Hearings to examine improving wellness among seniors, focusing on setting a standard for the American Dream.

1[Senate Hearing 119-038]2[From the U.S. Government Publishing Office]34                                                        S. Hrg. 119-03856                   IMPROVING WELLNESS AMONG SENIORS:7                           SETTING A STANDARD8                         FOR THE AMERICAN DREAM910=======================================================================1112                                HEARING1314                               BEFORE THE1516                       SPECIAL COMMITTEE ON AGING1718                          UNITED STATES SENATE1920                    ONE HUNDRED NINETEENTH CONGRESS2122                             FIRST SESSION2324                               __________2526                             WASHINGTON, DC2728                               __________2930                            JANUARY 15, 20253132                               __________3334                           Serial No. 119-013536         Printed for the use of the Special Committee on Aging3738[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3940        Available via the World Wide Web: http://www.govinfo.gov4142                                __________4344                   U.S. GOVERNMENT PUBLISHING OFFICE4559-938 PDF                  WASHINGTON : 20254647-----------------------------------------------------------------------------------4849                       SPECIAL COMMITTEE ON AGING5051                     RICK SCOTT, Florida, Chairman5253DAVE McCORMICK, Pennsylvania         KIRSTEN E. GILLIBRAND, New York54JIM JUSTICE, West Virginia           ELIZABETH WARREN, Massachusetts55TOMMY TUBERVILLE, Alabama            MARK KELLY, Arizona56RON JOHNSON, Wisconsin               RAPHAEL WARNOCK, Georgia57MIKE CRAPO, Idaho                    ANDY KIM, New Jersey58TIM SCOTT, South Carolina            ANGELA ALSOBROOKS, Maryland59                              ----------60                McKinley Lewis, Majority Staff Director61                Claire Descamps, Minority Staff Director6263                        C  O  N  T  E  N  T  S6465                              ----------6667                                                                   Page6869Opening Statement of Senator Rick Scott, Chairman................     170Opening Statement of Senator Kirsten E. Gillibrand, Ranking71  Member.........................................................     27273                           PANEL OF WITNESSES7475Charlotte County Sheriff Bill Prummell, President, Florida76  Sheriffs Association, Punta Gorda, Florida.....................     377Maria Alvarez, Executive Director, New York Statewide Senior78  Action Council, Long Island City, New York.....................     679Dawn Carr, Ph.D., Director, Claude Pepper Center, Florida State80  University, Tallahassee, Florida...............................     881Susan L. Hughes, Ph.D., Founding Director, Center for Research on82  Health and Aging, University of Illinois Chicago, Chicago,83  Illinois.......................................................    108485                                APPENDIX86                           CLOSING STATEMENT8788Closing Statement of Senator Jim Justice.........................    338990                      Prepared Witness Statements9192Charlotte County Sheriff Bill Prummell, President, Florida93  Sheriffs Association, Punta Gorda, Florida.....................    3994Maria Alvarez, Executive Director, New York Statewide Senior95  Action Council, Long Island City, New York.....................    4296Dawn Carr, Ph.D., Director, Claude Pepper Center, Florida State97  University, Tallahassee, Florida...............................    4598Susan L. Hughes, Ph.D., Founding Director, Center for Research on99  Health and Aging, University of Illinois Chicago, Chicago,100  Illinois.......................................................    49101102                        Questions for the Record103104Charlotte County Sheriff Bill Prummell, President, Florida105  Sheriffs Association, Punta Gorda, Florida.....................    55106Maria Alvarez, Executive Director, New York Statewide Senior107  Action Council, Long Island City, New York.....................    57108Dawn Carr, Ph.D., Director, Claude Pepper Center, Florida State109  University, Tallahassee, Florida...............................    59110Susan L. Hughes, Ph.D., Founding Director, Center for Research on111  Health and Aging, University of Illinois Chicago, Chicago,112  Illinois.......................................................    60113114                       Statements for the Record115116John A. Hartford Foundation Testimony............................    65117118                   IMPROVING WELLNESS AMONG SENIORS:119                           SETTING A STANDARD120                         FOR THE AMERICAN DREAM121122                              ----------123124                      Wednesday, January 15, 2025125126                                        U.S. Senate127                                 Special Committee on Aging128                                                    Washington, DC.129    The Committee met, pursuant to notice, at 3:30 p.m., Room130106, Dirksen Senate Office Building, Hon. Rick Scott, Chairman131of the Committee, presiding.132    Present: Senators Rick Scott, McCormick, Justice,133Tuberville, Johnson, Gillibrand, Kelly, Warnock, Kim, and134Alsobrooks.135136       OPENING STATEMENT OF SENATOR RICK SCOTT, CHAIRMAN137138    Chairman Scott. The U.S. Senate Special Committee on Aging139will now come to order. This is my first committee meeting as140Chair. I have been up here six years. How about you?141    Senator Gillibrand. First one, and I have been here142fifteen.143    Chairman Scott. I just got lucky. I want to thank everyone144for being here. It is a pleasure to serve as the Chairman for145the Senate Special Committee on Aging for the 119th Congress. I146look forward to working with Ranking Member Gillibrand and all147our colleagues in this Committee to highlight the issues facing148older Americans and how the Federal Government can be more149accountable to the American people.150    This is something I have been focused on since my time as151Governor of Florida, and I am excited to have the opportunity152to continue this work as Chairman of the Special Committee on153Aging.154    My goal for this Committee is to make sure every American155senior is able to answer yes to this question, to these156questions: "Are you well?" because they have secured these four157things: their physical health, financial security, a safe158community to live in, and family and community support. If you159have all four of these things, your senior years can be the160best time of your life.161    Now, I would like to welcome all the new members, or all162the members of the Committee, Ranking Member Gillibrand of New163York. Also, we have got new members: Dave McCormick from164Pennsylvania, Coach Tommy Tuberville, fellow Governor Jim165Justice, we have got Andy Kim from New Jersey, and we have got166some others that I am sure will be here a little bit later.167    Aging is not a partisan issue. Whether or not we would like168to admit it or not, we are all aging, and it impacts every169single one of us regardless of political party. I think we are170all trying not to age. I believe we have a big opportunity in171this Committee to work in a bipartisan manner to support and172improve the lives of America's current senior citizens and173create change that will improve both the lifespan and health174span of future generations.175    It is pretty exciting when you look at the conversation176about what we are talking about, food safety, medicine safety,177and all these things. It is an exciting time.178    I think about how my work here will impact my grandkids. I179think all of us think about our kids and our grandkids, and it180drives what we do. I want them to have every opportunity to181live the American dream and have long and have long and healthy182lives, mostly around me.183    My staff and I are excited to work together with all the184members here to find common ground and ways we can advance our185shared goals.186    I would like to recognize Ranking Member Gillibrand now for187her opening remarks.188189                 OPENING STATEMENT OF SENATOR190               KIRSTEN GILLIBRAND, RANKING MEMBER191192    Senator Gillibrand. Thank you so much, Mr. Chairman. It is193a delight to be on this Committee. Thank you for all the new194members for selecting this Committee. I think it is one that is195highly relevant for everyone in the United States, but looking196at the Senate itself, it is quite relevant for us. I am197grateful that you are here.198    I am excited to serve as Ranking Member in this 119th199Congress. I want to thank Senators Casey and Braun for their200committee leadership during the 118th Congress. The Committee201examined many of the important issues that we are hoping to202continue to work on together.203    Senator Scott, congratulations on your position as Chair.204It is a big deal, and it is very exciting to get to serve with205you. We have a lot of ideas in common about what we want to do206with the Committee, and I think your agenda that you have laid207out is really inspiring and really important, and really208urgent.209    I am pleased to welcome both new and returning Committee210members, and I am really excited to hear your perspectives,211what you have learned from your State, what you have learned212from your own families, what you have learned in your own213lives. I think having interested and committed Aging Committee214members makes a huge difference in what we accomplish as a215committee, so I am very grateful for your leadership.216    This Congress, I hope to continue to work on lowering the217cost of prescription drugs, guarding against financial scams,218protecting the programs that older adults and people with219disabilities rely on, like as Social Security, Medicaid, and220Medicare.221    Today, we are discussing how to promote wellness among our222older Americans. We will address issues like accessible223housing, financial security, and engagement in the community.224This conversation is about making sure that we are creating and225supporting a society that gives people the tools to live, and226to live well. Those tools are different for everyone, but227include resources like nutrition assistance, Area Agencies on228Aging, Centers for Independent Living, supportive housing229programs, Medicare and Medicaid, and Social Security.230    I believe that it is our job to make sure these resources231exist and are robust enough to support those who need them.232    I look forward to hearing from our witnesses and discussing233ways to improve wellness for older adults and people with234disabilities.235    Thank you, Mr. Chairman.236    Chairman Scott. Thank you, Ranking Member Gillibrand. I237will now introduce the first witness. I would first like to238welcome Sheriff Bill Prummell from Charlotte County. The239sheriff serves as the President of the Florida Sheriffs240Association and has over 25 years of experience in law241enforcement, beginning his career with the Charlotte County242Sheriff's Office in 1992. In 2015, when I was Governor of243Florida, I had the opportunity to appoint him to serve as a244commissioner on the Criminal Justice Standards and Training245Commission, and he sits as a member of the Officer Discipline246Penalty Guidelines Task Force.247    Thank you for being here to discuss the importance of248public safety and ensuring older Americans in Florida and249across the Nation can achieve wellness is their senior years.250251             STATEMENT OF CHARLOTTE COUNTY SHERIFF252253           BILL PRUMMELL, PRESIDENT, FLORIDA SHERIFFS254255               ASSOCIATION, PUNTA GORDA, FLORIDA256257    Sheriff Prummell. Thank you. Chairman Scott, Ranking Member258Gillibrand, and members of the Committee, thank you for259inviting me to testify. Today I would like to outline ways in260which the Charlotte County Sheriff's Office is working to serve261and protect our senior population.262    Charlotte County does have a very large senior population.263Our average age is about 58 years old. We implement several264programs within the Charlotte County Sheriff's Office. Now, the265ones I am going to discuss here, they are not going to give you266the wow factor, but they are programs that make a difference in267my community.268    One of our programs we do is a Senior Outreach Program,269where we have a volunteer unit call members within our270community twice a week. We have also provided Christmas gifts271and birthday cards with these weekly phone calls. The272participants are over 60 years of age, disabled or living273alone, with little or no contact to the community, so we are274making sure that somebody is contacting them each week, and if275we do not hear from them, there is a scheduled time in which we276contact them. If we are unable to get in touch with them, we277send somebody out to their house to make sure that they are278okay.279    You know, we also have the population, they tend to wander280at their age, and we have the Take Me Home Program. It is281designed to assist deputies in locating loved ones who have282gone missing or lost. Information about your loved one, a283recent photo, and description is registered in our system. If284the individual wanders or goes missing, this information is285shared with the road patrol deputies immediately upon dispatch286in an effort to locate and reunite the family. Any office287member can register a participate to this program.288    In addition to that we have our DNA Scent Kits. It is a289program that enables participants to keep a DNA scent article290at their home in the event a loved one goes missing. Charlotte291County K9 deputies use that pure scent to begin a track in292order to locate the loved one and reunite them with family.293These are handed out by the Community Affairs Team, our Mental294Health Unit, and our patrol members.295    Project Lifesaver serves as a premier search and rescue296program locally operated by the Charlotte County Sheriff's297Office and is strategically designed for "at risk" individuals298who are prone to wandering. The program uses a GPS tracing299bracelet to locate the wandering party quickly.300    Another thing that we have that we do on a regular basis,301we have these in each one of our offices, is our Operation Pill302Drop. It allows individuals to drop off expired and unwanted303medication in drug receptacle boxes at participating district304office locations. This keeps family members and others that305might have access to a senior's medicine cabinet from getting306those old, unused medications.307    We have special vehicle decals. We provide free decals for308individual vehicles to alert deputies of a possible presence of309someone that may require special attention within the vehicle,310such as a hearing impairment or autism. This way the deputy311knows how to approach the vehicle and there may be somebody312with a disability inside of it.313    A real simple program we have is often seniors misplace or314leave items behind, such as their keys. Through our local Lock315Out Program, key tags are provided to help return lost keys to316the owners. The tags are registered with a special code in our317system with the owner's information, so if they are found, they318are turned into the Sheriff's Office, and we contact the owner319through that registration number. We educate them not to put320their name and address on the keychain in order to protect321themselves.322    Then we have our Citizen Police Academy, which is big for323our entire community but it is attended mostly by our seniors.324The classes are mostly seniors, to learn behind-the-scenes and325promote our volunteer program. The class lasts about nine weeks326long, and they learn a lot about our different programs within327our community policing class.328    A lot of our outreach, we do spend a lot of time visiting329local retirement homes to advise of the local scams and330problems that we see. In addition, we rely heavily on Facebook,331Instagram, our blog, and press releases. We know that many332seniors do not monitor this, but many family members and those333that work or live around seniors do. This helps us get the word334out to them to watch out for their neighbors.335    In addition to that, we get out there and we educate banks336and large retailers in reference to the different scams going337on, because often the seniors will go to the banks to make338large withdrawals, or they will go to these retailers, like339Walmart and Target, and start buying large gift cards or phone340cards, and by educating these individuals they know to alert us341when somebody is trying to do that.342    Last, we focus our effort on speaking to neighborhood343watches, local churches, and various organizations, such as the344Parkinson's Group. We average about one or two speaking345engagements a week. We work closely with OCEAN, which stands346for Our Charlotte Elder Affairs Network, which is a group of347business owners in the senior arena that want to specifically348help seniors.349    Currently we are seeing several different methods in which350criminals are attempting to scam our senior population. This351includes scammers visiting our website, looking up recent352arrests, and then calling family, pretending to have the353ability to bail out the arrestee. We are also seeing what is354referred to as "romance schemes," which can be long-running and355generally include a person asking for money while pretending to356love someone. Other schemes that have become more pronounced357center around sweepstakes lotteries, where individuals have to358play to win. In these cases, the scammers will ask for gift359cards to pay the taxes to get people their winnings.360    The Charlotte County Sheriff's Office has partnered with361Charlotte Behavioral Health Care for the addition of a362caseworker to be assigned to the CCSO. This caseworker receives363referrals from deputies who, during the course of their364business, identify a senior who might be in need of services as365well as calls from the public. This caseworker will refer and/366or provide services through Charlotte Behavioral Health Center367and/or make additional referrals to outside entities, depending368on the elder's needs.369    Our office provides a number of resources, including case370management assistance by giving brief overview of the program,371provide the contact number, and in some cases, provide hands-on372assistance. The case manager follows up by phone, if required,373and the case manager provides case management contact374information for additional assistance, if needed. Some of the375organizations we use are home care providers, transportation,376Family Service Center, St. Vincent De Paul, Active Age--it is a377daytime senior care--Senior Placement Services, Social Service378Resource Center, Florida Rural Legal Services, Meals on Wheels,379Senior Friendship Meals, CapTel, Dementia/Alzheimer's Caregiver380Support Group, and the Dubin Center, which is also a support381group for caregivers.382    We have more than 90 partners that provide an array of383services to our seniors and disabled. The needs of our seniors384are not one dimensional. If there is a need and we cannot385provide it, we find somebody that can. I think by a lot of the386programs we do we hit those four bullet points that you387mentioned earlier, when you opened.388    Thank you, Chairman Scott and Ranking Member Gillibrand,389for holding this hearing and focusing on senior population. I390look forward to working with members of this Committee to391develop proactive and effective ways to protect our communities392from crime.393    Chairman Scott. Thank you, Sheriff.394    Now I would like to recognize Ranking Member Gillibrand to395introduce the next witness.396    Senator Gillibrand. Thank you, Mr. Chairman. Maria Alvarez397is the Executive Director of the New York StateWide Senior398Action Council, Inc., a grassroots, consumer-directed and399governed nonprofit that has been serving communities for over40052 years. She has worked with senior citizen groups as an401organizer, advocate, and director of housing and caregivers402program for over 30 years. She has designed and implemented403educational, social service, and leadership programs for older404adults, and she has worked with me on my Working Group on405Aging, contributing to important policy priorities.406    In addition to her work with StateWide, Ms. Alvarez is a407board member of Ponce Bank, which serves underserved408communities in New York and New Jersey.409    Under Ms. Alvarez's leadership, StateWide has played a role410in bringing awareness to the importance of economic security411for elders, age-friendly banking, enacting the New York State412Observation Status Law, the Safe Patient Handling Law, and413refunding of the New York State Elderly Pharmaceutical414Insurance coverage.415    Recently, Ms. Alvarez has advocated for funding for New416York's Patient Rights Help Line and the state's Managed Care417Consumer Assistance Program. Under Ms. Alvarez, StateWide's418federally funded Senior Medicare Patrol has served to alert and419assist millions of New Yorkers to avoid Medicare fraud.420    Ms. Alvarez has also weighed in with the New York State in421favor of home and community-based services through local Area422Agencies on Aging.423    Ms. Alvarez also holds a bachelor's degree from Marquette424University, and a master's degree in nonprofit management from425the New School for Social Research, where she is a Sloan426fellow.427    Thank you very much for coming today and thank you for your428advocacy and expertise and leadership on such crucial areas429important to this Committee for the older New Yorkers who are430able to age with dignity and security. I am honored to have you431take the time to be my first witness on this Committee.432433        STATEMENT OF MARIA ALVAREZ, EXECUTIVE DIRECTOR,434435           NEW YORK STATEWIDE SENIOR ACTION COUNCIL,436437                   LONG ISLAND CITY, NEW YORK438439    Ms. Alvarez. Thank you so much, Chairman Scott and Ranking440Member Gillibrand, for inviting me here to come speak with you441today.442    As a participant of the White House Conference on Aging in443both 1995 and 2005, I can tell you that there have been444dramatic improvements in the system of preventive care and445health promotion, but we still have a long way to go. With your446leadership and advocacy, we can continue to make improvements447for the seniors of today and for future generations.448    Since 1995, the fabric of the older population has changed449dramatically. This means that systems to promote healthy aging450also need to change and modernize to better serve elders today.451    There has been a significant increase in the size of the452older, non-white, senior citizen population, which is on pace453to make up half of the elderly population by 2060. Fortunately,454though, many elderly can remain in the community despite455managing multiple chronic conditions. I suggest that one step456in the right direction would be to make sure that the 2025457White House Conference on Aging is held to help the country458chart a course for addressing the needs of this group, as 20459percent of this country is now of the age of 65 and over.460    Prior to 1995, Medicare and most private insurance would461cover treatment of an illness but not cover the cost of the462diagnostic test or prevention. Thanks to action by Congress to463improve Medicare in 1997 and 2003, and the implementation of464the Affordable Care Act in 2010, coverage of preventive465services has steadily increased. Now most preventive tests and466immunizations are available without copays, and Medicare467provides an annual wellness exam to help beneficiaries identify468health risks, schedule preventive tests, and identify social469determinants of health.470    In addition, the country