term strategy,’’ Douglas said. ‘‘This is not something we’re expecting to be able to point to in two, three, even seven years and say, ‘This happened 

because of that.’ It’s really a long-term investment in the county-wide community.’’ 

Julianne Holt-Lunstad, a health psychologist at Brigham Young University and 

lead author on the 2015 mortality analysis, said reducing social isolation on a national level likely will require something bigger, a societal change prompted by 

something like the public health campaigns that altered public perception of tobacco 

use and dramatically reduced smoking rates over the past four decades. 

A few efforts are getting underway. In December, the AARP Foundation launched 

Connect2Affect.org, a website aimed at raising awareness of social isolation as a 

major determinant of health. It includes links to research and a searchable data 

base of local and national resources. President Lisa Marsh Ryerson said she hopes 

it will help inspire more communities to take a broad-based look at how to improve 

health generally while putting isolation front and center. 

‘‘The reality is that social isolation cuts across the lifespan,’’ she said. 

John Gale, a researcher at the University of Southern Maine’s Muskie School of 

Public Service who grew up working on his grandparents’ Maine farm and is a national expert on behavioral health in rural communities, said the answer lies in 

finding new ways to rebuild the community fabric lost over the years. Such efforts, 

he said, don’t need scientific proof. 

‘‘The fact that someone is living out on a farm in the middle of nowhere, can’t 

get enough food . . . that seems to be a problem in and of itself,’’ Gale said. ‘‘We all 

fall into the trap of wanting an evidence base, but sometimes, at the end of the day, 

[it’s about] doing the right thing. We have to get started.’’ 

Which is where people like Overlock come in. During his visit, Brown reminisced 

about the days when televisions first arrived in town and she served as a member 

of the Friendship Women’s Ambulance Corps. As she sat in her recliner in what 

used to be the dining room, where she spends her days and nights, Overlock 

checked on her legs, swollen enough that she could be admitted to the hospital. But 

she won’t go. 

‘‘This is my life,’’ she said, sweeping her arms across her lap and over side tables 

overflowing with newspapers and letters, cans of food for her white-pawed Miss 

Alley Cat, and a television remote. ‘‘This room is my life.’’ 

Chelsea Conaboy is a freelance writer focused on health care and was features editor 

at the Portland Press Herald in Maine when this article was published. 

Dhruv Khullar, M.D., M.P.P., Massachusetts General Hospital 

and Harvard Medical School 

New York Times Op-Ed, 12/22/2016 

How Social Isolation Is Killing Us 

My patient and I both knew he was dying. 

Not the long kind of dying that stretches on for months or years. He would die 

today. Maybe tomorrow. And if not tomorrow, the next day. Was there someone I 

should call? Someone he wanted to see? 

Not a one, he told me. No immediate family. No close friends. He had a niece 

down South, maybe, but they hadn’t spoken in years. 

For me, the sadness of his death was surpassed only by the sadness of his solitude. I wondered whether his isolation was a driving force of his premature death, 

not just an unhappy circumstance. 

Every day I see variations at both the beginning and end of life: a young man 

abandoned by friends as he struggles with opioid addiction; an older woman getting 

by on tea and toast, living in filth, no longer able to clean her cluttered apartment. 

In these moments, it seems the only thing worse than suffering a serious illness is 

suffering it alone. 

Social isolation is a growing epidemic—one that’s increasingly recognized as having dire physical, mental and emotional consequences. Since the 1980’s, the percentAGING-SDG-5 with DISTILLER

53 

age of American adults who say they’re lonely has doubled from 20 percent to 40 

percent. 

About one-third of Americans older than 65 now live alone, and half of those over 

85 do. People in poorer health—especially those with mood disorders like anxiety 

and depression—are more likely to feel lonely. Those without a college education are 

the least likely to have someone they can talk to about important personal matters. 

A wave of new research suggests social separation is bad for us. Individuals with 

less social connection have disrupted sleep patterns, altered immune systems, more 

inflammation and higher levels of stress hormones. One recent study found that isolation increases the risk of heart disease by 29 percent and stroke by 32 percent. 

Another analysis that pooled data from 70 studies and 3.4 million people found 

that socially isolated individuals had a 30 percent higher risk of dying in the next 

seven years, and that this effect was largest in middle age. 

Loneliness can accelerate cognitive decline in older adults, and isolated individuals are twice as likely to die prematurely as those with more robust social interactions. These effects start early: Socially isolated children have significantly poorer 

health 20 years later, even after controlling for other factors. All told, loneliness is 

as important a risk factor for early death as obesity and smoking. 