has invested resources through471Part III D of the Older Americans Act to provide evidence-based472health promotion programs through the Area Agencies on Aging473and community-based agencies. Today, most communities have474programs like Chronic Disease and Diabetes Self-Management475Program and Falls Prevention. Many have been adapted to meet476the needs of older persons of different races and ethnicities.477These programs are cost-effective approaches and should be478expanded.479    At one time, Federal and State policymakers considered480services like congregate and home-delivered meals,481transportation, case management, and housing assistance as nice482but soft services that were not as important as health care. It483took years of advocacy and research to get the medical system484to finally recognize the importance of social determinants of485health, which are critical to the ability of older persons to486follow needed courses of treatment and maintain healthy487lifestyles. These are all important improvements that we can488buildupon, but we cannot ignore the need to recognize that489having health care and preventive services available is not490sufficient if they are not affordable or if discrimination,491actual or perceived, persists.492    Many problems still exist. Income security continues to be493a problem in a country where there is so much abundance. The494reality is that one in three senior citizens are not making495ends meet. Their incomes are under 200 percent of the Federal496poverty level, roughly $30,000 a year, and it is not keeping497pace with the increasing cost of living.498    Lest, you think that this is only one segment of the499population, I will tell you that we increasingly see people who500look good on paper, who consider themselves to be middle-501income, sliding into poverty at dizzying rates. According to502several reports, we are about to experience the largest amount503of homelessness in the elderly population ever. We are already504seeing it in New York City. More Section 202 housing must be505developed with social services attached to them. This will506ensure that seniors not only have an adequate place to live but507they have access to all of the programs and services for which508they qualify.509    I cannot end my time without telling you that along with510Social Security, Medicare, and Medicaid, the Older Americans511Act is a law that has had a seismic effect on the elderly512population. All of those programs form the framework that513seniors can rely on to continue to thrive and live in dignity.514Now that this generation makes up 20 percent of the country, we515need to strengthen and improve them, in their structures as516well as in their funding, to reflect the fabric of our country517today.518    I have many other points to make, and five minutes is just519not enough. I hope that you ask me about them during the time520that we have together and consider us a resource to you in the521future. I have also included a full list of programs and522recommendations with my formal testimony. Thank you.523    Chairman Scott. Thank you and thank you for being here.524    Next I would like to welcome Dr. Dawn Carr. Dr. Carr is the525Director of the Claude Pepper Center at the Florida State526University and serves as Professor of Sociology. Her mission as527a scholar and gerontologist is to identify and leverage factors528that bolster older adults' ability to remain healthy and active529as long as possible.530    Before joining Florida State University in 2016, she was a531researcher at the Stanford Center on Longevity, a postdoctoral532fellow in the Carolina Program for Health and Aging Research at533the Institute on Aging at the University of North Carolina534Chapel Hill, and a researcher at the Scripps Gerontology535Center.536    Thank you for being here today to discuss the impact of537community engagement on the physiological and emotional well-538being of seniors.539540            STATEMENT OF DAWN CARR, PH.D., DIRECTOR,541542        CLAUDE PEPPER CENTER, FLORIDA STATE UNIVERSITY,543544                      TALLAHASSEE, FLORIDA545546    Dr. Carr. Thank you, Chairman Scott and Ranking Member547Gillibrand, and the rest of the Committee. It is an honor to be548here today and to have an opportunity to share my testimony549with you.550    I am the Director of the Claude Pepper Center, and this is551a wonderful center at Florida State University that is named552for one of the strongest advocates for aging policy in U.S.553history, Senator Claude Pepper. I think he would be very554excited about the work that you are doing here today.555    Today I am here to discuss with you the importance of556expanding the scope of U.S. aging policy to increase chances557that future generations of older adults not only survive into558old age but they can thrive once they get there.559    Health problems in later life are strongly influenced by560events, exposures, and behaviors that occur well before we561reach our later years. Although the consequences of regular562harmful exposures and habitual behaviors accumulate to erode563health over time, there is growing evidence that if we564intervene early, we can significantly modify health565trajectories. Current clinical care is not designed with this566approach, and there will be significant consequences if we do567not change our current approach.568    Older adults who are navigating the period of old age when569health problems interfere with daily function, a period570sometimes referred to as the "Fourth Age," often experience571poor quality of life, and they lose the ability to live572independently. The needs of this group vary starkly with older573people who are healthy and able to engage in a variety of574active, meaningful, and purposeful social roles. This is the575period sometimes referred to as the "Third Age."576    This distinction is important because there are stark577differences in the needs of a typical 65-year-old and a typical57885-year-old, but also systematic differences in the health and579function of older adults of the same chronological age. Much of580our current ageing policy is focused on problems related to the581Fourth Age.582    Further, middle-aged adults today face more significant583health problems and disabilities than previous generations. In584the absence of significant changes, they are likely to face585more complex health issues in later life than previous586generations, and they are likely to enter the Fourth Age even587earlier.588    Our society could, instead, be enriched by a large and589growing group of healthy Third Agers if we leverage an aging590policy framework that emphasizes health maintenance at every591stage of life, targeting risks related to aging-associated592diseases and disabilities, engages older adults' unique593strengths that benefit society, and addresses barriers to594healthy aging that create inequalities in health outcomes as595people age.596    I believe the following four areas are especially597important: employment, social engagement and social598integration, health literacy and lifestyle behavior supports,599and health care access and early treatments.600    First, regarding employment and financial security, working601in later life is protective of health as people move into and602through the Third Age. However, older workers are less likely603to be hired, offered opportunities for upward mobility, or604offered opportunities for training. In addition, individuals in605physically demanding or hazardous jobs are more likely to606become disabled or retire early, with significant financial607consequences.608    Implementing health-protective occupational interventions,609where possible, and midlife retraining for transitions to new610career paths can increase the chance that workers remain611healthy and fully employed until they reach full retirement612ages. Further, making phased retirement or transitions to part-613time work opportunities available to all workers will make it614possible to remain engaged in paid work longer.615    Second, social isolation and loneliness accelerate616physiological aging. Isolating older adults within communities617is not only detrimental to the health and well-being of older618people. It also prevents communities from benefiting from their619skills and wisdom. There are very few programs designed to620reach isolated older adults. Effective programs like meal621delivery programs are low cost and have the added potential of622improving access to high-quality, nutritious foods. Expanding623these programs is likely to delay onset of disability.624    In addition, increasing engagement in volunteering not only625is health protective, it also helps people of all generations626work collectively to solve social problems. Investing in627volunteer infrastructure is not only beneficial to health628outcomes, it can provide exponential returns economically. For629instance, the Senior Corps volunteer programs have shown an630estimated return of between $3.50 and $5.08 for each dollar631invested, with the added bonus of reducing burden on the health632care industry.633    Third, most adults in the U.S. do not have access to634scientifically accurate information or resources they need to635gain access to a Third Age. One important solution is expanding636the number of community health workers, which offers one of the637most effective solutions for facilitating healthy behaviors638across the life course, by helping community members of all639ages build trust with the health care system and navigate640health care services to support healthy aging.641    Recent research suggests that there is a $2.47 return for642every dollar invested in community health workers for the643Medicaid program alone. Further, lack of access to high644quality, nutrient-dense foods is a persistent problem645reinforced by ultra-processed, unhealthy foods being subsidized646so they are low cost. Making healthy foods financially647accessible and disincentivizing consumption of ultra-processed648foods is key to increasing healthy aging.649    Last, most adults do not see a doctor regularly unless they650are facing health problems. We need scientific investments to651identify ways to halt disease progression early. This means652recalibrating health benchmarks at all stages of life to653support long-term, optimal health trajectories. For instance,654aggressively treating metabolic and lipoprotein health in655middle-aged adults has been shown to reduce risk of dementia,656diabetes, heart disease, and cancer, the most costly and657consequential aging-associated health conditions.658    This approach will require more frequent interactions with659health care providers, but it has potential to significantly660pay off. A recent study showed that a metabolic and lipoprotein661pharmaceutical intervention provided a five-year return on662investment of nearly $10.00 for every dollar invested.663    In conclusion, to build a future that is enriched by a664robust population of healthy Third Agers requires us to expand665our aging policy priorities to intervene during critical666inflection periods so we can modify health trajectories and667bolster physiological resilience as we age. If it becomes668possible for all adults to remain productively and socially669engaged in meaningful ways into late life, old age could become670a period of life that we all look forward to, and our society671as a whole will benefit.672    Thank you.673    Chairman Scott. Thank you, Dr. Carr.674    Next I would like to recognize Dr. Susan Hughes. Dr. Hughes675is a professor at the School of Public Health and directs the676Center for Research on Health and Aging at the University of677Illinois Chicago.678    Dr. Hughes is a gerontologist and health policy analyst679whose research focuses on the design and testing of evidence-680based health promotion programs for older adults.681    Thank you for being here to discuss the impact of physical682activity on the overall health of older Americans.683684         STATEMENT OF SUSAN L. HUGHES, PH.D., FOUNDING685686       DIRECTOR, CENTER FOR RESEARCH ON HEALTH AND AGING,687688       UNIVERSITY OF ILLINOIS CHICAGO, CHICAGO, ILLINOIS689690    Dr. Hughes. Thank you so much, Chairman Scott and Ranking691Member Gillibrand, other members of the Committee, for this692wonderful opportunity to talk with you and testify today about693this very, very important topic of older adult wellness. It is694an honor to be here.695    In terms of my background, I directed the Center for696Research on Health and Aging at the University of Illinois697Chicago, where I led five successive iterations of our NIA698Roybal Center. Like other Roybal Centers, we design evidence-699based health promotion programs for older adults.700    Today I would like to address the limitations of our701funding for health promotion programs for older adults and702strongly recommend the use of Medicare for that purpose going703forward.704    Medicare, as everyone knows, is a wonderful program that705serves millions and millions of people and greatly improves706access to acute and subacute care. However, the designers of707Medicare missed a major opportunity to cover wellness programs708that have the potential to pay for themselves many times over.709Medicare Advantage plans are managed care options that710encompass 54 percent of beneficiaries. Medicare Advantage plans711must offer all of the plans that regular Medicare offers, but712they can supplement that package any way that they choose. The713ability to supplement services makes these plans logical714providers of health promotion programs. However, plans will715only cover evidence-based programs if they see an advantage to716doing so.717    The good news is the Administration for Community Living718and CDC have developed criteria for evidence-based health719promotion programs. We need help from Congress to develop720incentives for Medicare Advantage plans to include these721programs as covered benefits. This will take time. In the722meantime, the only source of funding for our growing number of723evidence-based programs is Title III D of the Older Americans724Act (OAA). Fiscal year 2024 funding for Title III D was $33.6725million nationally. That amounts to $671,000 per State, or726$0.23 per senior in the State of Illinois. These funds support727care management and falls programs. Currently, there is no set-728aside funding for physical activity programs despite729overwhelming evidence supporting their impact.730    Eighty-four percent of older adults in the United States731are sedentary and at high risk for obesity, diabetes, heart732disease, and all-cause mortality. We know that any physical733activity is associated with lower mortality risk. My work with734homebound older adults found that arthritis was their most735common chronic condition and the condition that interfered most736frequently with their functioning. Our follow-up disability737study found that persons who had lower extremity joint738impairment were much more likely to become disabled.739    Once we understood the pivotal role of lower extremity740joints we developed an intervention to improve their function.741Fit & Strong! lasts eight weeks. It provides flexibility,742aerobics, and systematic lower extremity strength training, and743uses group problem-solving with peers to promote physical744activity. Our trials found significant gains in physical745activity at eight weeks that were maintained at 18 months and746accompanied by significantly improved joint pain, lower747extremity strength and mobility, and decreased anxiety and748depression at the same time points.749    Medicare spent $43,000 per total hip and knee replacement750combined in 2023. Fit & Strong! costs $300 per participant. It751has no harmful side effects and large effect sizes. Drugs have752a clear pipeline from bench to uptake. Our growing number of753evidence-based programs have no similar pipeline for754distribution. We have no way to communicate program benefits to755clinicians who can recommend them and no way to reimburse756program providers.757    Currently, Title III D of the OAA is critical but758insufficient to meet growing demand caused by the fact that759more programs are coming online. We need to reauthorize the760OAA, increase funding for Title III D, and create a new title761for physical activity. Currently, NIA and CDC are creating762great programs that unfortunately have nowhere to go in terms763of a route for distribution.764    To impact older adult wellness, Congress needs to improve765coverage of evidence-based health promotion programs by766Medicare Advantage plans. This effort would require a full-767fledged partnership between the National Institute on Aging,768CDC, the ACL, and CMS to speed up the process of disseminating769programs that meet clear criteria for suitability for adoption.770    Thank you again for this opportunity to share our work with771you. I hope this has been helpful, and I look forward to your772questions.773    Chairman Scott. Thank you, Dr. Hughes.774    Now we will go to questions. I am going to go ahead and775pass my time to Senator McCormick.776    Senator McCormick. Great. Thank you, Mr. Chairman, and777thank you, Ranking Member Gillibrand, for kicking this off. It778is great to be here in my first meeting of the Special779Committee on Aging. This is a big issue for Pennsylvania, where780I am from, and my predecessor was the Chairman of this781Committee, so it is an issue very near and dear to the hearts782of Pennsylvanians.783    My first question is for you, Dr. Carr. You alluded to the784research on part-time work opportunities in your written785testimony. What are the benefits of someone choosing to remain786in the workforce, and what are some of the barriers that older787workers face as they seek to remain in the workforce?788    Dr. Carr. Thank you for the question. One of the clear789benefits of part-time work is obviously being able to be paid790longer, and oftentimes it is not possible to work full-time or791it is very challenging as we get older because there may be792some physical health problems that people need to address,793making it more difficult to maintain that full-time work load,794or caring for other family members.795    There are a lot of reasons why part-time work is helpful,796and it is meaningful. I mean, all of us in this room, I think,797have jobs that are extremely meaningful, that we would be very798sad to give up because it gives us a lot of sense of meaning799and purpose in our lives. Those things are both helpful because800they make us feel good but also, they improve our physical801health.802    A lot of work I have done over the years with my colleagues803has shown remarkable protective effects on physical health as804well as cognitive health with continued engagement in paid805work, so that alone, I think, is an important piece by itself.806We also find that the health effects, health benefits of807working, are roughly the same for part-time work and full-time808work as we move into later life. If you think about effect809sizes, part-time work is quite potent in lots of ways.810    Regarding the barriers that you mentioned to continued811part-time work, there are a lot of different kinds of things,812and certain groups of people face more barriers than others. It813is easy if you are in, I will say, a high-ranking kind of role814to negotiate a singular opportunity to maybe consult or move815into a part-time job mentoring others, doing things of that816nature, but for a lot of workers, there are not many choices817that pay sufficiently or are meaningful enough for it to kind818of be worthwhile or even available as an option, except hourly819work or maybe stepping back and doing work that is not very820cognitively engaging, so that lack of opportunity, we do not821have a lot of, I will say, institutionalized opportunities for822people to take on or transition to an intended part-time role.823It is more haphazard or one-on-one basis.824    Senator McCormick. Yes. Thank you. Sheriff, a question for825you. You made mention of scammers taking advantage of all of us826but in particular focusing on the elderly. What are some of the827protective measures that you would recommend, particularly for828hoaxes that are telephonic? What can people do to protect829themselves and recognize the potential scam call?830    Sheriff Prummell. Well, you know, the best defense is a831better offense, because we have got to get out in front of this832because a lot of these scams are very, very difficult to track833down. Many of the offenders are not just outside your State,834normally, but they are outside the country.835    What we try and do, especially with the jail scams, your836IRS scams, things like that, we try to tell everybody to give a837safe word. This way if somebody is calling you saying, "Hey,838Little Johnny, I'm arrested in jail. I need bail money," there839is some sort of safe word that they both know, that that person840is going to use. The scammer, of course, is not going to know841that safe word, so they are not going to know to use it, and842the person on the other end will catch on to that and realize843it is a scam.844    The most part is we just educate, educate, educate, in845every way possible and to everyone possible, because as you846stated, everyone is being scammed, but our seniors are847especially being targeted.848    Senator McCormick. Thank you.849    Chairman Scott. Thank you, Senator McCormick. Next I will850turn it over to Ranking Member Gillibrand.851    Senator Gillibrand. I would like to defer my time to852Senator Alsobrooks.853    Senator Alsobrooks. Good afternoon. First of all, thank you854to Chair Scott and to Ranking Member Gillibrand for convening855this really important meeting. I am enthusiastic about joining856the Senate Special Committee on Aging and really pleased to be857here today. I want to thank all of our witnesses who came858today. Thank you so much for your presentations and your work859and all the information that you shared.860    As the daughter of two aging parents, I have witnessed,861like so many, some of the challenges that our seniors face. Our862seniors have spent their entire lives, many of them, working to863earn benefits such as Social Security and Medicare, and I view864these programs as a promise that we have made to our seniors. I865am committed to ensuring that every senior, regardless of their866background or circumstances, has access to resources and867opportunities that they need to thrive.868    With that I will begin my questions. I would like to say to869Ms. Alvarez, direct the first question to you, that like so870many Americans I am a part of what they call the "sandwich871generation," which means that I am both caring for a 19-year-872old daughter as well as my aging parents. While I am really873grateful for the opportunity to support my parents and874understand the rewards that come with caregiving, I also875recognize how challenging it is to bear the full weight of876caregiving responsibility.877    Now we know that many Federal programs that are so critical878to our seniors and that guarantee the support and stability879that they need, are really in jeopardy.880    In Maryland we have over 1.2 million residents who are over88160, and the Maryland Department of Aging oversees a range of882these programs, but Maryland also relies heavily on Federal883funding. I wonder, do you believe that volunteer-based884organizations who we rely on very often have either the885capacity to adequately fill the gaps that would be left by886reduced Federal funding, and do you believe that these887organizations likewise have the obligation to provide that888care, particularly in states like Maryland, where Federal889programs are vital to seniors?890    Ms. Alvarez. Thank you very much for that question. To891answer your question, right now if there is a reduction--if892things stayed the same, if the funding stayed just the same,893just by the fact that we have a larger senior population and894more and more aging--in every single day there are 10,000895people who turn 65, every single day in