The evidence on social isolation is clear. What to do about it is less so. 

Loneliness is an especially tricky problem because accepting and declaring our 

loneliness carries profound stigma. Admitting we’re lonely can feel as if we’re admitting we’ve failed in life’s most fundamental domains: belonging, love, attachment. 

It attacks our basic instincts to save face, and makes it hard to ask for help. 

I see this most acutely during the holidays when I care for hospitalized patients, 

some connected to I.V. poles in barren rooms devoid of family or friends—their 

aloneness amplified by cheerful Christmas movies playing on wall-mounted televisions. And hospitalized or not, many people report feeling lonelier, more depressed 

and less satisfied with life during the holiday season. 

New research suggests that loneliness is not necessarily the result of poor social 

skills or lack of social support, but can be caused in part by unusual sensitivity to 

social cues. Lonely people are more likely to perceive ambiguous social cues negatively, and enter a self-preservation mind-set—worsening the problem. In this way, 

loneliness can be contagious: When one person becomes lonely, he withdraws from 

his social circle and causes others to do the same. 

Dr. John Cacioppo, a psychology professor at the University of Chicago, has tested 

various approaches to treat loneliness. His work has found that the most effective 

interventions focus on addressing ‘‘maladaptive social cognition’’—that is, helping 

people re-examine how they interact with others and perceive social cues. He is collaborating with the United States military to explore how social cognition training 

can help soldiers feel less isolated while deployed and after returning home. 

The loneliness of older adults has different roots—often resulting from family 

members moving away and close friends passing away. As one senior put it, ‘‘Your 

world dies before you do.’’ 

Ideally, experts say, neighborhoods and communities would keep an eye out for 

such older people and take steps to reduce social isolation. Ensuring they have easy 

access to transportation, through discounted bus passes or special transport services, can help maintain social connections. 

Religious older people should be encouraged to continue regular attendance at 

services and may benefit from a sense of spirituality and community, as well as the 

watchful eye of fellow churchgoers. Those capable of caring for an animal might 

enjoy the companionship of a pet. And loved ones living far away from a parent or 

grandparent could ask a neighbor to check in periodically. 

But more structured programs are arising, too. For example, Dr. Paul Tang of the 

Palo Alto Medical Foundation started a program called linkAges, a crossgenerational service exchange inspired by the idea that everyone has something to 

offer. 

The program works by allowing members to post online something they want help 

with: guitar lessons, a Scrabble partner, a ride to the doctor’s office. Others can then 

volunteer their time and skills to fill these needs and ‘‘bank’’ hours for when they 

need something themselves. 

‘‘In America, you almost need an excuse for knocking on a neighbor’s door,’’ Dr. 

Tang told me. ‘‘We want to break down those barriers.’’ 

For example, a college student might see a post from an older man who needs 

help gardening. She helps him plant a row of flowers and ‘‘banks’’ two hours in the 

process. A few months later, when she wants to cook a Malaysian meal for her boyfriend, a retired chef comes by to give her cooking lessons. 

‘‘You don’t need a playmate every day,’’ Dr. Tang said. ‘‘But knowing you’re valued 

and a contributing member of society is incredibly reaffirming.’’ 

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54 

The program now has hundreds of members in California and plans to expand to 

other areas of the country. 

‘‘We in the medical community have to ask ourselves: Are we controlling blood 

pressure or improving health and well-being?’’ Dr. Tang said. ‘‘I think you have to 

do the latter to do the former.’’ 

A great paradox of our hyper-connected digital age is that we seem to be drifting 

apart. Increasingly, however, research confirms our deepest intuition: Human connection lies at the heart of human well-being. It’s up to all of us—doctors, patients, 

neighborhoods and communities—to maintain bonds where they’re fading, and create ones where they haven’t existed. 

Correction: December 24, 2016 

An Upshot article on Thursday about the health risks of social isolation misstated 

the purpose of a grant by the Robert Wood Johnson Foundation to a program, linkAges, dedicated to fighting the problem. The grant to linkAges was for testing a new 

project connected to the program; it was not meant to help linkAges expand across 

other areas of the country. 

Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School. 