this country, so with896no increased funding and more people to serve, that constitutes897a cut.898    Just starting from that point, I would say that we cannot899afford not to increase the funding. Decreasing it would put us900in a crisis, and then when you are talking about the mission of901organizations that manage volunteers, that is their mission,902and my organization also, you know, we are volunteer-based, as903well, and it is our mission to do it, and however being904realistic, we have to be able to marshal our resources905effectively so that we can do a good job and be responsible in906our work.907    With less funding, you know, it is not possible, right. We908are constantly thinking of ways that we can get more people,909because there are people out there who are very well meaning910and who want to do the work, but we also have to have the911wherewithal to administer all of this work, with volunteers912coming in, as well as the job at hand, which is an increasing,913you know, senior population.914    Senator Alsobrooks. Next, Dr. Carr, I just have a question915also for you. The question is regarding the cost of increasing916prescription drug medications. This is yet another area where I917have seen really so much struggle. I mentioned my parents. My918father is my mother's caregiver, and one of the things I note919in Maryland, and around, is that nearly 90 percent of all of920our seniors take prescription drug medications. We also know921that over 20 percent report that it is extremely difficult to922afford those medications, and we know that access to affordable923prescription drugs is not just about health, but it is about924dignity, as well, and peace of mind.925    The question is, how can we ensure that our seniors will926have reliable access to affordable prescription drug927medications?928    Dr. Carr. Yes, I agree that making sure that everyone has929access to the medications that they need is extremely930important. I do not have a clear history of studying931prescription drug costs, but I can say that in order for us to932be able to maintain a healthy aging population, inadequate933access to prescription drugs will undermine our efforts. The934scientific advancements in pharmaceuticals are astonishing and935playing a big role in helping with prevention at all ages.936There is lots of room for pharmaceuticals to play a strong937role, in coordination with other health care efforts, to ensure938healthy outcomes.939    In terms of financial supports, it would be largely940undermining to the efforts to ensure a healthy aging future if941we did not have financial support for all of the pharmaceutical942needs of order adults.943    Chairman Scott. Thank you, Senator. Now we will hear from944Senator Tuberville.945    Senator Tuberville. Thank you, Mr. Chairman. I am thrilled946to be on this Committee with you. You laid out great vision for947the Committee: Are Americans doing well? We should have some948great hearings. I think most Americans would respond to that949question with concerns or worries.950    Americans who are not just seniors are concerned about951their safety, health care, finance, nutrition, and stability952for communities, the fact that so many Americans are concerned953about their general welfare is unacceptable. We live in the954most abundant country in the world. Anxiety about things like955public safety, harmful chemicals in foods, financial security,956and retirement security should not be at the forefront of957Americans' minds, but they are.958    Elites in Washington have ignored these concerns for far959too long, and the American people are tired of it, so when960President Trump's election, Republicans taking back the Senate,961we are going to leave no stone unturned, thanks to our962Chairman.963    I want to make sure that when Americans are asked about964their wellness they respond with hope and optimism, not fear965and anxiety. I look forward to digging into these with you, Mr.966Chairman. It should be fun, we should have a good time, and967maybe we can make some progress.968    Sheriff, real quickly, I know you hit the spam and the969robocalls. I have gotten several spam texts as we have been970sitting here. It is annoying. I am sure to seniors who are971tired, sitting around, they get absolutely sick of it. You have972worked with this.973    What can we do on the Federal level to help this? Is there974anything that we can do to eliminate some of this garbage?975    Sheriff Prummell. You know, I do not know if we are ever976going to be able to eliminate it, because with AI and with all977the different technologies that are coming up, they are using978technology to commit the crimes, and we are trying to use the979technology to catch them now, so we are trying to keep up.980    The problem is there is a lot of legislation, both on State981levels and Federal levels, that is not keep up with technology.982It is years behind, so that is a big thing that we need to look983at is legislation and technology.984    You know, when people receive phone calls and all that, now985they can spoof numbers so they can use a number that is very986familiar with them. I mean, we have people that use the987Sheriff's Office number when they are trying to do the jail988scam, because they can easily spoof the numbers. It is just989trying to keep up with technology. We really need to get a990handle on it.991    Senator Tuberville. Yes. Dr. Hughes, we have got a serious992nutrition wellness problem in this country, serious. Can you993speak to the importance of a lifestyle in earlier years to help994our young people understand what they are getting ready to get995into in later life?996    Dr. Hughes. Yes. I think that is a great question. I think997we have a real opportunity to educate people early on and998develop a life course perspective to health education, physical999fitness and so on and so forth. It is going to be far more cost1000effective in the future if we can get people to adopt healthy1001nutrition habits, physical activity, other types of activities1002that will really improve their functioning and quality of life1003as they age, and into old age.1004    Senator Tuberville. You know, our young people do not have1005it as good as we have had it growing up because we used fresh1006food and vegetables. They eat all this processed food now. I do1007not know where it is going. I hope we can get a handle on that.1008I really do.1009    Dr. Carr, whether it be friends or family, what is the1010significance of community and social engagement?1011    Dr. Carr. Can you repeat that question? What is the1012significance?1013    Senator Tuberville. I want to read it myself again.1014    Dr. Carr. Okay.1015    Senator Tuberville. Whether it be friends or family, what1016is the significance of community and social engagement? In1017other words, what does the community do? Not just your family1018but your community and your social outcome, you know,1019boyfriend, girlfriend, husband, wife. I mean, how can that all1020work together to make us have a better, longer life?1021    Dr. Carr. Well, it has been very interesting over the last102220 years because I think for the first time scientific efforts1023have been able to show that friends matter a lot. The growing1024research showing morality consequences of loneliness and social1025isolation have really accentuated our understanding of why1026relationships matter.1027    I think for a long-time things like friendships and family1028relationships were thought of as sort of soft, not real health1029behaviors.1030    Senator Tuberville. Make a huge difference.1031    Dr. Carr. Yes. I think that there is clear evidence, and1032sometimes when I talk to people and they say what are the key1033issues when you think about longevity, and I put social1034broadly, broadly speaking, at the top of that list, and that is1035not just you have a good marriage or you have a few good1036friends, but the interconnected relationships we have within1037our community are heavily related to that. If we are in a1038community where we belong and we are able to have our needs met1039and work as part of a team, like I mentioned, I think, in my1040testimony solving problems together, those are really powerful1041relationships that help us feel like we matter and we have a1042place in the spaces that we are in.1043    Senator Tuberville. Yes. I will not ask this to anybody. I1044would just like to put it on the record, but you know--and1045hopefully we will talk about this in the future--Americans are1046suffering from a record-breaking, trillion dollars of credit1047card debt, trillion, and what can we do in the future, as a1048group, to take----1049    Chairman Scott. The highest interest rates for credit cards1050ever, also.1051    Senator Tuberville. Pardon?1052    Chairman Scott. I think it is the highest interest rates1053for credit cards ever, in the history of the country, too.1054    Senator Tuberville. Interest rates and the debt, and we1055just keep racking up. People are broke. They do not have cash.1056    Chairman Scott. Yes. Highest credit card debt in history1057and highest interest rates on credit cards ever.1058    Senator Tuberville. Yes. Thank you, Mr. Chairman. Thank you1059very much.1060    Chairman Scott. Senator Kim.1061    Senator Kim. Yes. Thank you, Chairman. Thank you, Ranking1062Member. Thank you, everybody, for joining up here. I appreciate1063it.1064    Dr. Carr, I think I will just pick up where my colleague1065was getting at, you know, this issue about loneliness, issue1066about mental health in particular. I think that is something1067that is becoming all the more apparent in our society. I think1068we have a mental health crisis as a nation right now. It1069affects young kids. I have got a seven-year-old and a nine-1070year-old, and I am worried about that generation, but just kind1071of all throughout this, and from my standpoint it feels like we1072do not have the workforce that we need right now to be able to1073address this.1074    I guess I just wanted to get a little bit more a sense from1075you of just what are the some of the best practices? Are there1076certain states or communities that are doing this better, you1077know, things that we can draw on? We do not want to reinvent1078wheels here, but if there are certain things we can lift up to1079a federal level, you know, I am interested in trying to explore1080that. I just thought I would kind of tease that out a little1081bit more from you.1082    Dr. Carr. Yes. I mean, I agree with you that we do not have1083the resources we need to address the growing mental health1084issues that we are facing as a Nation, and it is getting worse,1085and the pandemic was a big spike, that has not really recovered1086fully in that regard.1087    In terms of specific case example, I actually think that is1088a wonderful suggestion for the work that we should be doing is1089identifying some communities that are getting it right. I am1090not familiar with any specific individual communities.1091    I will say that communities in which there are1092opportunities for people to have all of their basic needs met1093are doing much better than ones that are suffering in terms of1094issues with high levels of unemployment and poverty. That is1095partially because there is this connection with having1096meaningful roles and connections and being able to connect with1097other people within the community. Volunteering is one of the1098ways that a lot of people have been able to maintain those1099relationships above and beyond having those basic needs met. I1100think that places where there is a lot of intergenerational1101engagement, this is particularly useful to a healthy, sort of1102social fabric.1103    With this recommendation I am going to be looking for some1104great communities that provide excellent examples that we1105should be able to look at.1106    Senator Kim. I would love to stay in touch with you about1107them. Mr. Chairman, I think that is something that this1108Committee might be able to do, is really try to draw upon these1109different issues of mental health and financial situations. It1110is hard here in Congress to come up with something completely1111from scratch, a new, completely novel idea, but if there are1112pilot projects, if there are other examples that we can draw1113upon, scale, try to exemplify, that is something that we can1114lift up here in this work. I hope that we can have a chance to1115work together on that.1116    Ms. Alvarez, a similar-ish type question. If you don't mind1117I will be a little personal here. I was listening to one of my1118colleagues talk about she is part of the sandwich generation. I1119am, as well. My father had a major accident last summer, and is1120not able to walk anymore, and now having significant cognitive1121decline.1122    We are really struggling with this, and I think, Ms.1123Alvarez, one thing I wanted to raise with you is the thing that1124really stood out to me was the difficulty of our family trying1125to get a sense of like where we can turn. What is my father1126eligible for? What other types of services are available,1127resources that are out there? Even navigating Medicare. I mean,1128I am a United States Congressman at that time, and I was having1129so much trouble just trying to navigate. I cannot imagine what1130other Americans have to deal with.1131    From your standpoint, working in New York, what have you1132seen as sort of the best examples of getting that information1133out there. The challenge is often that it is, at least from my1134family and may I talk to, you are often experiencing some of1135this in an emergency situation, where things have changed1136dramatically in your life. Are there ways that we can try to1137ramp up better, try to prepare people better, so that it is not1138just under this crucible of pressure and emotion in terms of1139trying to get to it? I wanted some of your thoughts here.1140    Ms. Alvarez. Yes. Thank you so much for bringing that up.1141At StateWide we operate three help lines. A lot of our work, we1142are a grassroots organization, and a lot of our work is going1143out into the community, and many times there are hard-to-reach1144populations. They might be ethnic minorities. There might be1145rural areas.1146    We are constantly thinking of ways in which to outreach to1147different areas. We have gotten to the point where we are doing1148a lot of ads in the newspapers, because we know that seniors1149like to read the newspaper. We do radio interviews, and a ton1150of outreach into the community through tabling events, fairs.1151Anywhere they invite us, we are statewide, as the name1152connotes, but it is also important, not only to reach the1153senior but the caregiver.1154    Senator Kim. Yes, the families.1155    Ms. Alvarez. What you are talking about is the family, the1156caregiver, the friend. It is very important because many times1157those are the people who are assisting or even making1158decisions, depending on what State the person is in.1159    I will say, in response to, if you are looking for a1160community project that works, we are very proud of a project1161that we have with our Senior Medicare Patrol Program, where1162what we have done is to reach out to community organizations,1163community-based organizations, that are trusted sources in the1164community, and working with them. What we do is we train people1165that they identify, people who are active in the community, and1166so we train them on different issues, who then go speak with1167their peers.1168    I always find that the most effective way of reaching out1169to others is through your peers. You are going to listen to1170your friends, and we ask them. We do not dictate what it is1171that we want to do. We have the content that we want to1172communicate, of course, which is the fraud and health and1173things like that, but how they want to be communicated to, that1174is up to the community. We go to the community and we ask them.1175They know best, and that is not only that they know and they1176are trusted, but also that they are then empowered with1177information. They can go out, and they can become leaders, and1178they are empowered to go out, so it is a mixture of a lot of1179things, and the other thing I wanted to followup a little bit1180on what Senator Alsobrooks----1181    Senator Kim. If you don't mind, keep it very brief. I don't1182want to go too long over. Otherwise, the Chairman, I don't want1183to cause trouble in my first hearing.1184    Ms. Alvarez. It is on me. The family caregivers--no, it is1185a statistic, very important, I want to say--is that family1186caregivers, on an average, spend about 20 percent of their own1187income on the person that they are caring for, the senior, and1188it is important, you know, we were talking about financial1189issues before, it is important to note that because then that1190might put the person caring for the elderly person, or whoever,1191in jeopardy, and they are not able to build wealth or they will1192be in more debt, moving forward, and they will be worse off1193than the person they are caring for when they finally need it.1194That is all I wanted to say.1195    Senator Kim. Well, thank you so much. I appreciate it. I1196yield back.1197    Chairman Scott. You know who should be helping you, your1198health plan should have a health care advocate that should be1199able to help you navigate that whole system.1200    Senator Kim. Yes.1201    Chairman Scott. Most of these, especially these bigger1202companies, all have a whole program now of advocates that are1203supposed to be helping, because how would you know? I used to1204be in the business, and people call me all the time because I1205was in the business, but other than that, I mean, you are not1206going to become an expert. That is where it should be done.1207    Senator Johnson.1208    Senator Johnson. Thank you, Mr. Chairman. As you are well1209aware, I am kind of a late entrant onto this Committee, and I1210mainly joined because you became the Chair, and I think you1211laid out a pretty good vision for what you want to do with this1212Committee.1213    It will come as no surprise to you, and I think my1214Committee members will quickly learn that I am not a real fan1215of the Federal Government. I think it causes or exacerbates1216more problems than it solves. I think the question you will1217hear repeatedly out of me--I have certainly heard a lot of1218support for government programs. I think my overriding question1219always is what is the negative, unintended consequence of a1220well-intentioned program.1221    I will lay one out. I am currently working on a program, or1222my project, we are trying to make sure everybody is aware of1223how much the Federal Government spends. In 2019, total1224government spending was $4.4 trillion, and we had the pandemic,1225and it shot up to $6.6 trillion.1226    How if you are a normal family, if you have an illness,1227your spending dramatically increases and you get well, you go1228down to the previous level. We did not do that. For the last1229five years we have averaged $6.5 trillion. Last year we spent1230about seven.1231    It is completely unsustainable. The result has been the1232devaluation of our currency. A 1998 dollar is now worth 511233cents. A 2014 dollar is now worth 74 cents. A 2019 dollar is1234now worth 80 centers. I could ask you the question, you know,1235how much more devastating is that devaluation of a senior's1236wealth compared to the loss of one government program.1237    The mismanagement of Social Security is profound. Social1238Security, when it was first established, I think the retirement1239age was set at 65 and life expectancy was less than 62. Now,1240being 69 myself, I am really glad life expectancy has1241increased, but with that increasing life expectancy you end up1242with Alzheimer's, you end up with more cancers, you end up with1243some really difficult problems that we are all trying to solve1244here.1245    I appreciated Senator Tuberville's comment about social1246interaction and community. I think it has been a recurring1247theme that that is like sort of the number one solution. Strong1248families, supportive communities. That does not come from the1249Federal Government.1250    I guess I just kind of want to at least have everybody1251think of the Federal Government programs you are advocating1252for, the costs of those things, helping drive the $1.8 trillion1253deficit. I mean, if we want to prioritize spending on seniors--1254and again, we are a compassionate society and we want to help1255people who cannot help themselves, and seniors are often in1256that category--what other spending can we put down the priority1257scale and not do?1258    My mission as a U.S. Senator is to wean as many Americans1259off the government as is possible, so we can rely on our1260families, we can rely on our communities, because that is1261really where the solution lies here. I just kind of want your1262comments.1263    Part of the isolation we are finding is if everybody thinks1264they can just get a quick check from the government, nobody has1265to really feel responsible for Mom and Dad, so as people become1266more and more isolated, the less and less they are connected to1267their community, or even dependent on their family and their1268community.1269    I will start with you, Dr. Hughes. Can you comment on some1270points I made there?1271    Dr. Hughes. Okay. I think that there are a number of things1272that we can do. I understand where we are headed, you know,1273with the current deficit, and obviously it is huge. It is not1274trivial. You are correct that we have issues with maintaining1275Social Security in the future. However there are also a lot of1276people out there working on this problem, and what I have read1277is that it is not an insurmountable one.1278    There is a group at Boston College that is headed by Alicia1279Munnell. She is an economist who has spent her whole life1280working on this issue, and she has basically come up with some1281relatively simple, straightforward ways of kind of getting us--1282--1283    Senator Johnson. Can I----1284    Dr. Hughes. Yes. Go ahead.1285    Senator Johnson. Well, I mentioned the mismanagement of1286Social Security. You realize we took all that surplus money,1287and we had lots of surplus money for years, because there were1288tens of workers for every retiree. Now we are down to under1289three to one.1290    Dr. Hughes. Right.1291    Senator Johnson. We did not invest that money. We spent it.1292It is gone, and in its place are government bonds, which really1293have no value to the Federal Government.1294    Dr. Hughes. Right.1295    Senator Johnson. Now, had we invested those in something1296like a Dow Jones Index Fund, which did not exist back then--1297this is a couple of years ago--we would have $8 trillion in1298hard assets, but we did not do that. We spent it.1299    Dr. Hughes. Right.1300    Senator Johnson. It is gone. It was mismanaged. Again, that1301was the Federal Government did that, and the other unintended1302consequence of that, we led seniors to believe, boy, just get1303to the age of 65 and we are going to pay for your retirement.1304We are going to pay for your health care. I do not know any1305senior that can really get by on just Social Security benefits.1306That is a poverty-stricken life, but we kind of lead people to1307believe that, because we really do not educate them. We do not1308educate our kids and go, "Hey, save for your retirement,1309because you are not going to want to live off what Social1310Security provides, and oh, by the way, we have kind of1311bankrupted it anyway, and it is not going to be able to provide1312all those benefits in about 10 years anyway."1313    Professor Hughes.1314    Dr. Hughes. Well, I would disagree that the program is1315going to be bankrupt anyway, respectfully. I think that there1316are things that we can do to keep the program solvent. I am,1317unfortunately, not a health economist. This is not my area of1318expertise. I know there are people out there who are