Meals on Wheels 

Additional Statement for the Record 

Chairman Collins, Ranking Member Casey and Members of the Committee: 

We first want to commend you for your bipartisan leadership and commitment to 

improving the lives of, and protections for, our nation’s older adults. Second, we 

want to express our appreciation to you for holding this important hearing and 

bringing to light the serious issue of social isolation and loneliness among this population. Meals on Wheels of America is grateful for the opportunity to submit this 

statement for the record and eager to work with you as we continue to seek solutions to address the growing problems of senior hunger and isolation. We offer our 

perspectives on the risks and consequences of social isolation and loneliness as they 

relate to the individuals served through Meals on Wheels, as well as our thoughts 

about how this nationwide network is delivering a cost-effective and vital intervention for America’s most at-risk seniors every day. 

In a recent speech to healthcare journalists, Ellie Hollander, our President and 

CEO, highlighted an alarming statistic originally presented by Dr. Julianne HoltLunstad, both a leader in loneliness research and a witness at the hearing, that the 

effects of loneliness and isolation are comparable to the impact of well-known risk 

factors such as obesity and substance abuse, and are the equivalent of smoking 15 

cigarettes a day. Loneliness is prevalent among older adults, and the statistic of one 

in three older adults over the age of 60 experiencing loneliness is thought to be an 

underestimate, as witness Dr. Lenard Kaye presented in his testimony. We echo Dr. 

Holt-Lunstad’s assertion that senior social isolation and loneliness is an epidemic 

and a growing public health concern amidst demographic, geographic and societal 

shifts toward smaller, more isolated families. 

The factors that make older adults more susceptible to social isolation and loneliness are commonly found among individuals receiving Meals on Wheels. According 

to AARP Foundation’s Isolation Framework, living alone, having lower incomes, and 

having more physical impairments make already vulnerable older adults susceptible 

to loneliness. Data from the Administration for Community Living’s State Program 

Reports and National Survey of Older Americans Act (OAA) Participants indicates 

that seniors receiving meals at home and in congregate settings, such as senior centers, are primarily women, age 75 or older, who live alone, have multiple chronic 

conditions, take six or more medications daily and are functionally impaired. Significant numbers of OAA meal recipients are also impoverished, live in rural areas and 

belong to a minority group, making them more at-risk for social isolation and loneliness. 

Findings from a 2015 study entitled More Than a Meal, conducted by our organization in conjunction with Brown University and AARP Foundation, found that 

those receiving and/or requesting Meals on Wheels services are significantly more 

vulnerable compared to a nationally representative sample of comparably-aged 

Americans. Specifically, seniors who are on Meals on Wheels waiting lists were significantly more likely to: 

• Report poorer self-rated health (71% vs. 26%) 

• Screen positive for depression (28% vs. 14%) and anxiety (31% vs. 16%) 

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• Report recent falls (27% vs. 10%) and fear of falling (79% vs. 42%) that limited 

their ability to stay active 

Moreover, functional impairment is not just a risk factor but also a consequence 

of social isolation and loneliness (Luo, Hawkley, Waite, & Caccioppo, 2012), along 

with mortality and chronic illnesses like cardiovascular disease (Holt-Lunstad & 

Smith, 2016). The good news, however, is that Congress’ foresight 45 years ago to 

authorize a nutrition program demonstration for older adults in the greatest economic and social need has since grown into a highly effective community-based, nationwide network of 5,000 senior nutrition programs (e.g., Meals on Wheels). Today 

this network is successfully fulfilling its purposes outlined in the OAA and carrying 

out what it was intended and designed to do by: 

• Reducing hunger and food insecurity among older individuals • Promoting socialization of older individuals • Promoting the health and well-being of older individuals • Delaying adverse health conditions for older individuals 

Delivering More Than Meals 

During the hearing, Senators drew from their own experiences of delivering Meals 

on Wheels and shared compelling testimonials from constituents about how volunteer drivers often identify medical issues before they became serious problems. It 

was also noted that Meals on Wheels provides opportunities for meaningful social 

engagement among a particularly vulnerable older adult population. In his testimony, Mark Clark, Director of Pima Council on Aging and Member of Meals on 

Wheels America, reiterated anecdotal evidence that Meals on Wheels volunteers can 

become important members of seniors’ social networks, helping to deter loneliness. 

Below are some additional quotes gathered from recent news articles or were shared 

with our organization that illustrate the social benefits of Meals on Wheels services, 

as told by older adults receiving Meals on Wheels or family members or local programs: 

• Meals on Wheels delivers more than food; they deliver companionship and 

friendship five days a week. I think that’s vital for people who are shut-ins or 

semi-shut-ins. That’s our visitor. Food and friendship and pleasantness. It’s 

more than food. • I am served nourishing meals and enjoy being able to eat with friends. Socialization is almost as important as the food. • We hear story after story of people who are hungry and have nobody to help. 

Often times, our clients tell us that the driver is the only person they see throughout the week. It breaks my heart to think about the number of people who are 

on our waiting list because we don’t have the funding to feed them. • I have a reason to live now. I need to be up and dressed in time to greet my 

Meals on Wheels delivery person when they arrive. • Both my mother and father were fortunate to be able to receive this service starting on 2012 until my mother’s death at age 85 in 2014 . . . my father still enjoys 

this service today at 88 years old. Not only does the service provide him with 

a good nutritious meal but the added benefit of having the delivery person touch 

basis with him is a blessing. 

Along with compelling personal stories of the health benefits of Meals on Wheels, 

the same More Than a Meal study referenced above found that seniors who received 

daily home-delivered meals (the traditional Meals on Wheels model of a daily, homedelivered meal, friendly visit and safety check), experienced the greatest improvements in health and quality of life. Specifically, between baseline and follow-up, seniors receiving daily home-delivered meals were more likely to report or exhibit: 

• Improvements in mental health (i.e., levels of anxiety) • Improvements in self-rated health • Reductions in the rate of falls and the fear of falling • Reductions in hospitalizations • Improvements in feelings of isolation and loneliness • Decreases in worry about being able to remain in home 

Meals on Wheels can be used to reduce the social isolation that occurs due to 

functional decline and also help prevent costly hospitalizations and nursing home 

placement (Valtorta & Hanratty, 2012) that, in and of themselves, lead to social isolation. In addition to being a preventative measure for emergency department visits 

and hospital admissions, Meals on Wheels is also a proven way to reduce readmissions to the hospital and other post-discharge costs. Based on the results of a pilot 

for a five-year program that eventually spanned 36 states and more than 135,000 

Medicare Advantage beneficiaries, post-discharge costs were reduced by one-third on 

average per patient who was served by Meals on Wheels, as compared to those who 

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did not participate. Furthermore, several other pilot projects showed seniors receiving short-term nutrition interventions from Meals on Wheels post-hospital discharge, ranging from a daily hot meal to a combination of different meal types (i.e., 

lunch, dinner, snack, hot or frozen meals), resulted in readmission rates of 6%–7% 

as compared to national 30-day readmission rates of 15%–34%. 

As noted above, Meals on Wheels programs deliver so much more than nutritious 

meals to the seniors they serve. Many programs are providing social isolation interventions beyond the daily visit and safety check. In his testimony, Dr. Kaye summarized AARP’s Framework for Isolation in Adults Over 50, highlighting the importance of drawing on multiple methods of intervention. Below are some examples of 

creative interventions currently being used by Meals on Wheels programs to address 

social isolation and loneliness among their clients: 

• Many Meals on Wheels programs across the country are offering extended or 

follow-up visits with clients beyond the mealtime delivery. Others conduct regular wellness checks that incorporate casual conversation, and still others have 

volunteer befriending or friendly visitor programs to accompany home-delivered 

meal services. The efficacy of these types of interventions is supported by research which finds that the addition of volunteer visitors to planned homemaking and nursing care made a difference for elderly in the community 

(MacIntyre, 1999). • Numerous Meals on Wheels programs across the country are helping to support 

older adults with pets by also delivering pet food along with the seniors’ meals. 

As noted by Senator Cortez Masto and Dr. Kaye, pets can alleviate social isolation, feelings of loneliness and doctor visits among older adults, especially 

among individuals who live alone (Stanley et al., 2014). 

• Dr. Kaye discussed the importance of technology as a potentially powerful tool 

for connecting socially isolated older adults and introduced the University of 

Maine’s initiative to develop these tools. Some Meals on Wheels programs are, 

in fact, partnering with businesses and other local community organizations to 

install technologies in clients’ homes that would help facilitate both social connections and telehealth. Although leading to some positive outcomes, we must 

also reiterate Dr. Holt-Lunstad’s caution that more research is necessary to better understand which interventions are most effective and under what conditions, as we do not fully understand the adverse effects of some of these newer 

technologies (Chen et al., 2016). 

• An important strategy for addressing social isolation is getting homebound seniors out into their communities. One particularly innovative and exciting program called ‘‘Outings to Your Taste’’ took older adults receiving home-delivered 

meals to a restaurant of their choosing. The program seemed to attract sociodemographically diverse clients, and older adults who participated seemed satisfied with the endeavor (Richard et al., 2000). 