working1319very hard on this, and have some very good ideas about how we1320can increase the share from people who have more wealth, for1321example, in terms of their contributions to Social Security. We1322have already increased the retirement age. There are other1323things that we can do along that line as people become1324healthier and have a longer life expectancy.1325    I think it is, of course, a very, very, very important1326issue, and one that everybody should be very concerned about1327and working very hard on.1328    Senator Johnson. Well, I will just relentlessly point out1329how the government has screwed up time and time and time again,1330and again, the definition of insanity is doing the same thing1331over and over again, expecting different results. I mean,1332continuing to rely on the Federal Government to solve these1333problems. I think we have to find different solutions.1334    Thank you, Mr. Chairman.1335    Chairman Scott. Thank you, Senator Johnson. Senator Kelly.1336    Senator Kelly. Thank you, Mr. Chairman, and congratulations1337on your new role, and the same to you, Ranking Member1338Gillibrand. I am glad to be returning to the Aging Committee1339this Congress. Almost one-fifth of Arizona's population is 651340and older, and that number continues to grow. I think it is1341pretty simple. Arizona is a great place to live, to raise a1342family. It is also a great place to retire, has great weather,1343especially this time of year. I am looking forward to1344continuing to work with my colleagues on this Committee to make1345sure that that stays the case. One of the things we could do is1346adequately fund senior programs and services, making health1347care more affordable and accessible, and by giving people the1348ability to choose where and how they age.1349    I want to take this opportunity to remind any of my1350constituents, who happen to be watching, that my office here1351and in Arizona, we are here to help. If you need some help with1352a Federal agency, and that includes a problem with your Social1353Security benefits or an issue with the VA, we are here to help.1354Please go to my website or give us a call if you need1355assistance.1356    I know we have got two big years ahead of us in this1357Congress, and I am looking forward to making some positive1358change for Arizonans and folks across the country.1359    My first question here is for Dr. Carr. First I see in your1360bio that you are an ASU grad. One of my kids went to ASU. The1361other is at U of A.1362    In your testimony you mentioned meal delivery as an example1363of a low-cost program that has a very valuable impact on older1364adults, especially those who are socially isolated, and this is1365something we heard a lot about as we worked on the1366reauthorization of the Older Americans Act. Many of our Area1367Agencies on Aging in rural areas of Arizona have a lot of1368interest in home-delivered meals, and yet they have to put1369folks on a waitlist for these services, and for some1370organizations this is the first time they have ever had to use1371a waitlist for meals.1372    That is one reason why I was glad that our bipartisan1373Senate passed Older Americans Act reauthorization included more1374flexibility for how local agencies can use their nutrition1375funding, allowing them to move more money toward delivering, if1376that is what the community, the local community, needs.1377    In the same spirit of meeting people where they are, last1378Congress, then-Ranking Member Braun and I introduced1379legislation to help food banks be able to provide delivery1380services for the Senior Food Box. This got a great reception in1381Arizona, and I would like to put it out there that if any of my1382colleagues on this Committee would like to work with me on1383this, this year, I am more than willing to do that.1384    Dr. Carr, could you talk about why these kinds of programs1385are so valuable, and from your perspective, why are they1386important for Congress to continue to support?1387    Dr. Carr. Thank you for that question, and yes, I am an1388Arizona State grad, and my brother went to the University of1389Arizona, so you can imagine what that is like sometimes.1390    I also want to start by just saying, one of my earliest1391memories is going in the car with my grandmother door-to-door,1392delivering meals with these programs, and it was a big part of1393our family growing up, making sure to volunteer and to help1394support other people in the community in the Tempe area. Where1395we grew up.1396    I think of the home-delivered meals programs as kind of the1397secret sauce of kind of a foundation for healthy aging, because1398it does a whole bunch of things at once. It has the opportunity1399to help make sure that people have food, which we know is1400important. It promotes social engagement.1401    We know with some colleagues I know at other universities1402who are really big experts in this field have shown that the1403more frequently a person gets a home-delivered meal delivered1404to their house, the better the outcomes, because there is more1405frequent interaction, and those small bits of social engagement1406are potent in terms of their benefits for feeling less isolated1407and more connected and feeling more valued in the community,1408and the person delivering the meal also gets benefits from the1409volunteering and engagement in the community, and they feel1410valued.1411    There is almost no program I can think of that has those1412combinations of things that are so collectively relevant. I1413think if there was a program that could have more impact, I1414cannot think of one that is as inexpensive as this one could1415be, to expand.1416    Senator Kelly. Yes, it is interesting you get an added1417benefit from doing this. I mean, the food is the goal. I1418experienced this as I delivered meals during COVID, and I saw1419seniors multiple times. I could tell that they were getting1420something out of this beyond just this delivery of lunch and1421dinner.1422    Thank you. I am going to have a couple of questions for the1423record, Mr. Chairman. Thank you.1424    Chairman Scott. Thank you, Senator Kelly. Senator Warnock.1425    Senator Warnock. Thank you very much, Chair Scott, and1426congratulations on holding the first Aging Committee hearing of1427the year. I look forward to working with you and also with1428Ranking Member Gillibrand together this Congress.1429    Far too many seniors are struggling with high out-of-pocket1430costs for medications that they need to live. That is why I1431have been laser-focused on reducing prescription drug costs and1432improving access to health care. I am proud that my bill,1433included in the Inflation Reduction Act, lowers the cost of1434insulin to no more than $35 per month of out-of-pocket costs1435for seniors, and that as of January 1st of this year, seniors1436will not pay more than $2,000 in out-of-pocket costs for their1437prescription drug coverage each year. I can tell you, as a1438pastor, that I have seen the impact that this has on the lives1439of ordinary people. I have seen it up close.1440    I am proud that this spending cap was made possible, again,1441and included in the Inflation Reduction Act.1442    Dr. Hughes, how does lowering out-of-pocket prescription1443drug costs actually help seniors who live on a fixed income? I1444think often in government we talk about these things in1445theoretical terms, but give us a clear picture of the human1446impact of this.1447    Dr. Hughes. Well, you know, we all depend right now on1448prescription drugs. Prescription drugs have almost replaced1449regular routine medical care in terms of their lifesaving and1450health maintenance effects, so they are a lifeline, and for1451people who are, because of income constraints, now able to get1452a medication renewed and/or have to make a choice between rent1453or food or something else and the needed medications, that1454should not happen. It should not happen to older adults. It1455should not happen in the United States of America. I just think1456that this legislation, the Inflation Reduction Act has been1457very important in terms of helping older adults to manage their1458prescription cost. It is a great piece of legislation, and I1459think it has enormous potential to help a lot of seniors.1460    Senator Warnock. I agree with you. I think it makes a huge1461difference. I agree that seniors should not have to choose1462between prescription drugs, which they need, and food on the1463table, which they also need. I look forward to building on this1464and working on it, not only as a member of this Committee but1465also as a member of the Finance Committee, where a lot of these1466issues related to costs and seniors comes up through the1467various programs that we have.1468    I am grateful for Senator Casey's work last Congress to1469champion the issue of Medicaid home and community-based1470services. Medicaid provides coverage for home and community-1471based services that allow older adults and people with1472disabilities to receive the care that they need from the1473comfort of their home without going broke paying for it.1474    However, in Georgia, over 7,000 people are on waiting lists1475to access these services, so we had the Better Care, Better1476Jobs Act last Congress to enhance Medicaid funding for folks1477who are still on the Medicaid list.1478    Dr. Carr, how would cuts to Medicaid proposed by some of my1479colleagues affect access to home and community-based services1480for our seniors?1481    Dr. Carr. Yes, so Medicaid and home and community-based1482services are an actually more cost-effective way to help care1483for older adults with disabilities than nursing homes, and one1484of the challenges is if people do not have the care they need1485it can spill over onto caregivers, family members, who are1486providing the best care they can, which can be problematic1487because then they may also be unable to work themselves, which1488I think has ripple effects that are consequential for families.1489    Then I think we would anticipate that in the absence of1490receiving care people need at home, they are more likely to go1491into a nursing home, and even if people do have money saved and1492they are not yet on Medicaid, within six months they are1493usually spent down to Medicaid, and that is very expensive for1494our system, and it does not meet people's needs that they want,1495which is to stay in the community.1496    I think the consequences of not allowing people to have the1497services they need to stay in their home and get care for as1498long as possible is the most cost-effective way for us to1499protect Medicaid costs, among other things, not the least of1500which is supportive of qualify of life for older people.1501    Senator Warnock. Thank you so much. It is fair to say that1502this has an adverse impact certainly on the seniors but also on1503their families, and not only on families, an impact on all of1504us through the ripple effect.1505    Thank you so much for your testimony, and I look forward to1506continuing to work on this Committee and also the Senate1507Finance Committee to make sure that we protect Medicaid and1508other critical programs that our seniors rely on.1509    Chairman Scott. Thank you, Senator. Sheriff, what role do1510you see for law enforcement promoting healthy aging and1511supporting older adults to remain active and engaged in their1512communities? Do you think there is any role for law enforcement1513to be involved?1514    Sheriff Prummell. Yes, I do. Like I said, we are out there1515engaged with our community. My philosophy is that you deal with1516quality of life issues within your community, and if you deal1517with the quality of life issues they will not explode into1518crime issues, and we have one of the lowest crime rates in the1519State, but you have to stay engaged with your population,1520whether they are kids or whether they are seniors.1521    We have a great volunteer program, and we encourage all of1522our retirees to come join our volunteer program, and we have a1523volunteer program about 70 members, so they come in and, as1524stated, they have a purpose. They are out there helping the1525community. They are giving back to the community. They are1526staying engaged with us, and in the same sense, they have1527become part of our family, and we check on them. Even when they1528come to the point where they decide to retire out of our1529volunteer program, they are still a part of our family. We are1530still checking on them. We are still making sure that they are1531okay and they are getting what they need.1532    Chairman Scott. That is great. Ms. Alvarez, your1533organization runs the Senior Medicaid Patrol for the State of1534New York. What are some of the fraud trends that you have seen?1535    Ms. Alvarez. There are so many frauds that we have a Fraud1536of the Month. That is how much fraud there is that exists, so1537recently we just had the durable medical equipment fraud, where1538somebody might call you and ask you if you want a back brace.1539Somebody just calls you on the phone. Well, we know that a back1540brace is something very personal, that should be prescribed by1541a doctor that knows you.1542    Then recently we had somebody who received like 50 back1543braces, because somebody got a hold of their Medicare number1544and charged it to their account.1545    There are other forms. You know, if there is anything1546happening in society, there is a fraud for it. For example,1547when COVID start, fraud really skyrocketed. One of the things1548that they were saying was that because there is COVID you will1549get a new Medicare card, and we will send you a text along with1550it, and we are going to send you a laminated card. We are going1551to send you all sorts of different--the reality is that there1552is no new card, right. You get the card and that is what you1553have.1554    I mean, it goes on and on. Anything that is happening,1555there is a fraud for it. I always say that while we get up in1556the morning to do that valuable work, a scam artist, that is1557their job, and if they were doing something productive with1558their time, they would be very successful.1559    Chairman Scott. Thank you. Dr. Carr, how does participating1560in activities like paid work or volunteering impact the1561psychological or physical health of older Americans?1562    Dr. Carr. Well, there is a lot of evidence that both are1563protective of physical, psychological, and cognitive health.1564With regard to volunteering, there is not a lot of specific1565research that says here is the thing about volunteering that1566makes you better or improves your health, and there have been a1567lot of researchers that have been trying to figure out sort of1568why it works, one of which, there is some initial evidence is1569related to the fact that when you help other people, you1570actually respond better physiologically to stress, so there is1571sort of a buffering effect of being engaged in your community1572to feeling better when you face everyday challenges.1573    That is not the only issue. Imagine just like working. You1574are more physically, cognitively, and socially engaged, when1575you are engaged in volunteering, and that is largely the reason1576why we think that remaining engaged in those activities are so1577good for your health over time.1578    I had mentioned earlier, 20 hours a week of work is pretty1579protective, and it really depends on what kind of work that is.1580If you are engaged in a really physically demanding or1581dangerous work, it is not health protective. It has to be work1582that allows people to be able to maintain their health and be1583able to be engaged, so it is important to keep that in mind.1584    Chairman Scott. Ranking Member Gillibrand.1585    Senator Gillibrand. Thank you. I just want to congratulate1586the Chairman on such a wonderful panel. Each one of you has had1587such important information to contribute, and I think all of1588the Senators feel that you were exactly the right people to1589answer their questions, so thank you very much for your1590expertise.1591    I just have a couple. I want to focus a bit on the1592financial security issue, even though we have talked a lot1593about it. Obviously, Social Security is one of the most1594successful and popular programs ever enacted, and tens of1595millions of older adults use their Social Security benefits to1596buy groceries, to buy their medicines, to pay for housing, to1597just basically live on.1598    For many older adults, their Social Security benefits are1599insufficient, and they have a difficult time making choices,1600and we have talked about some of those choices, those choices1601between heat and food and medication and not taking their1602medication or spreading out their medication inappropriately. I1603have heard about a lot of real horror stories of people just1604trying to make ends meet, and we heard some more today.1605    Ms. Alvarez and Dr. Carr, can you amplify a little bit some1606of these tough choices they have to make? How does it affect1607their well-being? And particular, I imagine it affects their1608mental health. When you are struggling on the basic needs that1609you need to survive, that must provoke enormous anxiety. I want1610to talk a little bit about how we can amplify or expand upon1611financial security to take away some of those burdens, and I1612would just like your insights on that.1613    Ms. Alvarez. Well, first of all, seniors are constantly1614juggling. If you are on a fixed income any time, they are1615constantly juggling their finances. You know, they say, well,1616can I get away with not paying for my prescription drugs, and1617cutting them in half, things like that, for a month. Can I get1618away with not paying my rent for a month. We all know that that1619constant juggling, at one point, is going to come to a head,1620where if you just simply do not have enough money coming in and1621you have to pay bills, things are going to collapse.1622    The programs that the Older Americans Act actually has,1623those are all programs that shore up people who do not make1624ends meet. We work with this Elder and Economic Security Index,1625and basically, in New York State, I mean, not New York State,1626in the country, in the United States, the average Social1627Security income is $29,678, so that is a little bit less than1628200 percent----1629    Senator Gillibrand. Poverty. Mm-hmm.1630    Ms. Alvarez. It costs more money than that to actually1631live, on an average, in any community in the United States.1632    When we have heating, when we have the SNAP program, when1633we have the MSP program, the Medicare Savings Program, when we1634have those things people are able to then benefit from programs1635that will keep money in their pockets.1636    One concrete thing I want to say is that the Medicare1637Savings Program helps with out-of-pocket costs for your health1638insurance, and your prescription drugs. It pays for your1639copayments, things like that, and it is calculated that if a1640person is not accessing one Federal program, they are not1641accessing four other Federal programs. That is an average of1642$7,000 that somebody could have in their household, that they1643do not have to spend money on, so because we have these1644programs, that is what is going to keep people in the community1645with dignity, if they do not have those programs.1646    Senator Gillibrand. Dr. Carr? And could you please expand1647on the Older Americans Act and why that matters?1648    Dr. Carr. Sure. Well, I will say a couple of brief things.1649One, I do not think we want to live in a society where we allow1650old people to suffer in poverty, and these programs are really1651critical to ensuring that that is the case, but they do not1652solve the problems entirely.1653    Second, being poor is really bad for you, in every aspect,1654and last, poverty is not the consequence of something you do1655wrong in old age. It is a life-long effect, so a lot of these1656things that we see with older adults is due to things that have1657accumulated over the course of their lives, and in later life,1658we do not have the ability to, many times, go out and recover1659financially when things go wrong and we run out of money,1660despite our greatest efforts.1661    These are really protective of the most vulnerable people1662who have needs and want to stay in the community, and the Older1663Americans Act is critical to ensuring that we do not have a1664massive group of people living in nursing homes because they1665have no other choices, and I think that in the absence of other1666opportunities, we cannot place these burdens on families or1667communities in other ways, so helping support people with these1668relatively small interventions by allowing them to stay in1669their homes is beneficial to the larger community.1670    Senator Gillibrand. Agreed. Dr. Hughes, you look like you1671want to add something. Would you like to add something?1672    Dr. Hughes. I am sorry. Could you repeat that?1673    Senator Gillibrand. Do you want to add something to the1674conversation of why fixed income is such a challenge,1675especially at $30K a year, and Older Americans Act being1676important?1677    Dr. Hughes. Thank you. I appreciate the opportunity to1678speak to this. The Older Americans Act is part of the fabric of1679our society in terms of the services that it provides and1680funds, and there are so many communities in the United States1681that really depend on these services.1682    I think part of the problem is that people do not1683understand where the money is coming from. If they knew where1684it was coming from and why, I think that there would be a much1685greater groundswell----1686    Senator Gillibrand. Support, yes.1687    Dr. Hughes [continuing]. of support for these programs,1688going forward.1689    Senator Gillibrand. Makes sense, yes.1690    Dr. Hughes. I think that the meals, there is no question1691about the home-delivered meals being hugely valuable. They were1692hugely valuable in Illinois during the pandemic. There is1693research showing that they reduce emergency department use.1694They improve nutrition. They do all kinds of things.1695    What is really amazing is how much the Older Americans Act1696has achieved with so little, in terms of resources. I think1697that that is an amazing success story, and my testimony was1698really attempting to build on that and just provide more1699documentation.1700    Senator Gillibrand. I agree. Thank you, Dr. Hughes. With1701the Chairman's permission, may I ask Sheriff Prummell one1702question about fraud? So Sheriff, I really appreciate your1703testimony about the work you do in your community, and it is so1704much appreciated. I have heard so many stories about seniors1705who have fallen for these scams, the grandchild scam, the IRS1706scam, the cryptocurrency scam. They are literally endless, and1707they are heartbreaking, because our seniors are duped, and they1708either take money out of their bank account, they send money1709through multiple means, but it is so rare that we get this1710money back.1711    I have also talked to law enforcement up and down my State1712and across the country, and they have very few tools to go1713after these transnational criminals, because they are1714sophisticated criminal networks that are using the internet,1715using the phone, using data information like who just got1716arrested, as you testified.1717    What can we do to crack down on the scams more, and is1718there any way, or anything we should be doing to get justice?1719Let's just say we cannot defeat the Chinese network of1720scammers. But shouldn't we be doing something to make sure the1721victim is given some measure of relief? Should we create a fund1722for that? What would you recommend, because you are dealing1723with the crime and not being able to arrest or put someone in1724jail most times.1725    Sheriff Prummell. Yes, and that is the problem, because1726like I opened with is most of your criminals, they