• In a multifaceted approach to addressing both social isolation and health, one 

initiative trained Meals on Wheels volunteers in health literacy coaching (Rubin 

et al., 2013). Loneliness has been associated with poor health behaviors, which 

adversely impacts health outcomes. This type of intervention also appeals to the 

call for more preventative work in the areas of both health and social isolation 

(Nicholson, 2012). 

Challenges Holding Meals on Wheels Back 

As outlined throughout this statement, Meals on Wheels programs are already 

doing much to address the issues of isolation among the nation’s elderly, but more 

can and should be done. The issues of senior isolation and hunger is grave and 

growing, with 1 in 4 seniors living alone and 1 in 6 struggling with hunger, a 65% 

increase since the start of the recession in 2007. Federal funding through the OAA 

has not kept pace with either inflation or need, and the network overall is serving 

23 million fewer meals today than we were in 2005. In 2014, funding provided 

through the OAA supported the provision of meals to 2.4 million seniors, yet there 

are millions more in need. In fact, a 2015 Government Accountability Office report 

found that about 83% of food insecure seniors and 83% of physically impaired seniors did not receive meals [through the OAA], but likely needed them. This gap, coupled with an increasing demand as the senior population grows at an unprecedented 

pace, portends a serious national dilemma. With this backdrop, we urge your consideration of the following policy priorities: 

1. Fund, Protect and Strengthen the Older Americans Act Nutrition Program 

The OAA has been the primary piece of federal legislation supporting social and 

nutrition services to Americans age 60 and older since 1965. In 2014, the last year 

for which data exists, the OAA enabled 218 million meals to be provided to 2.4 milAGING-SDG-5 with DISTILLER

57 

lion seniors. Despite the longstanding bipartisan, bicameral support for the Act, it 

remains woefully underfunded. As such, we ask Congress to: 

• Provide, at a minimum, a total of $874.6 million for all three nutrition programs authorized under the OAA (Congregate Nutrition Program, Home-Delivered Nutrition Program and the Nutrition Services Incentive Program) in FY 

2018. Current funding is $36.8 million below the levels authorized under the 

Older Americans Act Reauthorization Act and unanimously passed by Congress 

last year. 

• End sequestration for FY 2018 and beyond and replace it with a balanced plan. 

OAA programs, among others, were hit hard by the unnecessary and harsh cuts 

in 2013 and waiting lists for Meals on Wheels continue to climb in every state. 

2. Modify Medicare and Medicaid plans, as recommended by the National 

Commission on Hunger, to improve nutrition assistance options for our 

most vulnerable 

The health consequences of inadequate nutrition are particularly severe for seniors. Proper nutrition, on the other hand, averts unnecessary visits to the emergency 

room, reduces falls, admissions and re-admissions to hospitals, saving substantial 

Medicare and Medicaid expenditures. It is notable that a senior can receive Meals 

on Wheels for an entire year for about the same cost of 1 day in the hospital or 

10 days in a nursing home. Accordingly, we recommend the following: 

• Expand Medicare managed care plans to include coverage for home-delivered 

meals prepared and delivered by a private nonprofit for seniors with physician 

recommendation. 

• Expand Medicaid managed care plans to include coverage, with a physician recommendation, for home-delivered meals prepared and delivered by a private 

nonprofit for individuals who are too young for Medicare, but who are at serious 

medical risk or have a disability. 

• Allow doctors to write billable Medicare and Medicaid ‘‘prescriptions’’ for nutritious and medically appropriate meals prepared and delivered by a private nonprofit for individuals prior to being discharged from a hospital. 

Across the nation, we already see some outstanding initiatives to address social 

inclusion through Meals on Wheels services, but more systematic research and evaluation is necessary. In this effort, Meals on Wheels is beginning a research project 

that will test the effects of various types of loneliness interventions, including those 

that are technology-based, employed through Meals on Wheels programs. We again 

applaud Chairman Collins and Ranking Member Casey for holding the first congressional hearing on social isolation and loneliness among older adults. We cannot emphasize enough the timeliness of raising public awareness on this hidden issue. 

We look forward to working with every Member of the Committee to advance this 

agenda and ultimately, to not only eradicate senior hunger in our country, but also 

to make sure no older adult feels alone or left behind. We hope this information has 

been instructive and are pleased to offer our assistance and expertise at any time. 

Æ 

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