are not just1727outside the State. They are outside of the country, and they1728are outside the reach of local law enforcement. Your federal1729agencies, they have a little bit more far reach, but they will1730not touch a case unless it reaches a certain dollar amount,1731which I understand because their plate is full with all the1732other responsibilities.1733    Senator Gillibrand. Do you know what the dollar amount is?1734    Sheriff Prummell. I think it is close to a million dollars.1735    Senator Gillibrand. Oh. That is not going to help anybody.1736    Sheriff Prummell. No. That is not going to help anybody.1737    Senator Gillibrand. Every scam I have ever heard is a1738$5,000 scam or a $10,000 scam. I have heard a few where bank1739accounts have been completely eliminated, but it is usually1740$100,000 or $200,000.1741    Sheriff Prummell. Yes. It usually does not reach that1742dollar amount, but I understand because you cannot flood the1743FBI and the Secret Service with all these fraud cases either1744because they have other responsibilities, you know. The problem1745is, too, is it is heartbreaking because you do see a lot of1746people that are duped out of their life savings. They worked1747hard for that money, for retirement, and then now all of a1748sudden it is gone, and 99 percent of the time, it is not1749recovered.1750    You will have some of the financial institutions, very1751rarely, depending on the dollar amount, will reimburse the1752victim, partial or all of it, but that is rare, but there is no1753set fund, at least that I am aware of, that will help reimburse1754or get that victim back on their feet.1755    Senator Gillibrand. Thank you, Mr. Chairman.1756    Chairman Scott. Can I just followup? So I think what1757Ranking Member Gillibrand and I both care about is all these1758frauds, right. I was talking to, oh, I do not know who it was,1759the other day, but they said if you go to 50 years ago,1760whatever timeframe, the FBI put a lot of effort into bank1761robberies and things like that, because the local sheriff's1762offices, like yours, would not have had the resources to do it.1763Today, if there was a bank robbery, you do not really need the1764Federal Government to help you guys, right.1765    Sheriff Prummell. Mm-hmm.1766    Chairman Scott. What you really need is you need help on1767issues like this, so has there been any conversation by law1768enforcement to say, you know, that was great that the FBI,1769Department of Justice, whoever, helped us 50 years ago. We do1770not really need their help anymore. Maybe Union County in1771Florida does, a small county, but you do not need it, right,1772and they ought to focus on these things that you do not really1773have the resources to do, and you do not have the authority to1774handle. Has there been any conversation with law enforcement on1775that?1776    Sheriff Prummell. There has really been no discussion that1777I am aware of. You know, we are involved with a lot of the1778Federal agencies with regard to investigations that do cross1779over the borders, but mostly they are focused on terrorist type1780investigations and drug enforcement type investigations, but as1781for the fraud investigations, we really do not have a task1782force. They have some task forces with the Secret Service, but1783I do not hear much coming out of it.1784    Chairman Scott. I think for both of us, if you, and the1785organizations you are involved in, if you have--if there is a1786discussion, or if you think we ought to have a hearing on that,1787where we could have a real conversation about where should1788people focus their time. Because there is not unlimited1789dollars. I mean, nobody wants to pay more in taxes, so there is1790not unlimited dollars, but you do not need all the Federal help1791in your county for a lot of things that they probably want to1792come and help you on.1793    Sheriff Prummell. No. I mean, most of the stuff within my1794county we can handle, but like I said, when you are dealing1795with these major fraud cases that cross not just State lines1796but the country lines, we do not have an arm that reaches that1797far, and we do not have really the technology to trace them.1798They can spoof these numbers. They can hide IP addresses, so it1799is not as easy to trace them anymore either.1800    Chairman Scott. Right, but they do not take their resources1801and stop doing stuff that they do not need.1802    Senator Gillibrand. Yes.1803    Chairman Scott. I want to change the subject a little bit.1804Dr. Carr, and I think all of you have talked a little bit about1805we will get a return on investment if we spend this money,1806right, on something. What about spending money on healthy1807eating? How much money would we save if we got everybody to eat1808healthy all their life, or start even when they are 65? Has1809anybody done any studies about the problems of ultra-processed1810food or excess sugar intake or things like that, that would1811actually save us money on the other side?1812    I told Senator Gillibrand, the problem that we always have,1813like in my business life, if somebody comes to me and says,1814"Okay, if you spend money here I will save money over there,"1815it was easy. I would just cut the money over there, okay, and1816spend it over here, because I can make it happen. You know, in1817my job as Governor of Florida and now my job here, nobody has1818come up with a program that actually saves money. They all cost1819more money. Unfortunately, how many of you guys want to vote1820for tax increases? Nobody does, right. Nobody wants our taxes1821to go up.1822    We have to figure out how to do this in a manner that--and1823healthy eating seems like a logical way. I do not know if you1824have done any research on that or if you have seen any1825research.1826    Dr. Carr. I am not an expert in nutrition but nutrition is1827one of the things that we know matters for lifestyle, broadly1828speaking, related diseases, and almost all of the major1829illnesses of aging are related to lifestyle. Nutrition is hard1830to study because we cannot put people in a hospital for 301831years and watch them eat a certain diet and compare it over1832time, but we have learned a lot, and I think you are right to1833say that ultra-processed foods, as I noted in my testimony, is1834detrimental to health, and costs us immensely.1835    There are certain kinds of things, you mentioned sugar.1836There are lots of different studies looking at the consequences1837of poor nutrition across a whole variety of different1838categories, you know, inadequate protein consumption as we age,1839which becomes more important, and other varieties of things.1840    If you are talking about a nutrition intervention as a1841solution to save money, I cannot help but assume that it would,1842long term, save money if we found a way to make healthy foods1843accessible, easy to, I will say, encourage people to consume1844instead of the things that companies have helped us, you know--1845--1846    Chairman Scott. I am not anti-sugar.1847    Dr. Carr. Right.1848    Chairman Scott. I mean, I am like everybody else. I like a1849nice chocolate dessert, but, you know, there is a way to do1850this. There is a way to have healthier sugars, too, right?1851    Dr. Carr. Yes, but I agree with you, and I think that the1852challenge that we have in terms of saving money over time,1853which I agree with you, we need to be paying more attention to1854these ways to save money by improving health over the long1855term, this is a long game when you are talking about these1856things, and if the Federal Government is positioned to start1857helping us play a long game with healthy aging, I am really1858excited about that, and I think nutrition is part of that1859equation.1860    Chairman Scott. Dr. Hughes, the National Institute of Aging1861funded your research, the Fit + Strong program. You have shown1862that it is successful. What does NIA do with that data? You1863know, what do they do with it? Did they just do the report, or1864did they do something with it?1865    Dr. Hughes. We have been working with the Illinois1866Department of Public Health. We were very, very fortunate to1867get ARPA funding from them, and we have been able to basically1868disseminate the program all throughout the State of Illinois,1869including many rural areas. We also were able to beef up the1870presence of the program in Chicago through the same source, the1871Illinois Department of Public Health money from CDC, and the1872city of Chicago Area Agency on Aging that had ARPA funding from1873the AOA. We were able to use that money to get the program out1874to a lot of people in rural areas, to African Americans, we1875have a Hispanic version of the program, to people who really,1876really do not customarily access health promotion programs.1877    In terms of national presence, we have worked really hard1878on disseminating the program. We now offer the program in 321879states, nationally. Some of that is due to our partnership with1880the National Recreation and Parks Association to offer the1881program in collaboration with them, again, with CDC funding.1882    What I was trying to get at with the testimony is the fact1883that everybody now who has an evidence-based program has to1884reinvent the wheel. You have to do it all by yourself, and1885there is no playbook. There is no cookbook. There is nothing to1886help people who are developing these programs, and developing1887them to help older adults improve their wellness and improve1888their functioning. Investigators are spending years of their1889lives developing these programs. We are in a School of Public1890Health. It has always been important to us, if we find1891something that works to get it out into the community where1892people can benefit from it.1893    This has been a motivating force for what we do. This1894hearing is a very important opportunity to think creatively1895about what we can do to maximize health promotion1896interventions. We, for example, came up with a hypothetical1897case when we had to present before the Boston Consulting Group,1898to get our funding from the Illinois Department of Public1899Health. We basically said, okay, if we were able to demonstrate1900a three percent reduction in use of total joint replacement1901surgery, the program would pay for itself over and over and1902over again.1903    We know that these programs save money, and they benefit1904people, and they are very, very cheap, and people like them,1905and, you know, it is just----1906    Chairman Scott. You are doing good for people, too.1907    Dr. Hughes. Pardon?1908    Chairman Scott. You are doing something good for people. It1909is not like you are selling something that is bad for them.1910    Dr. Hughes. Right.1911    Chairman Scott. Do you have anything else you want to add?1912    Senator Gillibrand. No. I just want to thank the Chairman1913and I want to thank each of our panelists for their excellent1914testimony and for their outstanding insights on the challenges1915that so many of our seniors are facing right now. You are a1916real blessing. Thank you.1917    Chairman Scott. I would like to thank everyone for being1918here today and participating. I look forward to continuing to1919work with members across the aisle and down the dais.1920    If any Senators have additional questions for the witnesses1921or statements to be added, the hearing record will be open1922until next Wednesday at five p.m. Thank you, everybody, for1923being here.1924    [Whereupon, at 5:20 p.m., the hearing was adjourned.]19251926            CLOSING STATEMENT OF SENATOR JIM JUSTICE19271928    Chairman Scott, Ranking Member Gillibrand, and members of1929the Committee, thank you for the opportunity to participate in1930this vital conversation about improving the health, safety, and1931opportunities for seniors in our nation. I am honored to serve1932on this Committee and contribute to such an important cause.1933    In West Virginia, where nearly 20% of our population is1934over 65, seniors are the heart of our families, neighborhoods,1935and economy. They are the grandparents who raised us and the1936mentors who guide us. Yet, like many older Americans, they face1937significant challenges, including high rates of heart disease1938and diabetes. Additionally, our state's rural, mountainous1939landscape presents unique obstacles, such as social isolation1940and limited access to reliable transportation.1941    However, if there is one thing that defines West1942Virginians, it is our undeniable commitment to taking care of1943one another. Our close-knit communities and programs offering1944financial support and care are what help our seniors thrive. In1945my new position as a U.S. Senator, I am committed to advancing1946policies that reflect these values. By prioritizing initiatives1947that enhance safety, promote well-being, and foster meaningful1948engagement, we can ensure seniors across the nation not only1949live longer but live fuller, richer lives. Thank you.19501951=======================================================================19521953                                APPENDIX19541955=======================================================================19561957                      Prepared Witness Statements19581959=======================================================================19601961                U.S. Senate Special Committee on Aging19621963                  "Improving Wellness Among Seniors:1964               Setting a Standard for the American Dream"19651966                            January 15, 202519671968                       Prepared Witness Testimony19691970                         Sherrif Bill Prummell19711972    Chairman Scott, Ranking Member Gillibrand, and Members of1973the Committee, thank you for inviting me to testify. Today, I1974would like to outline ways in which the Charlotte County1975Sheriff's Office is working to serve and protect our senior1976population.1977    We implement several programs at the Charlotte County1978Sheriff's Office, including phone calls on Mondays and1979Thursdays, Christmas gifts and Birthday cards as well as weekly1980phone calls between trained volunteers and participants over 601981years of age, disabled, or living alone with little or no1982contact with the community.1983    Additionally, our Take Me Home Program is designed to1984assist deputies in locating loved ones who have gone missing or1985are lost. Information about your loved one, a recent photo, and1986description is shared with all road patrol officers in an1987effort to locate and reunite the family. Any office member can1988register a participant for this program.1989    Our DNA Scent Kits is a program that enables participants1990to keep a DNA scent article at their home in the event a loved1991one goes missing. Charlotte County K9 deputies use that pure1992scent to begin a track in order to locate the loved one and1993reunite them with family. These are handed out by our Community1994Affairs Team, Mental Health Unit, and patrol members.1995    Project Lifesaver serves as the premier search and rescue1996program locally operated by the Charlotte County Sheriff's1997Office and is strategically designed for "at risk" individuals1998who are prone to wandering. The program uses a GPS tracking1999bracelet to locate the wondering party quickly.2000    Operation Pill Drop allows individuals to drop off expired2001or unwanted medication in drug receptacle boxes at2002participating district office locations. This keeps family2003members and others that might have access to a senior's2004medicine cabinet from getting those old and unused medications.2005Special vehicle decals provide free decals for individual's2006vehicle to alert deputies of the possible presence of someone2007that may require special attention within the vehicle, such as2008a hearing impairment or autism.2009    Often seniors misplace or leave items behind such as keys.2010Through our Operation Lock Out Program, key tags are provided2011to help return lost car keys to the owners. The tags are2012registered with a special code in our system with the owners'2013information. We educate them not to put their name or address2014on the key chain in order to protect themselves. If the keys2015are turned in to us, we are able to then return the keys to the2016owner.2017    We offer Citizen's Police Academy classes for mostly2018seniors to learn behind the scenes and promote our volunteer2019program. Classes are held for seven or nine weeks throughout2020the year.2021    We also spend time visiting local retirement homes to2022advise on local scam problems.2023    In additional, we rely heavily on Facebook, Instagram, Our2024blog and press releases. We know that many seniors do not2025monitor this, but many family members and those that work or2026live around seniors do. This helps us get the word out to them2027to watch out for their neighbors.2028    Lastly, we focus our effort on speaking to neighborhood2029watches, local churches, and various organizations, such as the2030Parkinson's Group, averaging 1-2 speeches per week. We work2031closely with OCEAN, Our Charlotte Elder Affairs, a group of2032business owners in the senior arena that want to specifically2033help Seniors.2034    Currently, we are seeing several different methods in which2035criminals are attempting to scam our senior population. This2036includes scammers visiting out website looking up recent2037arrests and then calling family pretending to have the ability2038to bail out the arrestee. We are also seeing what is referred2039to as "Romance Schemes" which can be long running and generally2040include a person asking for money while pretending to love2041someone. Other schemes that have become more pronounced center2042around sweepstakes lotteries where individuals have to play to2043win. In these cases, the scammer will ask for gift cards to pay2044the taxes to get people their winnings.2045    The Charlotte County Sheriff's Office has partnered with2046Charlotte Behavioral Health Care (CBHC) for the addition of a2047case worker to be assigned to the CCSO. This case worker2048receives referrals from deputies who, during the course of2049business, identify a senior who might be in need of services,2050as well as calls from the public. This case worker will refer2051and/or provide services through CBHC and/or make additional2052referrals to outside entities depending on the elders needs.2053Our office provides a number of resources, including:2054      Area Agency on Aging - Provides a variety of assistance2055for qualifying seniors (home and community-based care,2056enrollment in Medicaid long-term supports, Elder help-line) CM2057assist by giving brief overview of the program, provide the2058contact number and in some cases provide hands on assistance.2059CM follows up by phone if required and CM provides CM's contact2060information for additional assistance if needed.2061      Home care providers (such as Highest Honor Home Care,2062Home Instead Senior Care, Right at Home) - Provides in home2063non-medical assistance based on individual's needs (personal2064care, meal prep, light housekeeping). CM assist by giving brief2065overview of the program, provide the contact number and in some2066cases help call the provider. CM follows up by phone if2067required and CM provides CM's contact information for2068additional assistance if needed.2069      Transportation - (Charlotte County Transit, F.I.S.H2070(Englewood only) CM assist by giving brief overview of the2071program, provide the contact number. CM follows up by phone if2072required and CM provides CM's contact information for2073additional assistance if needed.2074      Family Service Center - Has programs that assist with2075paying bills, Housing services, home repair. CM assist by2076giving brief overview of the programs, provide the contact2077number. CM follows up by phone if required and CM provides CM's2078contact information for additional assistance if needed.2079      St Vincent De Paul - Programs that help with food,2080utilities, rent payment assistance, equipment (wheelchairs,2081refrigerators, stoves). CM assist by giving brief overview of2082the programs, provide the contact number and in some cases2083provide hands on assistance by contacting the provider on2084behalf of POC. CM follows up by phone if required and CM2085provides CM's contact information for additional assistance if2086needed.2087      Active Age (Daytime Senior Care) - Daycare program for2088seniors. CM assist by giving brief overview of the program,2089provide the contact number. CM follows up by phone if required2090and CM provides CM's contact information for additional2091assistance if needed.2092      Senior Placement Services (housing) - Assistance with2093locating and placement into assisted living, memory care2094facilities. CM assist by giving brief overview of the programs,2095provide the contact number and in some cases provide hands on2096assistance by calling the provider on behalf of POC. CM follows2097up by phone if required and CM provides CM's contact2098information for additional assistance if needed.2099      Social Services Resource Center - Provides Guardian and2100POA services. CM assist by giving brief overview of the2101programs, provide the contact number. CM follows up by phone if2102required and CM provides CM's contact information for2103additional assistance if needed.2104      Florida Rural Legal services - Provides legal services.2105CM assist by providing the contact number. CM follows up by2106phone if required and CM provides CM's contact information for2107additional assistance if needed.2108      Meals on Wheels - Provides meals to seniors. CM assist2109by giving brief overview of the program, provide the contact2110number and in some cases provide hands on assistance. CM2111follows up by phone if required and CM provides CM's contact2112information for additional assistance if needed.2113      Senior Friendship Meals (Congregate meals, and Volunteer2114Services) - Provides congregate meals at a variety of sites in2115Charlotte County, offer volunteers that visit with home bound2116seniors. CM assist by giving brief overview of the programs,2117provide the contact number and in some cases provide hands on2118assistance. CM follows up by phone if required and CM provides2119CM's contact information for additional assistance if needed.2120      CapTel - Captioned telephone for hearing impaired. CM2121assist by giving brief overview of the programs, provide the2122contact number and in some cases provide hands on assistance.2123CM follows up by phone if required and CM provides CM's contact2124information for additional assistance if needed.2125      Dementia/Alzheimer's Caregiver support group - Support2126Group for caregivers. CM assist by providing the contact2127number. CM follows up by phone if required and CM provides CM's2128contact information for additional assistance if needed.2129      The Dubin Center - Support Group for caregivers. CM2130assist by providing the contact number. CM follows up by phone2131if required and CM provides CM's contact information for2132additional assistance if needed.2133    Thank you, Chairman Scott and Ranking Member Gillibrand,2134for holding this hearing and focusing on senior population. I2135look forward to working with members of this Committee to2136develop proactive, and effective ways to protect our2137communities from crime.21382139                 U.S. Senate Special Committee on Aging21402141                  "Improving Wellness Among Seniors:2142               Setting a Standard for the American Dream"21432144                            January 15, 202521452146                       Prepared Witness Testimony21472148                             Maria Alvarez21492150    Chairman Scott, Ranking Member Gillibrand, and members of2151the Senate Special Committee on Aging, thank you for the2152opportunity to testify before you today to discuss Wellness2153Among Seniors. My name is Maria Alvarez. I am the Executive2154Director of New York StateWide Senior Action Council, Inc., a2155consumer directed and governed grassroots organization serving2156the community for 52 years. It has been an honor for me to2157serve as the Executive Director for the past fifteen years.2158Thank you for inviting me to speak with you today.2159    As a participant of the White House Conference On Aging2160(WHCOA) in both 1995 and 2005, I can tell you that there have2161been dramatic improvements in the systems of preventive care2162and health promotion, but we still have a long way to go. With2163your leadership and advocacy, we can continue to make2164improvements for the seniors of today and for future2165generations.2166    I want to also note that in the three decades that have2167elapsed since the 1995 WHCOA, the fabric of the older2168population has changed dramatically. This means that the2169systems to promote healthy aging also need to change and2170modernize to better serve our current older population. There2171has been a significant increase in the size of the older non-2172white population which is on pace to make up half of the2173elderly population by 2060. Fortunately, though, many elderly2174can remain in the community despite managing multiple chronic2175conditions. I suggest that one step in the right direction2176would be to make sure that the 2025 WHCOA is held to help the2177country chart a course for addressing the needs of the growing2178older population as 20 percent of this country is now over the2179age of sixty-five.2180    Prior to 1995, Medicare and most private insurance would2181cover treatment of an illness but not cover the cost of the2182diagnostic tests or prevention. Thanks to action by Congress to2183improve Medicare in 1997 and 2003 and the implementation of the2184Affordable Care Act in 2010, coverage of preventive services2185has steadily increased. Now most preventive tests and2186immunizations are available without copays and Medicare2187provides an Annual Wellness exam to help beneficiaries identify2188health risks, schedule preventive tests, and identify social2189determinants of health.2190    In addition, the country has invested resources through2191Part III D of the Older Americans Act to provide evidenced base2192health promotion programs through the Area Agencies on Aging2193and community-based agencies. Today most communities have2194programs like the Chronic Disease and Diabetes Self-Management2195Program and Falls Prevention. Many have been adapted to meet2196the needs of older persons of different races and ethnicities.2197These programs are cost-effective approaches and should be2198expanded.2199    At one time, federal and state policy makers considered2200services like congregate and home delivered meals,2201transportation, case management, and housing assistance as nice2202but "soft services" that were not as important as health care.2203It took years of advocacy and research to get the medical2204system to finally recognize the importance of social2205determinants of health, which are critical to the ability of2206older persons to follow needed courses of treatment and2207maintain healthy lifestyles.2208    These are all important improvements that we can build2209upon, but we cannot ignore the need to recognize that having2210health care and preventive services available is not sufficient2211if they are not affordable or if discrimination, actual or2212perceived, persists. Many problems still exist.2213    Income Security continues to be a problem in a country2214where there is so much abundance. The reality is that one in2215three senior citizens are not making ends meet. Their incomes2216are under 200% of the Federal Poverty Level (roughly $30,000),2217and it is not keeping pace with the increasing cost of living,2218let alone their out-of-pocket healthcare costs, food,2219transportation, and housing among other expenses.2220    Lest you think that this is only one segment of the2221population, I will tell you that we increasingly see people who2222look good "on paper", who consider themselves to be middle2223income, sliding into poverty at dizzying rates.2224    According to several reports, we are about to experience2225the largest amount of homelessness in the elderly population2226ever. We are already seeing it in New York City. More Section2227202 Housing must be developed, with social services attached to2228them. This will ensure that seniors not only have an adequate2229place to live, but they have access to all of the programs and2230services for which they qualify.2231    I cannot end my time without telling you that along with2232Social Security, Medicare and Medicaid, the Older Americans Act2233is a law that has had a seismic effect on the elderly2234population. All of those programs form the framework that2235seniors can rely on to continue to thrive and live in dignity.2236Now that this generation makes up 20 percent of the country, we2237need to strengthen and improve them - in their structures as2238well as their funding - to reflect the fabric of our country2239today.2240    I have many other points to make, and five minutes is not2241enough. I hope that you ask me about them during the time that2242we have together. I have also included a full list of programs2243and recommendations with my formal testimony.2244    Thank you.22452246Recommendations:22472248Reauthorize the Older Americans Act in 202522492250    We were honored to work with Senator Gillibrands workgroup2251on the Older Americans Act. Some of the recommendations were2252able to help inform the update of the regulations in 2024.2253However, the reauthorization of the act did not occur and that2254should be a primary objective of the new Congress I 2025. It2255provides the foundation for the network of evidenced based2256wellness programs offered across the country.22572258Convene a 2025 White House Conference on Aging (WHCOA)22592260    This summit is critical to help the nation chart a course2261for addressing the health and wellness needs of the growing2262older population.22632264Help Communities Achieve Health Aging 2030 Objectives22652266    Improve health and well-being for older adults by helping2267communities achieve the Older Adults Objective in the Office of2268Disease Prevention and Health Promotion's Healthy People 20302269Plan.2270    [https://odphp.health.gov/healthypeople/objectives-and-2271data/browse-objectives/older-adults]22722273Expand the Patients' Bill of Rights:22742275    The family member can often detect negative changes in a2276patient's affect long before hospital staff yet they are often2277powerless to get the hospital to attend to their concerns. We2278recommend that Congress expand the patients' bill of rights to2279allow patients or their care givers to obtain a rapid response2280second opinion if they believe the current treatment is not2281effective. Massachusetts and South Carolina have already2282implemented this requirement and it can be a life saver in2283times or acute care crisis.2284    [https://casetext.com/regulation/code-of-massachusetts-2285r'segulations/department-105-cmr-department-of-public-health/2286title-105-cmr-130000-hospital-licensure/subpart-d-2287supplementary-standards-particular-services/section-1301600-2288rapid-response-method]22892290Identify Discrimination22912292    Provide patients with the opportunity to report experiences2293of racism or other types of discrimination when completing2294standard patient satisfaction surveys.22952296Develop a Diverse Health Workforce22972298    Promote cultural competency in the health care system and2299address the lack of diversity in the workforce especially in2300underserved communities.23012302    Please see attached StateWide's Legislative Goals and2303Priorities and Insufficiency Tables - Attached.23042305Extra Comment23062307Affordability is still a barrier23082309    While Medicare and the Affordable Care Act have made health2310care more affordable one in six older Black adults (16%) and2311one in seven older Hispanic adults (14%) report problems paying2312for health care.2313    [source: https://www.kff.org/racial-equity-and-health-2314policy/issue-brief/older-adults-health-care-experiences-by-2315race-ethnicity/]23162317    Discrimination is a problem. It is disheartening to see2318that amongst advanced countries:23192320    Older adults in the United States are by far the most2321likely to report that their health system treats people2322differently because of their race or ethnicity.2323    Nearly half of older Black women say the health care2324system often treats people differently because of their race or2325ethnicity.2326    One in four Black and Latinx/Hispanic older adults report2327racial or ethnic discrimination when seeking health care.2328        about one in seven (15%) older Black adults report2329experiencing unfair or disrespectful treatment in the past2330three years compared to smaller shares of older White (7%),2331Hispanic (7%), and Asian (8%) adults.2332    [source: https://www.commonwealthfund.org/publications/2333issue-briefs/2022/apr/how-discrimination-in-health-care-2334affects-older-americans]2335        about one in seven (15%) older Black adults report2336experiencing unfair or disrespectful treatment in the past2337three years compared to smaller shares of older White (7%),2338Hispanic (7%), and Asian (8%) adults.2339    [source: https://www.kff.org/racial-equity-and-health-2340policy/issue-brief/older-adults-health-care-experiences-by-2341race-ethnicity/]23422343                 U.S. Senate Special Committee on Aging23442345                  "Improving Wellness Among Seniors:2346               Setting a Standard for the American Dream"23472348                            January 15, 202523492350                       Prepared Witness Testimony23512352                             Dr. Dawn Carr23532354    Thank you to the Committee and chairman Scott for providing2355me with the opportunity to testify before you. My name is Dawn2356Carr. I am a professor of sociology and I direct the Claude2357Pepper Center, a translational policy center at Florida State2358University, which was named and funded in honor of one of the2359strongest advocates for aging policy in U.S. history- Senator2360Claude Pepper.2361    Since its inception in 1961, this Committee has worked to2362evaluate critical problems and potential policy solutions to2363address the immediate needs of a rapidly growing population of2364older adults in the United States. As we navigate our later2365years, we are inevitably at higher risk of disability, loss of2366independence, social isolation, and poverty. In addition,2367middle-aged adults today face more significant health problems2368and disabilities than previous generations, and as they move2369into their later years over the next several decades, they are2370likely to face more complex health issues than previous2371generations of older adults.2372    However, in addition to ensuring that older adults and2373their families today have the supports they need to manage the2374challenges of daily living, we need to expand the scope of U.S.2375aging policy to ensure that future generations of older adults2376not only survive into old age, they thrive once they get there.2377Health problems in later life are strongly influenced by2378events, exposures, and behaviors that occur well before we2379reach our later years. Although the consequences of regular2380harmful exposures and habitual behaviors accumulate to erode2381health over time, there is growing evidence that if we2382intervene during critical inflection periods, we can modify2383health trajectories and bolster physiological resilience as we2384age.2385    Current clinical care is not designed with this approach,2386and with Medicare and Medicaid paying over $400 billion per2387year spent on long-term care alone, there are significant2388consequences if we maintain current practices. For example,2389genetic variations and lifestyle factors may place a thirty-2390year-old at higher risk of advanced heart disease three decades2391later, but if routine evaluation of blood-based markers shows2392"normal range" cholesterol, early interventions that could2393offer significant lifelong protection are unlikely to be2394discussed. Instead, treatment typically begins when a person is2395facing more advanced disease progression and irreversible2396damage has already occurred. Further, what is considered2397"normal function" is based on population averages, and in a2398population facing earlier onset of disease and disability,2399averages are unlikely to provide meaningful benchmarks for2400long-term treatments that increase the likelihood of extended2401years of healthy aging. If our goal is to reduce disability and2402aging-related disease progression, we need to shift our focus2403from identifying problems based on deviations from the mean to2404leveraging a range of strategies that support maintenance of2405optimal health and function outcomes at all stages of life.2406    Identifying problems early and addressing health risks is2407not only important for the quality of life of individuals and2408their families, the benefits to society are also significant.2409If people reach later life with fewer years disabled, and2410several disability-free decades ahead of them, our families,2411communities, and businesses will benefit. We develop unique2412skills and abilities as we age that are largely under-utilized.2413Relative to younger people, older adults are better at2414processing complex emotions and dealing with interpersonal2415conflicts. Our goals shift and we prioritize relationships,2416legacy, and ways that we can make a difference, supporting the2417wellbeing of future generations. We are more willing to take2418risks and put our values on the line for the greater good.2419Multi-generational teams of workers are more effective and more2420productive than those that include only younger adults. Having2421a larger group of healthy older adults who have an active and2422meaningful role in society could help us solve some of the most2423pressing social problems of our time.24242425A New Framework for Aging Policy24262427    To create a society enriched by a large group of healthy2428older people requires a new framework for aging policy, guided2429by several key principles:2430    1. An emphasis on health maintenance at every stage of life2431targeting risks related to aging-associated diseases and2432disabilities;2433    2. Acknowledgement of the developmental changes that occur2434as people move into and through later life, including the way2435older adults' unique strengths benefit society; and2436    3. An emphasis on the barriers to healthy aging that result2437in significant inequalities in health outcomes as people age.2438    Old age is often defined as age 65 or older, an age that is2439also often synonymous with retirement. Aside from 65 being the2440eligibility age for Medicare, this age is arbitrary and2441provides relatively little information about what people can2442do. Treating the period in which we are age 65 or older as a2443monolithic stage of life and age demographic does not make it2444possible to consider the stark differences in the needs of a2445typical 65-year-old and a typical 85-year-old, or the2446systematic differences in the health and function of older2447adults of the same chronological age.2448    Older adults who are navigating the period of old age when2449health problems interfere with daily function, a period2450sometimes referred to as the "Fourth Age," face significant2451challenges. Although many people living with certain2452disabilities lead high quality lives despite their health2453limitations, the significant losses that come with accelerated2454physiological aging often lead to poor quality of life, and2455loss of the ability to live independently. The needs for of2456this group vary starkly with older people who are healthy and2457able to engage in a variety of activities and are seeking to2458engage actively in meaningful and purposeful social roles. This2459is the period sometimes referred to as the "Third Age."2460    Increasing the proportion of our lives spent as Third-agers2461and reducing the number of years in which people live in the2462Fourth Age could have a profound benefit for older people2463individually and for society. Third-agers have the ability to2464remain engaged in paid and unpaid (e.g., caregiving,2465volunteering) work. They help their families by providing care2466to children or adults who are sick, they have the time and2467wisdom to take on important leadership roles in their2468community, and they have a drive to leave a legacy, and mentor2469others. Although we have social programs designed to provide2470Third-agers with ways to stay busy, these opportunities often2471are not designed to leverage or support development of the2472unique capacities of healthy older people, and may even silo2473older people from younger people who can benefit from their2474abilities and wisdom. That is, Third-agers have a pool of2475talent that often goes unacknowledged and untapped.2476    Despite the potential of an expanded population of Third-2477agers, having access to a Third Age is not equally distributed.2478On the one hand, people who have spent their careers working in2479physically demanding jobs, have been exposed to dangerous2480materials on a regular basis, or who did not have access to2481high quality medical care across their adult lives, not only2482may stop working well before age 65 by necessity, they may not2483even survive that long. Alternatively, those who have had2484access to regular medical care across their adult lives and2485have had "good jobs" may be healthy enough to choose to use2486their time and abilities to engage in meaningful paid or unpaid2487roles even two decades beyond typical retirement ages.2488    Our current aging policy plays a critical role in2489addressing the needs of adults in the Fourth Age and should2490remain central priorities of this Committee. Issues such as the2491enormous costs and challenges we face with long-term care as we2492prepare for a rapidly aging population, and new cohorts of2493middle-aged adults who, in the absence of major interventions,2494will continue to experience accelerated physiological aging,2495including early entry into the Fourth Age. Important Fourth Age2496policies also include those providing safety nets for poor and2497low-income older adults who rely on a fixed income because they2498are no longer able to work, and face increasingly complex2499health problems coupled with rising healthcare costs.25002501Expanding Aging Policy to Include Third Age Policy Priorities25022503    To increase the chances that future generations of older2504adults can spend the majority of their later years in the Third2505Age will require an expansion of our current aging policy2506efforts. Aging policies that target the complex factors that2507shape our third-age life expectancy (i.e., the number of years2508we are in the Third Age) will ensure that future generations2509are both healthier and better positioned to utilize their2510health resources in ways that benefit our families, communities2511and society as a whole. These policies address issues such as2512occupational pathways that facilitate financial security in2513later life for all workers across the life course, access to2514high quality food, engagement in healthy behaviors (e.g.,2515exercise), and medical care that is informed by evidence-based2516research that promotes optimal health function at each life2517stage. These policies should also prioritize integration of2518older adults as valued members of our communities, their2519families, and as they choose, in paid and unpaid social roles.2520    Consequently, a healthy aging policy framework is one that2521emphasizes health maintenance at every stage of life, targeting2522those at highest risk for accelerated aging. I believe the2523following four key areas are the most pressing: 1) employment;25242) social engagement and social integration; 3) health literacy2525and lifestyle behavior supports; and 4) healthcare access and2526early treatment.25272528Employment and Financial Security25292530    Working in later life is protective of health as people2531move into and through the Third Age. However, in many2532industries, older workers are less likely to be hired, and more2533likely to be excluded from opportunities for upward mobility2534and offered fewer opportunities for training/re-training. In2535addition, those in physically demanding or hazardous jobs are2536unlikely to be able to sustain their work into their 50s and253760s without significant health consequences, leading to early2538departure from work and retirement prior to full Social2539Security retirement age.2540    Hazardous work environments may be inevitable for a certain2541population of workers, but implementing occupational2542interventions where possible, and mid-life re-training for2543transitions to new career paths can increase the chance that2544workers remain healthy and fully employed until they reach full2545retirement ages. Part-time jobs are rarely institutionalized as2546a standard option in U.S. firms. However, making phased2547retirement or transitions to part-time work opportunities2548available to all older people would allow older workers to2549remain engaged in paid work longer. For example, schoolteachers2550might stay in the labor force longer if they are able to2551transition from running their own classrooms to splitting a2552classroom with another part-time teacher.25532554Social Engagement and Social Integration25552556    Social isolation and loneliness accelerate physiological2557aging. Isolating older adults within communities is not only2558detrimental to the health and wellbeing of older people, it2559also prevents communities from benefiting from their skills and2560wisdom. There are very few programs designed to reach isolated2561older adults. Effective programs like meal delivery programs2562are low cost and have the added potential of improving access2563to high quality nutritious foods. Expanding these programs2564could have a significant impact on healthy aging trajectories.2565    In addition, increasing engagement of adults at all ages in2566their communities through activities like volunteering not only2567is health protective to volunteers, it facilitates social2568integration in the community and helps people of all2569generations work collectively to solve social problems.2570Developing a vibrant volunteer work force will require2571investment in new infrastructure within our communities, an2572investment that has been shown to provide exponential returns2573economically and support healthy aging outcomes. For instance,2574the Senior Corps volunteer programs have shown a conservatively2575estimated return of between $3.50 and $5.08 for each dollar2576invested, reducing burden in the healthcare industry.25772578Health Literacy and Lifestyle Behavior Supports25792580    Most adults in the United States do not have access to2581scientifically accurate information or resources they need to2582maintain lifestyles that greatly increase their chances of2583achieving a healthy old age and a long Third Age. Expanding the2584number of community health workers (CHWs) is one of the most2585effective tools for facilitating healthy behaviors across the2586life course, helping community members of all ages build trust2587with the healthcare system and navigate healthcare services to2588support healthy aging. Recent research suggests that there is a2589$2.47 return for every dollar invested in community health2590workers for the Medicaid program alone. For instance, CHWs2591increase engagement with behavioral health intervention2592programs which have profound benefits for mental and physical2593health and increasing health literacy and adherence to healthy2594lifestyle behaviors. Lack of access to high quality, nutrient2595dense foods is a persistent problem reinforced by ultra-2596processed unhealthy foods being subsidized so they are low2597cost. Making healthy foods financially accessible and2598disincentivizing consumption of ultra-processed foods is key to2599increasing healthy aging.26002601Healthcare Access and Early Treatment26022603    Most adults do not see a doctor regularly to evaluate their2604health unless they are facing health problems. This is heavily2605influenced by clinical guidelines and insurance reimbursement.2606Scientific investments designed to identify disease progression2607in the earliest stages and effective interventions for halting2608disease progression is critically needed and can have a2609significant impact on healthcare costs even over a short period2610of time. We need to recalibrate health benchmarks so they2611reflect optimal health thresholds rather than population2612averages and identify critical biomarkers early enough that we2613can implement long-term treatment plans. For example, one in 102614adults over 65 has Alzheimer's Disease (AD), with the average2615person who gets AD living with it for eight years. AD is among2616the most expensive aging-associated diseases, with AD treatment2617costs estimated at $321 Billion in 2022, with costs projected2618to increase. In addition, about half of all family caregivers2619care for an adult with dementia, collectively contributing2620close to 16 billion hours a year, worth about $270 billion,2621which doesn't count costs related to their foregone wages.2622However, growing evidence suggests that aggressively treating2623metabolic and lipoprotein health in middle aged adults will not2624only significantly reduce the number of adults who go on to get2625dementia, it will also reduce the number who go on to get2626diabetes, heart disease, and cancer, the most costly and2627consequential aging-associated health conditions.2628    Developing new metrics and strategies for treating early2629indicators of disease progression such as metabolic and2630lipoprotein health into the standards of clinical care is key2631to increasing our Third Age life expectancy. Although more2632frequent interactions with healthcare providers will be needed2633to monitor health, MDs are not needed for all stages of2634successful lifestyle interventions. Most lifestyle-related2635treatments can be monitored and carried out by nurse2636practitioners, physician assistants, and other healthcare2637providers, and with support from lower cost telemedicine2638monitoring technologies. The benefits to this approach are not2639only related to long-term health outcomes, but a recent study2640showed that a metabolic and lipoprotein health intervention2641leveraging pharmaceutical interventions alone provided a five-2642year return on investment of nearly $10 for each dollar2643invested.26442645Next Steps26462647    Reframing aging policy to promote healthy aging will2648require an expansion of our current aging-related policy goals.2649It will emphasize supporting healthy aging at every phase of2650the life course with a focus on expanding the Third Age and2651compressing the Fourth Age into fewer years. It means expanding2652healthy aging research, improving healthcare literacy and2653access, and incentivizing health behaviors and health2654interventions based on optimal health function goals. Finally,2655it also means thinking about viewing older people as a critical2656resource that improves our society, rather than as a barrier to2657societal progress. If future generations of older adults have2658access to a lengthy Third Age, and older adults can remain2659productively and socially engaged in meaningful ways into late2660life, old age could become a period of life we all look forward2661to, and our society as a whole will benefit.26622663                 U.S. Senate Special Committee on Aging26642665                  "Improving Wellness Among Seniors:2666               Setting a Standard for the American Dream"26672668                            January 15, 202526692670                       Prepared Witness Testimony26712672                            Dr. Susan Hughes26732674    Good morning. I am Dr. Susan Hughes. I am the Founding2675Director of the Center for Research on Health and Aging at the2676University of Illinois Chicago. I have served as the Director2677of five successfully funded iterations of our National2678Institute on Aging Midwest Roybal Center for Health Promotion2679and Translation.2680    I am also a Professor in the Division of Community Health2681Sciences in the UIC School of Public Health where I taught Long2682Term Care Policy for 20 years. My work involves the design and2683testing of evidence-based health promotion programs that2684improve the functioning of older adults and can be brought to2685scale nationally.2686    Let me start by thanking you very much for this opportunity2687to talk with you today about this vital topic of Improving2688Wellness Among Seniors.2689    Today, I would like to address the limitations of our2690current funding for health promotion programs for older adults2691and recommend a transformational re-thinking of our current2692focus on acute and post acute care using an example of UIC s2693Fit & Strong! program for persons with arthritisWhen Medicare2694was designed in 1966, it addressed a compelling need among2695seniors to access acute hospital care. The designers modeled2696the program after the Blue Cross and Blue Shield plans of the269760 s to help seniors pay for acute care from reduced post-2698retirement incomes.2699    Medicare has served this purpose beautifully but has two2700important missing pieces. The first is the capacity to provide2701long-term care to older adults with chronic conditions and2702disabilities. The second is a tragically missed opportunity to2703invest in wellness programs that have the potential to pay for2704themselves many times over. Medicare did not provide2705reimbursement for even the most basic form of health promotion-2706screenings- until 1990 when it first covered pap smears,2707followed in 1991 by mammograms (Gornick et al 1996). Recently,2708Medicare mandated the implementation of a single annual2709wellness visit which is a necessary step in the right direction2710but horribly insufficient in terms of dose needed to achieve2711behavior change.2712    As you all know, Medicare Advantage (MA) plans are2713voluntary options for Part B services for older adults who2714prefer managed care to customary fee for service care.2715Enrollment in these plans now encompasses 54% of beneficiaries2716(Kaiser Family Foundation, 2024). MA plans must offer all of2717the customary screenings provided by fee for service Medicare2718but they can supplement that package any way that they choose.2719Many plans offer vision services, glasses or other covered2720benefits to attract enrollment.2721    This ability to offer supplementary services makes these2722plans very logical providers or payors of health promotion2723programs, assuming that they perceive advantages, either in the2724form of reimbursement, savings, marketing and/or quality2725rankings, that will redound to themselves by doing so. The2726Administration for Community Living (ACL) and the2727Administration on Aging (AoA) aging services network have2728vetting procedures in place for evidence-based and best2729practice health promotion programs. Although it is important to2730preserve consumer choice regarding enrollment, this Committee2731can work on making the offering of evidence-based programs2732customary practice among MA plans. The recently mandated2733inclusion of systematic screening for exposure to Social2734Determinants of Health during the annual wellness visit could2735be a way to assess the need for these programs and facilitate2736referral to them.2737    Changing Medicare will take time. In the meantime, it is2738critically important to reauthorize the third leg of the2739programs passed in 1966 to help seniors; namely, the Older2740Americans Act (OAA). OAA services are administered at the local2741level and engage multiple types of community providers. The2742federal funding for and impact of these programs is multiplied2743by large amounts of private funding contributed by community2744organizations. During the pandemic, home delivered meals were2745used very creatively in Illinois and saved thousands of seniors2746from hunger. Research has also shown that these meals can2747significantly reduce Emergency Department visits (Berkowitz et2748al., 2018).2749    The renewal of OAA is part of a contract with seniors in2750which we, as a society, acknowledge that we are indebted to2751them for their service. Included in the OAA renewal is an2752important opportunity to expand the funding for Title III D and2753create a new title that explicitly supports PA programs. Total2754national FY24 funding for Title III D was $55.5 million2755dollars. This amounts to an average of $671K per state. Divided2756by the total number of persons over age 60, this amounts to 312757cents per senior in Illinois. That amount is used to fund all2758programs including falls prevention and chronic disease2759management programs (Colello & Napili, 2024). Physical activity2760can only be funded as an adjunct to those programs despite its2761demonstrated direct and independent impact on mortality, falls,2762mobility, brain health, etc. This is an untenable situation2763that must be fixed.2764    Why do we care? Despite overwhelming evidence supporting2765the importance of physical activity for healthy aging,2766participation in and maintenance of physical activity is still2767sub-optimal. Overall, 13.9% of adults aged 65 and older met2768federal physical activity guidelines for both aerobic and2769muscle-strengthening activities in 2022. Only 5.0% of older2770adults with disabilities met the guidelines; while 10.2% of2771Black older adults and 10.5% of Hispanic older adults met the2772guidelines (Elgaddal et al. 2022). Moreover, 30.9% of older2773adults over 65 reported performing NO physical activity in the2774past 30 days (America s Health Rankings, 2025).2775    We know that 84% of older adults (65+) are sedentary (Yang2776et al 2019), a condition that is associated with obesity,2777diabetes, heart disease, and all-cause mortality (Biswas et2778al., 2015). The good news is that we also know that any, I2779repeat any physical activity is associated with lower mortality2780risk (Ekelund et al., 2019; US Department of Health and Human2781Services, 2018). We also know that short bouts of physical2782activity are as effective as hours on a treadmill (Saint-2783Maurice et al., 2018). These findings matter because we can use2784them to create more positive messages to persuade older adults2785to engage in activity.2786    What else can we do? We can foster a culture that makes2787engagement in and maintenance of PA as easy as possible. This2788culture can start in grade school; we can have kids walk to2789school whenever possible. These efforts can be maintained in2790worksites over the life course. We know that older adults2791prefer destination over recreational walking opportunities. We2792can design senior housing that is in proximity to downtowns and2793provide sidewalks in communities for seniors whenever possible.2794    We can also examine causes of sedentary behavior in older2795adults. I began my research career working with homebound older2796adults in Chicago who reported that arthritis was their most2797common chronic condition AND that it interfered most frequently2798with their functioning. To learn more, we conducted a2799longitudinal study over four years with 600 older adults. Our2800study found that persons who had osteoarthritis (OA) in their2801lower extremity joints at baseline were much more likely to2802become disabled four years later.2803    Once we understood the pivotal role of lower extremity2804joints, we developed an intervention to break the disability2805chain. Our program- Fit & Strong! meets three times per week2806for eight weeks. It is different from other programs because it2807combines flexibility with low impact aerobics and systematic2808lower extremity strength training. Every session uses group2809problem solving to reinforce the importance and feasibility of2810using physical activity to manage OA symptoms (Hughes et al.,28112004; 2006).2812    Our clinical trials of F&S found gains in physical activity2813engagement at eight weeks that were maintained out to 182814months. If you maintain engagement in PA over time other good2815things happen. We found improved joint pain, and timed2816performance measures of lower extremity strength and mobility2817(risk factors for falls) as well as improved anxiety and2818depression at the same time points (Hughes et al., 2010).2819During this trial, we were asked by program participants on the2820south side of Chicago to include more information in the health2821education sessions about diet and weight management. We2822responded to this request by testing a new version of the2823program Fit & Strong! Plus that combined physical activity with2824diet. The new program demonstrated a decrease in BMI and2825improved mobility and arthritis symptoms at eight weeks that2826were maintained at six and twelve months (Hughes et al., 2020;2827Fitzgibbon et al., 2020).2828    Medicare spent $11.3 billion on lower extremity joint2829replacement surgery in 2017 (Liang et al., 2017). Our program2830clearly benefits people with OA and costs $300 per participant.2831It has no harmful side effects and large effect sizes. However,2832our program and others like it that are cost-effective and2833popular have no place to go. NIA is investing millions of2834dollars developing and testing high-quality, low-cost programs2835that demonstrate impact. Drugs have a clear pipeline from bench2836to uptake. We have no way at present to communicate the2837benefits of effective health promotion programs to clinicians2838who can recommend them or ways to market the programs directly2839to patients themselves.2840    We also have no effective way to reimburse Senior Centers2841and other organizations that market and offer the programs to2842seniors. Finally, we have no pass through funding mechanism2843that supports teams that are needed to manage the programs. The2844aging network is beginning to contract with Medicare Advantage2845plans to offer home and community based long term care services2846but collaborations to offer health promotion programs are very2847rare. Newly funded ACL Community Care Hubs are attempting to2848bridge the divide between aging and health care services by2849centralizing administrative functions like managing referrals,2850information security, data collection and reporting. They could2851be key players in this effort to disseminate and support EB2852programs in the future.2853    Meanwhile, Title III D of OAA is the only reliable source2854of funding for our program right now. At a minimum, we need to2855reauthorize the Older Americans Act. We also need to increase2856funding for Title III D and create a new title explicitly for2857physical activity programming.2858    Ultimately, however, we will see much bigger returns if we2859develop demonstrations and/or regulations or reimbursement2860mechanisms that support the dissemination of and access to EB2861health promotion programs as extensively as possible through2862Medicare.2863    To conclude, my recommendations are, in the near term,2864renew OAA, increase funding for Title III D and create a2865specific funding line for PA. Longer term, use whatever means2866you can find to promote wellness through MA programs that2867include assessments, referrals and reimbursement with EB2868programs.2869    Thank you, again, for this opportunity to share our work2870with the Committee. I look forward to your questions.28712872Citations28732874America's Health Rankings analysis of CDC, Behavioral Risk2875Factor Surveillance System, United Health Foundation,2876AmericasHealthRankings.org, accessed 2025.28772878Berkowitz, S. A., Terranova, J., Hill, C., Ajayi, T., Linsky,2879T., Tishler, L. W., & DeWalt, D. A. (2018). Meal delivery2880programs reduce the use of costly health care in dually2881eligible Medicare and Medicaid beneficiaries. Health Affairs,288237(4), 535-542.28832884Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver,2885M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time2886and its association with risk for disease incidence, mortality,2887and hospitalization in adults: a systematic review and meta-2888analysis. Annals of internal medicine, 162(2), 123-132.28892890Colello, K. J., & Napili, A. (2021). Older Americans act:2891Overview and funding. Congressional Research Service.28922893Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H.,2894Jefferis, B., Fagerland, M. W., ... & Larson, M. G. (2019).2895Dose-response associations between accelerometry measured2896physical activity and sedentary time and all cause mortality:2897systematic review and harmonised meta-analysis. British Medical2898Journal, 366, l4570.28992900Elgaddal, N., & Kramarow, E. A. (2024). Characteristics of2901Older Adults Who Met Federal Physical Activity Guidelines for2902Americans: United States, 2022. National health statistics2903reports, (215).29042905Fitzgibbon, M. L., Tussing-Humphreys, L., Schiffer, L., Smith-2906Ray, R., Marquez, D. X., DeMott, A. D., ... & Hughes, S. L.2907(2020). Fit and Strong! Plus: Twelve and eighteen month follow-2908up results for a comparative effectiveness trial among2909overweight/obese older adults with osteoarthritis. Preventive2910medicine, 141, 106267.29112912Gornick, M. E., Warren, J. L., Eggers, P. W., Lubitz, J. D., De2913Lew, N., Davis, M. H., & Cooper, B. S. (1996). Thirty years of2914Medicare: impact on the covered population. Health care2915financing review, 18(2), 179.29162917Hughes, S.L., et al., Impact of the fit and strong intervention2918on older adults with osteoarthritis. Gerontologist, 2004.291944(2): p. 217-28.29202921Hughes, S.L., et al., Long-term impact of Fit and Strong! on2922older adults with osteoarthritis. Gerontologist, 2006. 46(6):2923p. 801-14.29242925Hughes, S.L., et al., Fit and Strong!: bolstering maintenance2926of physical activity among older adults with lower-extremity2927osteoarthritis. Am J Health Behav, 2010. 34(6): p. 750-292863.Hughes, S. L., Tussing-Humphreys, L., Schiffer, L., Smith-2929Ray, R., Marquez, D. X., DeMott, A. D., ... & Fitzgibbon, M. L.2930(2020). Fit & strong! plus trial outcomes for obese older2931adults with osteoarthritis. Gerontologist, 60(3), 558-570.29322933Kaiser Family Foundation. (2024, January 8). Medicare Advantage2934in 2024: Enrollment update and key trends. https://www.kff.org/2935medicare/issue-brief/medicare-advantage-in-2024-enrollment-2936update-and-key-trends/29372938Liang L, Moore B, Soni A. National Inpatient Hospital Costs:2939The Most Expensive Conditions by Payer, 2017. 2020 Jul 14. In:2940Healthcare Cost and Utilization Project (HCUP) Statistical2941Briefs [Internet]. Rockville (MD): Agency for Healthcare2942Research and Quality (US); 2006 Feb-. Statistical Brief #261.2943Available from: https://www.ncbi.nlm.nih.gov/books/NBK561141/29442945Saint-Maurice, P. F., Troiano, R. P., Matthews, C. E., & Kraus,2946W. E. (2018). Moderate?to?vigorous physical activity and2947all?cause mortality: do bouts matter?. Journal of the American2948Heart Association, 7(6), e007678.29492950US Department of Health and Human Services. Physical activity2951guidelines for Americans, 2nd ed. Washington, DC: US Department2952of Health and Human Services; 2018. https://health.gov/sites/2953default/ files/2019-09/Physical--Activity--Guidelines--2nd--2954edition.pdf29552956Yang, L., Cao, C., Kantor, E. D., Nguyen, L. H., Zheng, X.,2957Park, Y., ... & Cao, Y. (2019). Trends in sedentary behavior2958among the US population, 2001-2016. Jama, 321(16), 1587-1597.29592960=======================================================================29612962                        Questions for the Record29632964=======================================================================29652966                 U.S. Senate Special Committee on Aging29672968                  "Improving Wellness Among Seniors:2969               Setting a Standard for the American Dream"29702971                            January 15, 202529722973                        Questions for the Record29742975                         Sheriff Bill Prummell29762977                          Senator Jim Justice29782979    Question:29802981    Elder abuse and scams are significant concerns in rural2982states like West Virginia, where seniors are often isolated and2983more vulnerable. What strategies has your department used to2984address scams targeting older adults, and how might they be2985adapted to rural, mountainous communities like those in West2986Virginia?2987    Response:29882989    The Charlotte County Sheriff's Office focuses strongly on2990Assisted Living Communities, church groups and men's and2991women's civic groups where we educate those individuals on the2992latest scams and trends. As we know, the scammers are2993constantly seeking new ways to operate differently once we2994catch on to their latest trickery. We encourage our community2995to advise us should they receive strange texts or emails that2996may be scams. We then examine those closely.2997    Additionally, we speak with banking institutions and advise2998their staff to be aware of our senior population who may be2999withdrawing large sums of money. This should raise concerns3000with banking officials. We ask them to question those seniors3001who are making withdrawals in the event they are being3002pressured to do so.3003    Lastly, we oftentimes post notices on or near bitcoins3004machines to educate on scams. The scammers frequently ask for3005payment through bitcoin or gift cards.3006    These presentations are conducted by our Community Policing3007Officers, Crime prevention specialists, during our civilian3008police academy (CPA), PSAs through social media, and our3009partnerships with the local media conducting interviews about3010scams and trends we are seeing.30113012                           Senator Mark Kelly30133014    Question:30153016    Sheriff Prummell, thank you for your testimony. My parents3017were both cops. We appreciate your service.3018    In your testimony, you mention a variety of programs and3019activities your department undertakes to engage with seniors in3020your community. One of those was visiting retirement3021communities to talk about scams. Throughout my time on this3022Committee, we've heard from a lot of law enforcement agencies3023on how they approach fraud and scams against older adults. It's3024something I'm interested in engaging more on.3025    Could you tell us more about what your department does? How3026do you collaborate with federal agencies or other law3027enforcement entities to prevent or stop senior scams?3028    Response:30293030    The Charlotte County Sheriff's Office has an extensive3031listing of resources associated with Federal agencies who deal3032directly with scams and fraud. One of those agencies is the3033Federal Trade Commission. They have deep resources in dealing3034with scams and fraud issues. Another agency well equipped to3035handle fraud is the United States Secret Service. The Charlotte3036County Sheriff's Office works closely with these federal3037agencies and shares critical information on a constant basis.3038    The Charlotte County Sheriff's Office crime analyst group3039has an extensive network with other law enforcement agencies in3040which they attend intelligence meetings to discuss and share3041trends other agencies experience. This is also an opportunity3042to share how each agency is trying to educate and prevent their3043senior population from becoming victims.3044    We are fortunate to have the Our Charlotte Elder Affairs3045Network (O.C.E.A.N.) which was formed in 1991 and now includes3046142 members with 66 companies who meet regularly to discuss3047issues our elderly population might be dealing with: while3048providing education on services available in our county. The3049group also acts as an advocate to help provide any unmet needs3050or services. (www.ocean-fl.org)3051    The CCSO additionally has an Economic Crimes Unit that3052investigates all types of fraud and utilizes all resources3053available to them to assist in bringing cases to successful3054conclusions.30553056                 U.S. Senate Special Committee on Aging30573058                  "Improving Wellness Among Seniors:3059               Setting a Standard for the American Dream"30603061                            January 15, 202530623063                        Questions for the Record30643065                             Maria Alvarez30663067                           Senator Mark Kelly30683069    Question:30703071    Housing is the pretty much the top issue we hear about in3072Arizona when it comes to older adults.3073    Affordable housing is scarce. Folks who are on fixed3074incomes are seeing new ownership come into their buildings and3075rent is going up. In Arizona, a household needs to make $68,0143076annually in order to afford a two-bedroom rental at HUD's fair3077market rent, and last year's median home sale price was3078$422,717, but in Tucson, where I live, the median household3079income for the 65 and older age group was only $59,457. Those3080don't match up.3081    What is the most effective thing Congress can do right now3082to help mitigate this senior housing crisis?30833084    Response:30853086    Affordable Housing is one of the biggest concerns people3087living on fixed incomes experience, and recognizing that3088markets vary from place to place is important. Many times, in3089the spirit of progress and development seniors who have lived3090in a community and raised their families and have quire frankly3091contributed and advocated for a better environment in their3092living conditions, get priced out of their own neighborhoods.3093    Where should they go?3094    The HUD Section 202 program which provides affordable3095housing has not developed new properties for 20 years, and many3096of those properties, which are 30 or 40 years old, are in3097disrepair.3098    So, a community needs assessment should be conducted to3099identify the needs in different communities where new Section3100202 housing should be developed.3101    In addition, this would be ab opportunity to do an3102assessment to upgrade, improve, and expand on existent3103properties. There are many 202 buildings that in need of an3104overhaul. With the increasing elderly population, these tenants3105will become more physically incapacitated as they age. These3106units should be retrofitted accordingly. Universal Home3107features would be a good place to begin thinking of3108modernization models.3109    Section eight is another successful program that has been3110stagnant for many years with no new vouchers being issued for a3111long time. This programs was started as a program where the3112benefit was attached to a contracted building. The contracts3113continue with existent providers, but the Housing and Urban3114Development has discontinued it since 1983. Now this benefit is3115disseminated through vouchers administered by the states.3116Waiting lists - for all segments of the populations - can last3117between 10 to 20 years, so this program could also be expanded3118so that more low income seniors and families could access3119affordable housing units in their communities.3120    However, one glaring problem exists: Statistics show that3121in the United States, a total of 55.1 % of seniors 65 years of3122age and over are rent burdened and 25.5 per cent of the seniors3123are owner burdened. This means that they pay more than one-3124third of their incomes in housing expenses.3125    Many senior citizens, who largely live on fixed incomes,3126cannot afford to age in their communities because their3127retirement incomes, including their Social Security benefits3128and pensions, are not keeping pace with the cost of living3129today.3130    From a pragmatic perspective, the older adult population3131makes up fully 20% of the country. Providing affordable and3132supportive housing that enables them to age in place will be3133less expensive, far better for their families and their quality3134of life than if they were prematurely institutionalized in3135expensive nursing homes that will end up costing the government3136millions of dollars more.31373138Recommendations:31393140    HUD Section 202 Program31413142    1. Developing New Properties:3143      Conduct community needs assessments to identify specific3144areas where new developments are most needed.31453146      Increase federal funding to support the construction of3147new Section 202 housing developments.31483149      Explore development of a public-private partnership3150model to encourage private developers to invest in affordable3151senior housing.31523153    2. Renovating Existing Properties:31543155      Designate funding for the renovation and modernization3156of aging Section 202 properties.31573158      Implement Universal Home features to ensure buildings3159are accessible and safe for elderly residents.31603161      Establish a maintenance fund to support ongoing upkeep3162and prevent future disrepair.31633164    Section 8 Program:31653166    1. Expanding Voucher Distribution:31673168      Increase the number of Section 8 vouchers issued3169annually to meet growing demand.31703171      Streamline the application and distribution process to3172reduce waiting times for applicants.31733174    2. Addressing Long Waiting Lists:31753176      Propose a pilot program to test innovative solutions for3177reducing waiting lists, such as prioritizing applicants based3178on need or creating a fast-track process for vulnerable3179populations.31803181      Collaborate with local housing authorities to develop3182strategies for efficient voucher management and allocation.31833184    Addressing Rent Burden:31853186    1. Ensuring Adequate Retirement Incomes:31873188      Advocate for adjustments to Social Security benefits and3189pensions to reflect the rising cost of living.31903191      Propose tax incentives or subsidies for seniors to help3192offset housing costs.31933194    2. Implementing Rent Control Measures:31953196      Support the adoption of rent control policies to limit3197annual rent increases for seniors and low-income families.31983199      Encourage local governments to offer property tax relief3200to landlords who provide affordable housing.32013202    Aging in Place:32033204    1. Developing Supportive Housing:32053206      Promote the construction of supportive housing units3207that provide on-site services, such as healthcare and social3208support, for elderly residents.32093210      Advocate for policies that incentivize developers to3211include supportive housing features in new developments.32123213    2. Enhancing Community-Based Services:32143215      Expand access to community-based services, such as home3216healthcare and transportation, to help seniors age in place.32173218      Partner with local organizations to provide resources3219and support for seniors living independently.32203221    Next Steps:32223223    1. Research: Gather detailed information and statistics on3224the current state of HUD Section 202 and Section 8 programs, as3225well as rent burden among seniors.32263227    2. Draft Policy Proposals: Use the information collected to3228create comprehensive policy proposals that address the issues3229identified.32303231    3. Engage Stakeholders: Present the proposals to community3232organizations, policymakers, and other stakeholders to gain3233support and drive action.32343235                 U.S. Senate Special Committee on Aging32363237                  "Improving Wellness Among Seniors:3238               Setting a Standard for the American Dream"32393240                            January 15, 202532413242                        Questions for the Record32433244                             Dr. Dawn Carr32453246                          Senator Jim Justice32473248    Question:32493250    West Virginia's strong sense of family offers opportunities3251for intergenerational programs. How can such initiatives3252promote wellness for seniors while also engaging younger3253generations?32543255    Response:32563257    Thank you for this very important question. West Virginia's3258focus on family connections is an important component of health3259over the life course. Meaningful relationships with family3260members play an important role in helping people feel connected3261to something larger than themselves and provide an important3262function by providing social support systems when people need3263help. Intergenerational programs can either be designed to3264bring multi-generational family members together around3265specific activities, such as volunteering to support the3266community, or they can be designed so that older people in the3267community work together with younger people, regardless of3268their family relationships. Both models have been shown to be3269beneficial in a variety of ways.3270    I will focus on the model that involves unrelated older3271people and younger people, for which there is particularly3272robust evidence of beneficial effects. Intergenerational3273volunteer activities in which older people support young3274people, specifically young people who are struggling in school,3275have been shown to not only benefit younger adults in their3276academic outcomes, it has been shown to be associated with a3277wide range of health benefits for older volunteers. This3278program, called the Experience Corps program, is now managed by3279AARP, and involves significant investment of older people in3280volunteering to work with a young person at the local schools,3281and they maintain a consistent relationship over long period3282(typically a school semester or school year). When young people3283have adults in their lives who can see their potential and are3284rooting for their success, they are likely to see increases in3285self-esteem and development of a sense of meaningful and3286purpose that helps guide them towards working towards future3287goals. The Experience Corps trial, a large-scale randomized3288control trial that was conducted by Johns Hopkins University,3289showed long-term robust benefits to cognitive function,3290physical health and mental health of older adult volunteers.3291Although the Experience Corps trial is the only large scale and3292long-term randomized control study on intergenerational3293volunteering, other intergenerational volunteer programs have3294shown similar health benefits for older volunteers.32953296                 U.S. Senate Special Committee on Aging32973298                  "Improving Wellness Among Seniors:3299               Setting a Standard for the American Dream"33003301                            January 15, 202533023303                        Questions for the Record33043305                            Dr. Susan Hughes33063307                          Senator Jim Justice33083309    Question:33103311    West Virginia has some of the highest rates of chronic3312diseases, such as diabetes and heart disease, among seniors.3313What strategies have you found most effective in helping older3314adults manage these conditions, and how can these be tailored3315to West Virginia's unique healthcare landscape?33163317    Response:33183319    Thank you for the opportunity to reply to these questions,3320Senator Justice.3321    West Virginia is one of the most challenging states to3322provide health promotion programs for older adults due to the3323mountainous conditions, the number of older adults in rural3324areas, and the lack of transportation and internet access.3325Despite these challenges, several programs currently exist that3326can help.3327    You asked about programs that could help older adults with3328diabetes and heart disease. There are two evidence-based3329programs that might help. The first is the Chronic Disease3330Self-Management Program (CDSMP) developed at Stanford3331University. It is a 6-week program that meets once per week and3332helps people with chronic conditions manage them. CDSMP is3333broadly available in most states. It is offered at group sites3334like senior centers with funding from the Older Americans Act3335Title-III D and also is available online and by telephone. The3336program is managed by the Self-Management Resource Center. Your3337staff should be able to reach a resource person there very3338easily to learn more about the availability of the program in3339West Virginia.3340    CDSMP: https://selfmanagementresource.com/programs/small-3341group/chronic-disease-self-management-small-group/3342    The same group at Stanford has developed a diabetes3343management program (DSMP) that is currently reimbursed by3344Medicare. Information about the diabetes program is available3345at the link below.DSMP: https://selfmanagementresource.com/3346programs/small-group/diabetes-self-management-small-group/3347    Arthritis is also common among older adults. Unfortunately,3348West Virginia has the highest prevalence of arthritis of any3349state (Barbour, 2018). CDC works with the West Virgina3350University Research Corporation to raise awareness and promote3351physical activity and other lifestyle management programs for3352people with arthritis. We know that physical activity can help.3353CDC has a roster of recommended physical activity programs for3354people with arthritis. Fit & Strong! is on that list located at3355the link below.CDC Arthritis Programs: https://www.cdc.gov/3356arthritis/programs/index.html3357    We have worked with the WISH Center in White Sulphur3358Springs West Virigina previously to offer Fit & Strong. We3359would love to expand the program to other locations in West3360Virigina and can be reached at shughes@uic.edu.33613362                        Senator Raphael Warnock33633364    Question:33653366    The Older Americans Act (OAA) was signed into law in 19653367and authorizes critical funding for various programs to support3368older adults.\1\ Specifically, Title III-D of the OAA provides3369grant funding for evidence-based health promotion programs that3370improve seniors' health and well-being.\2\3371---------------------------------------------------------------------------3372    \1\ Kirsten J. Colello and Angela Napili, Older Americans Act:3373Overview and Funding, Congressional Research Service (May 6, 2024),3374https://crsreports.congress.gov/product/pdf/R/R43414.3375    \2\ Health Promotion, Administration for Community Living (Nov. 21,33762024), https://acl.gov/programs/health-wellness/disease-prevention.3377---------------------------------------------------------------------------3378    How do services authorized by the OAA enhance the health3379and wellness of seniors and older adults?3380    Response:33813382    Thank you for the opportunity to reply to these questions,3383Senator Warnock.3384    Currently, Title III-D of the OAA is the only reliable3385national source of funding for evidence-based health promotion3386programs for older adults. Evidence-based health promotion3387programs for older adults have improved disease management3388(Ory, et al., 2013; Hughes, et al., 2010), improved lower3389extremity strength and mobility (Duarte, et al., 2019; Duarte,3390et al., 2020; Der Ananian, et al., 2017; Hughes et al., 2010),3391and reduced anxiety and depression among older adults (Hughes,3392et al., 2010).3393    Several programs have also impacted healthcare costs.3394EnhanceFitness reduced total healthcare costs by 20%3395(Ackermann, et al., 2003) with a 41% decrease among3396participants with good attendance (Nguyen, et al., 2007). CDSMP3397also found potential net savings of $364 per participant which3398would yield a national savings of $3.3 billion if 5% of adults3399with one or more chronic conditions were reached (Ahn, et al.,34002013)3401    Support from Title III-D is vital but this Title is3402substantially underfunded at present. Fiscal year 2024 funding3403for Title III-D was $33.6 million nationally. That amounts to3404$671,000 per state, or $0.40 per senior in the state of Georgia3405(Consumer Affairs, 2024). Despite their low cost, very few3406evidence-based programs have been approved for funding by3407Medicare.3408    Furthermore, Title III-D funding is restricted to the3409support of disease management and falls prevention programs.3410Despite the huge amount of literature demonstrating the3411benefits of physical activity, and the high levels of sedentary3412behavior among older adults, Title III-D does not have an3413explicit funding line to support physical activity programs.3414This is a serious drawback.3415    I strongly recommend that Congress re-authorize the OAA,3416increase funding for Title III-D, and add an explicit line of3417funding for the promotion of physical activity.34183419    Question:34203421    Why is OAA reauthorization important to ensure that Area3422Agencies on Aging can continue to provide supportive services?34233424    Response:34253426    The supportive services authorized by the OAA enhance the3427health and wellness of older adults in multiple ways. The home3428delivered meals funded by the OAA are a lifeline to many3429disabled older adults, especially during the recent pandemic.3430The meals have demonstrated impacts on improved nutrition,3431reduced ED visits (Zhu & An, 2013), and increased likelihood of3432continued community residence among recipients who were Black,3433enrolled in Medicaid, or frail (Berkowitz, et al., 2017; Walsh,3434Weaver, & Chubinski, 2023).3435    The congregate meals funded by the OAA are major reasons3436why older adults in local communities use senior centers and3437other community organizations that provide multiple3438opportunities for older adults to socialize and connect with3439important services ranging from health promotion programs and3440screenings to foreign language groups, book clubs, and help3441with Medicare and other health insurance issues as well as3442preparation of income taxes. We all know that social isolation3443and loneliness kill older adults (Schutter, et al., 2022; Yu,3444et al., 2023). The opportunities to socialize provided by3445programs at senior centers, libraries, park departments and3446other organizations funded by the OAA are major weapons in3447efforts to defeat social isolation and depression.3448    Reauthorization of the OAA is absolutely necessary to3449continue the availability of these services that have become3450embedded in the fabric of communities all over the United3451States. Older adults and their families have hugely benefited3452from OAA funded programs.3453    Importantly, the core funding for these services that is3454provided by OAA is multiplied many times over by philanthropic3455contributions from the community. The multiplier effect of the3456OAA funding is huge and a very important byproduct of the3457program.3458    I strongly recommend that Congress reauthorize the Older3459Americans Act as soon as possible, expand the funding for Title3460III-D of the Act, and add a separate Title III-D funding line3461for physical activity programs.3462    I also strongly recommend the initiation of a clearing3463house that would include representatives from NIA, ACL, CDC,3464and CMS that would have a clear and transparent process to3465expedite the scaling up and reimbursement of programs3466demonstrated to benefit older adults.3467References34683469Ackermann, R. T., Cheadle, A., Sandhu, N., Madsen, L., Wagner,3470E. H., & LoGerfo, J. P. (2003). Community exercise program use3471and changes in healthcare costs for older adults. American3472journal of preventive medicine, 25(3), 232-237.34733474Ahn, S., Basu, R., Smith, M. L., Jiang, L., Lorig, K.,3475Whitelaw, N., & Ory, M. G. (2013). The impact of chronic3476disease self-management programs: healthcare savings through a3477community-based intervention. BMC public health, 13, 1-6.34783479Barbour, K. E. (2018). Geographic variations in arthritis3480prevalence, health-related characteristics, and management-3481United States, 2015. MMWR. Surveillance Summaries, 67.34823483Basu, R., Ory, M. G., Towne Jr, S. D., Smith, M. L.,3484Hochhalter, A. K., & Ahn, S. (2015). Cost-effectiveness of the3485chronic disease self-management program: implications for3486community-based organizations. Frontiers in public health, 3,348727.34883489Berkowitz, S. A., Terranova, J., Hill, C., Ajayi, T., Linsky,3490T., Tishler, L. W., & DeWalt, D. A. (2018). Meal delivery3491programs reduce the use of costly health care in dually3492eligible Medicare and Medicaid beneficiaries. Health Affairs,349337(4), 535-542.34943495Consumer Affairs. Population over 65 by state. (2024).3496ConsumerAffairs.com. Feb. 06, 2024, https://3497www.consumeraffairs.com/homeowners/elderly-population-by-3498state.html34993500Der Ananian, C., Smith-Ray, R., Meacham, B., Shah, A., &3501Hughes, S. (2017). Translation of fit & strong! for use by3502Hispanics with arthritis: a feasibility trial of en forma y3503fuerte!. Journal of aging and physical activity, 25(4), 628-3504638.35053506Duarte, N., Santos, C., Hughes, S. L., & Pa#l, C. (2020).3507Feasibility and impact of Fit & Strong! Program in Portuguese3508older adults with osteoarthritis: A pilot randomized controlled3509trial. Geriatric Nursing, 41(6), 804-811.35103511Duarte, N., Hughes, S. L., & Pa#l, C. (2019). Cultural3512adaptation and specifics of the Fit & Strong! program in3513Portugal. Translational behavioral medicine, 9(1), 67-75.35143515Hughes, S. L., Seymour, R. B., Campbell, R. T., Desai, P.,3516Huber, G., & Chang, H. J. (2010). Fit and strong: bolstering3517maintenance of physical activity among older adults with lower-3518extremity osteoarthritis. American journal of health behavior,351934(6), 750-763.35203521Illinois Department on Aging. (2024). Aging Network Reports:3522Annual Report. Retrieved on January 31, 2024 from https://3523ilaging.illinois.gov/resources/newspublicationsandreports/3524agingnetworkreports.html35253526Nguyen, H. Q., Ackermann, R. T., Berke, E. M., Cheadle, A.,3527Williams, B., Lin, E., ... & LoGerfo, J. P. (2007). Impact of a3528managed-Medicare physical activity benefit on health care3529utilization and costs in older adults with diabetes. Diabetes3530care, 30(1), 43-48.35313532Ory, M. G., Ahn, S., Jiang, L., Smith, M. L., Ritter, P. L.,3533Whitelaw, N., & Lorig, K. (2013). Successes of a national study3534of the chronic disease self-management program: meeting the3535triple aim of health care reform. Medical care, 51(11), 992-3536998.35373538Schutter, N., Holwerda, T. J., Comijs, H. C., Stek, M. L.,3539Peen, J., & Dekker, J. J. (2022). Loneliness, social network3540size and mortality in older adults: a meta-analysis. European3541journal of ageing, 19(4), 1057-1076.35423543Walsh, S. E., Weaver, F. M., & Chubinski, J. (2024). Meals On3544Wheels Clients: Measurable Differences In The Likelihood Of3545Aging In Place Or Being Hospitalized: Study examines Meals On3546Wheels clients aging in place and hospitalization. Health3547Affairs, 43(3), 408-415.35483549Yu, X., Cho, T. C., Westrick, A. C., Chen, C., Langa, K. M., &3550Kobayashi, L. C. (2023). Association of cumulative loneliness3551with all-cause mortality among middle-aged and older adults in3552the United States, 1996 to 2019. Proceedings of the National3553Academy of Sciences, 120(51), e2306819120.35543555Zhu, H., & An, R. (2013). Impact of home-delivered meal3556programs on diet and nutrition among older adults: a review.3557Nutrition and health, 22(2), 89-103.35583559=======================================================================35603561                       Statements for the Record35623563=======================================================================35643565                 U.S. Senate Special Committee on Aging35663567                  "Improving Wellness Among Seniors:3568               Setting a Standard for the American Dream"35693570                            January 15, 202535713572                       Statements for the Record35733574                The John A. Hartfod Foundation Testimony35753576[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]35773578                                 [all]